Dear Readers, We are pleased to announce the first of our new changes and additions to Back Mountain Music Therapy. The first is our new email contact address: Antoinette.Morrison@BackMountainMusicTherapy.com. Additionally, we will be soon adding new profile pages to our website including new additions to our team.. Back Mountain Music Therapy is growing and we want to thank all our faithful followers who have stayed patiently with us through this process! Please feel free to contact us at out new address to find out more!
This week, I had to catch up on a couple of weeks’ worth of notes (not my typical routine) for one of my clients, an adult with intellectual disabilities. Fortunately, I had been video-recording his sessions and could replay them back. I have a little break right now in-between contracts, and it was a rainy day at home anyway. The nice things about watching a recording of a session later is that one really gets the time to process everything. This particular client goes through growth cycles. At the start of each cycle, there is a tremendous amount of resistance. By the end of the cycle, he demonstrates the most amazing, expressive, regulated means of improve. It looks like he has been training and practicing for a long time. That is not the most important part though: his guardians always report to me some area of growth, one that has been getting in his way of functioning his whole life, has changed and developed for the better at the end of these cycles. I personally never know where this is going or what he is working on. All I know and work with is his relationship to the music and myself in the session. (To read more – click the arrow to the right)
I have been working with a client who whose parents called me to inform me of his needs: he was unable to concentrate well or make any close friends or belong to any groups despite a friendly disposition. When the boy came to see me, I could tell he was a very friendly, outgoing, happy boy. However, although he spoke in complete sentences, I had difficulty understanding him because his speech was so rapid and unclear. At his first session, he came in and began to explore my instruments. He enjoyed making music with me and stayed connected to the rhythm, but was totally unable to synchronize with the beat. He did enjoy the music making, but he would play, then wander, then play, then chat, then play briefly and wander some more. It was difficult for him to play for very long consecutively, but he continued to go back to it. His mom told me he had been taking clarinet lessons for 2 years privately, but had learned nothing. Mom said they had continued the clarinet because he enjoyed being part of the band in school. He was not coordinated enough to impair his overall ability to be in public school unassisted, but not at all coordinated enough to be good at sports. Ironically, the instruments that he gravitated to most were the drums and the trumpet. Although synchronizing his playing with the beat did not seem to be within his capabilities at the time, playing with the rhythm seemed to attract and sustain his attention. As our sessions continued, and he played more, he also complained about being tired and would talk for longer periods before resuming his playing. His mom told me he does that kind of thing often to get out of work. I remember thinking as I watched him attend to the beat but fail to synchronize his playing to it, that no wonder he could not learn the clarinet. If he could not synchronize to the beat, how was he going to learn fingerings, breathing patterns, reading music, or any of the other techniques involved with a wind instrument? So I decided to work on 3 areas: synchronizing to the beat in his playing, playing for longer periods (to increase his endurance), and increasing his attention to be able to do this. Although he was very attentive to what I was doing, he did not yet have the ability to repeat something I had played, or change his playing with intention to do so, nor could he adapt to any changes I had made when playing. He physically could not coordinate or hear these efforts. Despite the fact that his attention was attracted to the rhythm and he gravitated towards the drums, his drum playing was related to the beat but was chaotic at the same time, as if he was drowning. Fortunately, at this time, he gave up on instruments with many choices, like the piano. He gravitated to instruments that had fewer options and that he was more easily able to manipulate. This week, approximately 6 months later, I was impressed by what I saw, and so I pulled out his records to see where he began. I tried to explain to my husband – the more science and math-minded person out of the two of us – why what this boy was doing was so significant. He kept asking me, “But how did you affect change in his brain?” This is how I attempted to explain it: I saw this week that not only was N playing for 4 consecutive minutes at a time, but doing that several times throughout the session. Not only that, but he did so with few and shorter breaks. His playing was also completely synchronized to the beat, sometimes using both hands and feet on the drumset. Earlier on in the sessions, N used to like to continue giving a big drum finale to the piece, as we ended. He would hear me play the end and then react by developing a great big drum cadence that went on and on and on. It seemed as though when he heard the end, his reaction was somewhat delayed. However, the fact that he thought he heard this and comprehended (like getting encouraged by knowing the right answer in school), he would continue to repeat the process, feeling encouraged and proud. In addition, he previously would request popular songs which I would then play so that I was able to support and carry him when he would lose the beat on his own. I would then continually be aiding him in finding it. This particular day, as we turned up the radio recording and both played along, he did not need my assistance to hear and stay with the beat. Not only that, but when I watched him, he was really, really listening and attending with focus. N was hearing, in the recorded song, where the drums dropped out and began again: he was hearing cadences and varying his playing to match them. At this point, my husband kept asking, “Yes, but how did this effect his brain, how did you help him?” Because I knew N briefly when he was little, I knew how delayed he was early on in life and development. He was currently in the proper grade, but was getting lots of help. N had been diagnosed with Lyme Disease, which took a while to finally diagnose and then treat. He was a smart guy, and caught up on many things developmentally; but he had also missed some important. He had undeveloped pockets that were in-between more developed pockets. I explained to my husband that attending is difficult when there are undeveloped pockets. I made a couple of attempts at this using my guitar tuner as an illustration. I said, “See how you are able to tell when the string is in tune? It all lines up. Now, if you have pockets here and there” – then I began to turn the guitar peg back and forth – “it is difficult to find that middle line, the thing you are supposed to focus on. So when N sees 3 + 4, even though he can probably add those two numbers easily, when he looks, maybe he sees an 8 instead of a 3 at times, and at times when he sees 3, maybe he sees ‘h’ instead of 4, so he starts to chat and redirect my attention because this is so hard to see and he can’t do what I am asking him to do.” My husbands reply was, “Okay, but what did you do?” I told him that when he can’t coordinate his playing to synchronize to the beat, but he can feel the pull of the rhythm, that is him seeing 8 and ‘h.’ The more I isolate the 3 and 4, by limiting the music to what he can do, the easier it gets for his brain to just do it: to see 3 and 4 more often instead of blinking, changing forms. Now, he has something he can hold onto. So when he plays without that help, to the predestined beat, he can see 3 and 4 and he can perceive and what he needs to. The more he is able to do this, the more perceptive his brain becomes, and he is able to hear other things surrounding the beat, cadences, dynamics, and chord progressions. Or, the easier he can see 3 and 4 and write down 7, the easier it is to get bigger numbers, because he can now perceive and understand what is in front of him. The more success he has at this (like the elongated drumming at the end of the song), the more practice he employs because he is interested and motivated. The more he practices this, the longer he attends and the more successful he gets. His development continues to capture more and more subtlety as he builds one thing on top of the other. But in order to do this, I had to start with what already interests him, and play it with him at his level on his time, so that he will not get stressed out, but instead will have fun and continue the process. This made sense to my husband. I said that I was guessing that when I mentioned to his mom that we could help things get easier for him if we could work on him synchronizing to the beat, she probably wondered where my tie-dye shirt and sandals were. Since her occupation was in the medical field, I sent her some research to support my premise. I had only begun looking for him to synchronize with the beat and play and attend longer, but when I pulled out his assessment, I was happy to see we were accomplishing the four areas I initially noted as most immediate goals: 1) Increase the duration of participation in any musical intervention 2) Develop the ability to jointly hear, anticipate and end the musical play with the therapist 3) Increase the ability to hear and anticipate recurring musical responses as cued by the therapist 4) Develop the ability to musically change focus or follow subtle change as led by another. I hope at this point it is easy to see, as he fills in these pockets with success, how he will be able to catch up with his peers socially by being able to perceive and control his body and interpret what is happening and how he can respond more appropriately. I would love to hear from my readers on this. Is it making sense to you?
Hello once again to those of you who have been patient and persistent enough not to unsubscribe me from your mailbox despite my long silence. The Marywood Music Therapy Department has continued to grow and amidst its growth, it’s wonderfully progressive Music Therapy Director, Dr. Anita Gadberry, has moved on to University of North Dakota. Such a loss for the Music Therapy students and faculty, but what a gain for UND! I have truly enjoyed working with such an empowering professional. The loss for me is heartfelt, but as the door closes, I am waiting to see what a new open window will bring. Also amidst the ongoing changes, Summit Music Therapy of Pennsylvania, owned and operated by Cheryl Mozdian, MT-BC – also a colleague at Marywood – and my own Back Mountain Music Therapy are joining forces. Each established in two separate counties, we are hoping to work together to aid the growth of Music Therapy in this part of PA. As much change, positive at that, is happening, part of the process is also mourning the losses. As in Music Therapy, although our forward-looking direction is where we are headed, the direction is never superseded by what is happening in the moment. As I frequently mention to my students, no one climbs a constant incline. Sometimes we have to pause and rest, and take in what is surrounding us before continuing on. Sometimes in therapy, when we are out of breath and need to pause, it doesn’t always look like our clients are still headed upward. They are; they just need the time they need for everything to catch up, level off, properly align, and balance before leaning on the leg that will give the push up the incline again. At those times we need not worry about data progress or productivity. We need to be patient and trust. We look for the signs: eye glance, body posture, or facial expression to allow us to know where we are. Then we trust in the process, in ourselves, and in our clients, that this is what is needed now. It is important before resuming the incline, being attentive to the moment, and keeping the direction in which we are heading in mind. Sometimes the process or the client will surprise us with a turn we didn’t see or expect., yet will still continue to head in the right direction. Current societal norms make it difficult to remember this importance and need, but are part of the progressive process. What helps us to remember the importance is to look carefully and see the very sudden signs of growth, reflection, momentary regression (we have to step to lean back on that one foot for leverage before pushing off for the climb), the positive stillness, quietness, calm, self-regulatory process that we didn’t used to see. We need to remember exactly where the client was 18 months ago compared to where they are now. As I pause as all the school years of schools with which I am involved end, I am taking the time to clean up and reorganize, leaning back on that foot before taking off again. Take the time for the pause: it’s the reserved energy that will lunge you forward when it is time. Antoinette Morrison, MT-BC
Hello to all my faithful readers! It has been almost a year since my last blog writing and reflecting on the many months, I thought that this was the most appropriate subject to come back with. Last fall, an unexpected job opened up which I applied for and subsequently filled as Coordinator and Supervisor of the Music Therapy clinic at Marywood University. Literally the same week that I got the job, a couple other contract jobs that I hadn’t expected nor went looking for also came looking for Back Mountain Music Therapy. Being a small business and because all of this was unexpected nor planned for, major readjustments needed to be made. Back Mountain Music Therapy hired its first subcontractor and the work that I love doing suddenly had endless opportunities and hours. Personally, when I started this business, I had two teens in high school and a child yet in elementary school. That has all changed also. My oldest child has now graduated from college with an engineering degree on a Saturday and began working professionally the following Monday. My middle child is beginning his third year of college and my youngest just received her driver’s license and has taken us on the first of the last round of college visits. Needless to say, the blog and social media when on hold. As I have observed my personal and professional life going through dramatic life processes, so have I simultaneously observed this more closely in some of my long term clientele. With summer time school break, I have also had the opportunity to reflect on the process of the past academic year. Reflecting on all of these adaptions I have once again had my attention brought to the importance of the process and having the ability to see its importance. In Music Therapy sessions, sometimes you have those “Miraculous Appearing” sessions where one outwardly observes dramatic change in clients that you do not see anywhere else. The sessions where onlookers hear mute children produce spontaneous one word phrases; withdrawn un-attentive children engaging; adults lost in dementia having brief appropriate conversation. What is harder to see is the client whose internal process is happening, yet the process takes its time to demonstrate the results of good progressive therapy. Many clients whom a therapist has had a longer termed therapeutic relationship often have demonstrated over time what their particular inner process looks like on the outside. (One example – the little boy who withdraws for approximately one week and sleep patterns change – then at the end of this period displays some area of growth). The therapist working with these newer clients may not know exactly how their progress will be demonstrated but knows valuable things are happening. The hardest to see is the client whose responses are very subtle but still very valuable to their own process. In these clients, staying attentive to the slightest of changes, the most menial eye glance, movement or vocalization is significant and needs to be responded to as so. Although it is not a conversation from an otherwise mute client, the inner process for that individual client is as meaningful if not more because it is building to a change in growth that needs time and nourishment from another in order to happen at all. May of today’s funding sources are eager to see immediate results but almost nothing in life that lasts happens with little effort nor immediacy. It is very much like the personal and professional results that I have enjoyed recently. None of them happened overnight but out of lots of time and quiet effort that were not all public. When I tell people what it is I do, who I work with, very often, the comment following is “that must take a lot of patience”. In my opinion, it is not so much patience as having an attentive eye and appreciation for the subtlest changes, adaptions or responsiveness in an individual and the realization to understand it does not always look “pretty or productive”. Valuable responses may include crying or less “show” than what many may think. It is an accumulation over time that proves their validity. Antoinette Morrison MT-BC
Sometimes we need to be patient with ourselves and then extend this virtue to our clientele in order for progress to develop. In the midst of this, our documentation and education of those we work with and their families needs to be very specific and clear. If everyone has a clear expectation, not only does progress occur more quickly and clearly, but this also lessens frustration and bewilderment. It is difficult with goals, dates, funding, and state or facility requirements to do this, but it is needed. In order to encourage consistent progress we either need to be able to document, explain, or break steps down in written form so that patience with progress is seen as such and is valued and developed with consistency. This week, as I worked with a TBI client, I had seen so much progress in certain areas. However, other needs are surfacing, needs that include the integration of physical and cognitive capacities. At the beginning, my client demonstrated to me that there were cognitive skills that he remembered and recalled, but because of the various difficulties from the TBI, there was great disconnect between the skills that he could outwardly and easily demonstrate. He recognized people, but could not call them by name. He could recognize many objects, but often got stuck with their label, or repeated the last label he used. This caused those around him to believe he did not remember. The speed at which others expected him to demonstrate remembering threw in a little stress and frustration, causing more disorganization and making demonstration of skills more difficult. He has come quite far with all of that. So I decided to begin to work on increasing the rate for which he could demonstrate these skills easily and accurately. As I began to pull up numbers on an iPad (numbers were easy, like a memorized list that slips out without much initial cognitive work) and sing the numeral, he maintained control of the speed of numbers that appeared by pulling them up manually himself. This hand is weak and shaky, so in-between decades he taps the drum to the beat with me. The first time I pulled this out, I had no expectations for him. He just watched. As he listened and watched the numbers with intensity, he had come so far with speech, labeling, and organizing thoughts, but there were still so many unaddressed physical needs. The shaky hand is steadier as he focuses on the numbers, So I decided to make the shaky hand the priority. As he focused instantly and identified the sequential numbers by tapping them, I utilized his focus on one skill and used the continuity from the rhythmic flow of the tune to help gain more motor control over that hand (which will inevitably help with the speech control also). My client is remembering, organizing, and demonstrating more and more. He can not yet identify a random number quickly (1-100), can not yet name all those numbers on the spot, nor can he tap the drum steadily. However, it is documented as, attending to each number, tapping the correct number, and tapping so many beats out of so many beats correctly (raising that number for each objective), or tapping the drum in double time to the beat, gains in the integration of these steps will begin to occur. As we focus on the steps, the correct possibilities that the client can demonstrate and other team members’ expectations of him will include more work on the same areas, increasing the rate and opportunity for success and lessening the frustration of skills that are not YET ready to evolve. This demonstrated progress AND education keeps the ability to receive other services (by insurance standards) open by demonstrating the current possible skills that are currently demonstrate-able. The clients documentation must be able to show his demonstrate-able progress, it must be broken down so that others wandering by, wondering why he isn’t demonstrating the skills they expect. They think these may not be appropriate skills to deomnstrate for the client at the current time. This attitude toward who should receive services still keeps the possibility open that goals are possible, services are needed, and accomplishment of skills is possible. The integration of the cognitive speech and organizing skills, along with the motor areas of the steady hand will take some time. Careful intentions, documentation, and education will allow others to see the tremendous gains being made. Those of us without physical or cognitive weaknesses or difficulties in day to day functioning tend to forget sometimes that our own individual weaknesses have taken time and small accomplish-able steps to be overcome or dealt with . Therefore, careful, measurable documentation and education needs to occur. Antoinette Morrison MT-BC
Previously, I have focused my writings on actually enjoying what one does and how important that is in therapy. This week I thought I would go back to one of my own daily stories about this. I very recently began a new summer contract with preschool children with special needs. I knew before arriving that this age and population would be fun and familiar. I had so much fun that I took up twice the amount of time I was originally supposed to and had no idea until I went back to my car. I was completely in the moment, the kids were very attentive, and the staff enjoyed interacting along with the kids. As I was getting ready to leave the final group, a little boy asked me, “Do you have to go back to work now?” To which I chuckled and replied, “Yes, I do.” After my last couple of articles, this coincidental comment was very timely. Yes, the job that I had been paid to do was over and it was time to get back to work. Go back out into the heat, deal with the foreign traffic on this part of 81 with my malfunctioning air conditioner, and get back to work. However, my job, the one that I had been contracted to do, had left me feeling more energized upon completion than when I had started. I came in with a general plan, but tweaked it to fit the immediate needs and motivations that I observed. My focus and enjoyment on what I was doing caused me to forget, stay in the moment, and lose track of time. I went beyond what I had been asked to do. Someone had posed the question about fun and the need for discipline in one of my recent articles. In other words, what happens to the things kids need or have to learn, but do not want to? My answer to this was something to the effect of when day-to-day life is already a challenge, beginning at a place where the child is focused is one less stress-producing stimulus and eventually may be something the child continues on his or her own. When most everything is a challenge, is learning to be disciplined in pursuit necessary? This made me think of another personal story. One year, when my kids were in high school, we were on our way to some relatives house. I don’t remember what started the conversation, but I do remember my oldest son saying, “How is it that every time you tell us to clean the bathroom, you make it sound like the most exciting thing we could possibly do?” In our house, this is a necessary life skill. Did the boys ever learn to love doing it? Most likely not, but practice does endow some improvement. This skill was not stretching anyone’s abilities, but rather their preferences. However, the regular discipline of this earned my younger son a compliment from management at his first job, to which my son replied, “You can thank my mother.” How much better can our disciplined occupations be if they are things we go and do because they are pleasurable and satisfying? How much better can they be if we want to do them over and over again until we have achieved a new level? Then, because of the confidence that arises from our success, our eagerness to practice even more also rises. We all have skills that come easily, skills that we are good at and enjoy. All the skills we develop from childhood naturally were practiced before they were mastered because there was something satisfying in doing them. If we can attune ourselves to watch what pulls another’s attention and facilitate that, we have taken the struggle out of discipline. Those who have learned from life that it’s too hard”, may find it is just what they are good at. They just need a different angle from which to begin. Antoinette Morrison MT-BC
In last week’s blog, I wrote about the importance of active participation. When an individual is actively participating in an activity, something that is done by their choosing, and is motivated, not only is their enthusiasm and focus increased, but also their motivation and control. An individual will continue to engage in this way if the activity challenges them just enough. What is just enough is that it is challenge that is intriguing and do-able, but yet a step up from what they have previously done. When an individual experiences success in challenge, the cycle of intrigue, engagement, and focus continues. Whether this challenge occurs with a group of others or individually, the result is the same: trust is built. Both trust in self and with a group, a mutual safety is achieved through the trust built in achievement. Sometimes my clients surprise me in what they are willing to challenge themselves after this sense of trust in self occurs. Mothers have reported this trust in self being secure enough to try experiences, especially sensory ones, that previously were not tolerable. For example, the little boy who was sensitive to loud noises experiencing tolerable sound in enjoyable yet challenging levels, such as going to the circus and enjoying every minute of it. Even when the clown was shot out of the very loud cannon. The boy who had difficulty in new situations enjoying the crowd of strangers and the energy they brought with them and the loud, obtrusive noises that accompanied the events was now part of the enjoyable event, experienced as that effect of the event. Or what about the same little boy, working on some speech goals, singing his songs on the car ride of daily errands after leaving Music Therapy? Practicing, on his own, the skills he was going to therapy for and having fun doing so because this was something challenging, but attainable. How about the small group of young children, each with differing diagnoses, who have difficulties in some social situations? Each one of them comes to the group feeling secure enough, not only with themselves, but also with the others there, to begin to take unprompted steps out of their various individual comfort zones. The little boy who was asked to leave preschool because of his behavior, due to the inability to process so much information in a group. He now is the group leader, who encourages others and makes sure no one is left out .He even directs the friendly energy of the group. When he is having difficulty processing, he leaves the group, hoards toys, yells, and appears rude and defiant. But when he feels secure with himself and others because what they say and do makes sense is sweet, compliant, gentle and makes sure all are included. Then there is the little guy who has some language, but doesn’t use it unless he is in a 1 on 1 situation. He often gets far away from the crowd, demonstrates a flat affect, an eye glance that appears to look at nothing at all, and burrows into isolation. When he walks into this room of individuals, whether it is a day he talks or not, he comes into the room and leaves with a huge smile and giggles. He initiates the play with the toy monkeys and giggles as the others join in. There is also the little guy who prefers not to talk at school, although he is very verbal. He asks for a turn, initiates some of the activities, and loves leading the group in the more structured parts of the session. Lastly, there is the individual I spoke of at the beginning. He does not always say much, but is the life of the group and provides the heartbeat and the rhythm to the group. Although he does not always demonstrate the extent of his verbal abilities in the group, he processes it and then demonstrates what he has learned outside the group. That is the point of the group, to carry those skills outside. Intrinsic motivation, active participation, and trust in self, the world and others in it. It’s a great place to be. Antoinette Morrison MT-BC
https://www.youtube.com/watch?v=kE1LsYATBRY Last week I spoke about the significance of intrinsic motivation. This is important not just for children on the spectrum, but for all. This week, I would like to write about the significance of “active participation.” Lets begin with a definition of “active participation.” When I looked up the definition, this is what I found: the involvement, either by an individual or a group of individuals, in their own governance or other activities, with the purpose of exerting influence. (Source: RHW http://www.eionet.europa.eu/gemet/2004/06/concept?langcode=en&cp=77&ns=1) One can watch a child do the same activity under different circumstances, and each one is not active participation. For instance, if a child is promised a reward if he reads a book, and he does so, he is doing the activity, but most likely not actively participating. Now, if a child picks up the same book because he is genuinely interested in reading that book, he is actively participating. The grey area is if a child is prompted to read a book with the promise of a reward, and the child chooses a book he is genuinely interested in. The child reads the book out of his interest, and although he or she is prompted by the reward, it is still active participation . In my eyes, intrinsic motivation and play and active participation are partners. Wouldn’t it be great if our kids engaged in work like they do play? Well, what if we altered their perspective on work and play? Or even altered our own? What if our work felt more like our play? Wouldn’t we engage longer? In our work then, as the definition explains, we would be doing it with purpose, making decisions and exerting influence instead of running through the motions to get the prize. I do think many of us adults have difficulty with this concept because our society has led us to believe that busy, dedicated, stressed, multitasking, hurried and productive are the only ways in which we prove ourselves to be responsible adults. What if we were to take some of those words out and only use dedicated and productive, and then could that fit into both categories of work and play? What if we worked for hours, not because of what we get at the end (a paycheck, promotion, reputation), but also because we truly enjoyed what we were doing at the moment? Wouldn’t the results (paycheck, reputation, promotion) be similar? When we play (as adults) some examples may be skiing, bowling, reading, painting, boating, etc. Aren’t we at that time: a) intrinsically motivated? b) escaping reality for a bit? c) more concerned about what we are doing than what we will get when we are done? d) having fun because we get to decide what, where, when, and how? e) actively participating in the activity? We get involved because the activity is appealing to us. We are stimulated, but not to the point of being stressed; we are challenged at just the right level, and we are adapting to the requirements of the activity, not because someone else told us to do it or told us we should do it, but because it just feels good doing it. When we are actively participating in these activities, we are fully attentive to them, to the here and now. We are not concerned about the end primarily, and although there may often be a positive benefit at the end (being in shape, producing a beautiful portrait, etc.), that is not why we are doing the activity. We often get to shut off the daily stresses of our minds and focus on what we enjoy. When we “play” in this manner we are free to experiment and explore, which means we are free of fear. We control our time and actions in the activity. We feel confidence in the skills we have presently, thereby moving us to move beyond what we have and developing new skills. When our clients are intrinsically motivated and actively participating in their own therapy or learning, they are focused, fearless, practicing a skill until it is mastered by their own free will, motivation, and curiosity. They are in a fearless state thereby freeing them to adapt to a new, higher level skill in their play. What they have previously been doing is easy and now can happen spontaneously as they naturally move to the next level or step. This then is the client’s decision to move on, adapt, and practice, and it is all done with enthusiasm. They are engrossed in what they are doing. They feel they are in control of themselves and what they are doing. To be able to facilitate this type of development, play-work takes skills of attentiveness and listening. What onlookers sometimes do not realize is that to take responses of a client, one must facilitate and organize so that it is still in the client’s control and will and that they are engrossed and yet productive so their own needs do not look like “work” on the part of the therapist. It does still take skill. This type of facilitating aids the client in their own health, development, and growth, but only looks like the client is playing and having fun. As Music Therapists, we are very fortunate that our means of therapy in and of itself lends itself to this openness. Watching the clients movement or listening to their sounds and matching and supporting (validating) the client and simultaneously giving their activity rhythmical or phrase’s structure organizes the play together. The client in now engaged co-actively, and their activity is not an isolated one anymore. The client will decide when and how they will add to the musical, playful exchange as trust and confidence is built through the constancy of matching, supporting, and validating in song. This will allow the client to take the next step out of his own motivation to do so. I always think to myself of the opportunities missed when I hear a teacher or staff say to a student “You didn’t come here to have fun.” What if we set up our work and said “Okay, get ready to play, you can start when the whistling begins!” Think of the endless, long- term possibilities. How much fun our work can be? Antoinette Morrison MT-BC
I think on an intuitive level, all can agree on the importance of an activity being intrinsically motivating. But why, why is it important? To begin, we all know, that it is almost effortless to engage in an activity that we truly enjoy. We seek out those activities, healthy activities, that we are good at, that make us feel good, .When we actively participate in a purposeful activity that we are inwardly driven to do, we are in control,, we are clear and able to translate information.. We are then able to adapt, or meet the new needs of a particular project. When we are successful at what we set out to do, confidence is up and we want to do more, show others what we can do and are thus very focused and attentive to the work. When we can figure it out, organize and successfully implement our plan, we often feel like we are at the top of our game. We want to do more, build upon what we have just done and further the work. We feel value, significance and achieve understanding, thereby lending us the ability to build on what we have already learned. We are ready and motivated to learn the next new skill, because we have successfully learned and performed the previous one. What makes this learning easy is that it feels effortless, like play. We are challenged at just the right level. When what we are learning is matched with our skill, we enter the “flow” . This “flow” helps us to intently attend and effortlessly manage and regulate. We feel mastery from an internal state. Are you beginning to see the very positive, effortless cycle? In Music Therapy, when one is able to match interest (responsiveness of an individual) with a non-tangible structure,( such as rhythm,) we can facilitate in the organization of abilities. therefore facilitating in development or growth that lends itself to success. When interest and emotion are tied together, the motivation for self direction is much less challenging and much more enjoyable. Antoinette Morrison MT-BC
I recently read a post on differing approaches to working with autism that is not exposed to parents and caretakers. As I commented on the post, it got me thinking about the fact that autism, like anything else in a family, affects the whole family. Autism by its nature not only isolates the child, but also many times the family. Although the last statistic I read stated one in every 68 children would be diagnosed with autism, I am not seeing the social acceptance and understanding that you would think a ratio like that would bring. The absolute worst issue I see with this is that families are not supported and rarely consulted. Although the greatest need I hear from parents is about their child’s communication needs, I find there is no one who knows the child and can interpret better than the parents. The great issue then becomes if a child has difficulty communicating, and professionals concentrate on making sure the parents understand all the things their child is not doing, will not do, and stop listening to what the parents knows, parents question what they know about their child. Parents question themselves and what they intuitively know. That is not a word we like to hear in a “research based ” society. By the way, how did we come up with the ideas we are researching anyway? Why are we researching these ideas? Research is a very good thing, but isn’t what we do to validate what we think? All parents need support. Many of today’s successful cooks, musicians, and even entrepreneurs began their venture as inspired children, spending time with a family member and doing things they enjoyed. Parents, listen to yourselves. What you know about your child may not come from any scientific journal, but it is your best guide in finding what your child will need and who will help. Watch and listen to your child and take into consideration the opinions of others and contemplate hem. But in the end, listen to yourself and your child. Those of us privileged enough to be working with these kids and their families know what we know, have done our homework, and can help parents and kids connect the dots, but we need to listen and support not only the child, but their most basic and necessary connection, the parents or caretakers. Lets decrease the stress and increase the joy. Antoinette Morrison MT-BC
I spotted an article written by another Music Therapist entitled “Music Therapists Do It Differently,” by Rachel Norman (http://soundscapemusictherapy.com/2013/10/14/music-therapists-do-it-differently/ ) The article is about how when walking by a Music Therapy room it may only look like people are having fun, playing, or singing along with the music, but there is much more going on than meets the eye. Sometimes I think that because of the years and hours we have spent in school learning things we did not know, we forget we had to have something first, a basis, to be able to learn what was set out to be taught. It seems to me that many people, when working with a person that is not where their peers are in a certain area, we tend to look at where the peers are and begin to try to help the disadvantaged person from this perspective, which, in my opinion, is erroneous. To progress anywhere, we need to begin with a foundation. We have to look at our clients with what they already possess and what they already can do, and then progress from there. I call this working from inside out, working with what we already have and facilitating growth. Working this way may take a little longer to get the visibly desired skill; however, when acquired, lasts without prompting. For example, one may be able to get a quicker answer from a child with a speech delay by taking a child’s face and saying, “The sky is ……. BLUE.” Besides being disrespectful, this method only works with unnatural hands on prompt. Before getting that verbal response, we need to be able to get the child’s attention. We have to be interesting enough to get that which may take some time in learning what works for this child. The best clues will come from the child himself. Lets say this child spends lots of time flapping his arms and not looking.. Well then, when in Rome… In other words, play and/or sing to the flapping. Now, admit it. If you walk by my room and see me playing music with a nonverbal child who is flapping along with me without this previous information, what will you assume? Is this nonverbal child speaking yet? Probably not yet, but he is looking at me and responding to what I am doing. Nonverbal only describes some of the needs, not the child. We have to see and get to know the child and work with their strengths. Make it pleasant, make it relatable to the individual, and make it easy. When life is already a struggle and confusing, sometimes getting by is hard enough. Music itself contains the structures we need: beginnings, endings, phrasing, and predictability. Tempo and volume can be adjusted to fit the individual, the group, or the moment. Melodies and harmonies can express the emotions that we can not yet put into words, but can feel internally. Antoinette Morrison, MT-BC
This week, Music Therapy once again exhilarated and moved me. However, this week I was only the observer, not the one conducting the session. I remembered being a college student and going away to the regional Music Therapy conferences, and for a few days, being away from the academic responsibilities, not yet being a Music Therapist, and listening to the stories and information of those who were doing the work. I left feeling excited to get back to school so that one day I could be doing this also too. This week, as a professional, I observed a college student working. The student was working with teens. At the beginning of the term, the Music Therapy student collected for each individual their favorite music and each week took one teen’s music and did a group intervention focused on that individual’s music. This day, the last day for sessions, the last teen to have his music played was not yet back in the classroom. In addition to this, there was a new teen in the class. April is pretty late into the school year, so this teen was not familiar with the school, the kids, or the routine. The teen rarely looked up and remained very quiet. As I watched the Music Therapy student subtly try her best to encourage this teen’s participation, I was planning in my head how to tell the student that everyone has their own time. Everything is very new for this teen. Just as I was thinking this, the teen began to very quietly sing along with the group. I watched as warm smiles broke out amongst the staff. The other teen that caught my attention had been there each semester I had. The teen started out as the one that always had a sarcastic or heckling kind of comment for everyone and everything. The staff there supervised him closely, as his attitude and comments could be very negative and intimidating to some of the other teens. This semester, this same student acquired and began to bring his own instrument on Music Therapy days. As soon as the music began, he initiated the group participation and sang and played his heart out with the Music Therapy student conducting the session. I watched as some of the quieter, shyer students, and those students who also did their share of challenging staff and intimidating others, watched this teen play and sing his heart out with complete freedom. This encouraged others to participate more freely also. This teen softened his attitude and was fully and eagerly awaiting whatever was being presented. What truly captured me was the gentle way he also encouraged the new teen’s participation. He made the comment that he would not answer for the new teen, but he wanted this new teen to be able to answer for herself. I was remembering back to my first observance at this sight, and what a different person I saw sitting in that chair then I saw 3 semesters ago. As I once again watched this group of teens, the shy teen I was preparing to tell the Music Therapy student to allow time for, began to sing solo. This teen was certainly not a confident child, but the all-encompassing music and group attitude allowed her the freedom to participate without fear and become part of the group process. The observant and warm smiles from the staff outside the group circle encouraged and confirmed the freedom of this quietly relaxed, inclusive, and transforming process that was occurring before my eyes. This day, I was not excited to be a Music Therapist. I was grateful to be one and very proud of what it is we do and excited for the work that is yet to be revealed. Antoinette Morrison, MT-BC
There are several elements of music that Music Therapists employ in order to meet and accompany our clients in movement forward. This week, the element of rhythm and its importance in forward movement seemed to be a theme for my week. All of life happens in a rhythm, appropriate for the situation: night to day, season to season, and even in our own heartbeats and daily living patterns. When there is little consistency in rhythm or the rhythm is not appropriate for the situation, that is usually when healthy movement forward is stalled and stability is uncertain. Let me use the example of a crying baby. Usually, the first reaction when caring for a crying baby is when holding them, begin to rock. If the rocking was erratic, it would not be helping the infant very much. In fact, it could encourage more colicky, crying behavior. If the baby is rocked much too fast, the same result may ensure. If the baby is rocked too slow, that also will not help in satisfying the unhappy infant. A steady, appropriate tempo to a baby’s rocking is needed. Finding that tempo may mean trying rocking at different speeds before the infant lets us know what is working. Sometimes in our earnest, sincere attempts to help, we can use tempos that are too slow. We need to watch carefully to find out if this is working. Sometimes I see individuals, in attempts to encourage success and respect for an individual, use slower tempos, and then continue to slow as they wait for a correct response. Sometimes this works and is what is needed. However, sometimes the client needs a steady grounding at an appropriate rate before they are able to respond. Sometimes, the tempo needs to encourage alertness, and although response may not immediately ensue, alertness and attentiveness is needed first . I had two clients with speech difficulties this week, who each depended on a correct rhythm in order to move forward. One is an adult with traumatic brain injury. After being medicated this week, verbal response was not only very slow, but also very week . I had done a song with her that is familiar and brings success. It has several verses to encourage progress as the steady melody and rhythm carry the sing along. Initially, there were no attempts at vocal response; however, alertness was needed before vocal response, so I kept the tempo at an alert-needed rate and gave her a percussive instrument to use for participation. After a couple verses, some vocal response was displayed, and as we continued, the vocal responsiveness increased and her original whispering voice evolved to a normal volume and alertness continued to increase. Had I slowed the tempo to give time for response, I would have lost her attention totally. Another little boy with fluency difficulties can speak in full sentences, but is not consistent with getting words needed out. He sometimes gets stuck on words and repeats the last word heard. His brain is much too accustomed to stopping and starting, stalling, waiting, and getting stuck. For him, backing up a bit is necessary. We have backed up to getting the 1 or 2 word response out in a timed matter the goal for now. It is okay when he does not vocally respond. He is demonstrating attentive thoughtful response through his attentive position and eye gaze. Often, he picks up the drumsticks himself and will beat away in time with the music until those responses roll out. Controlling the gross motor movement of the arms and matching them to the beat is easy for him now. That way he can first hear the vocal response in his head. We do familiar and interesting but easy tunes for him. There is very little pausing or stopping and his attention is at it’s prime. His typical prosody is often inaccurate and his typical verbal responses are clipped and abrupt. When he only needs to respond to 1 word at a time right now, he is also able to correct prosody by singing the correct tone and holding it appropriately in the tune. If we were to slow the tempo down for correct responses, he could get them, but in day to day speech, this would not correct the problem. For him, the key is to allow his brain to continue moving forward in a timed manner, accepting what he can do at the moment and continue to move. When working with a group, watching attentive positions, eye contact, and erect posture are key to knowing where the tempo needs to go. If only a few are responding, where is everyone else? In working with kids with emotional difficulty, on chaotic days, tempos need to be adjusted to where the kids are. Energy spinning out of control? Slow down. Few responding and paying attention to other things? Speed up. Of course, other elements of music may need to be employed along with the rhythm, like dynamics. Everyone has their own time. These need to be watched carefully to see where the client is and what the immediate need is. When working with groups, this focus remains true too. However, where the group is diverse, shoot for the middle and give it time, and then adjustments. The important thing is not always what is on the paper. It may be what you need to strive for, but at the same time one must pay attention to where the client is, what their immediate need is, and what means they need at the moment to move forward. Antoinette Morrison MT-BC
As the little boy continues the game of “I want blue truck,” and rolls the truck as the therapist puts both parts to a tune, the little boy quickens the process to see if the therapist will continue to follow him and giggles. “She is still playing with me!” He has initiated an activity in order to receive a predicted response and is having fun. However, the game, if not watched carefully, could turn into a repetitive cycle that continues into self-absorption. The therapist recalled how the boy acquired his language in Music Therapy. As the boy grabbed a new car, the therapist would say, “**Boy’s name** has a blue car.” As the boy repeated this sequence a couple times, the therapist would leave out the color of the car and the boy would fill it in. Over time, the therapist began to leave out more and more words from that phrase which the boy began to fill in, little by little. The therapist noticed, however, that after he had accumulated approximately all the language that was age-appropriate, the boy began some repetitive movie-quoting. It appeared that when this began, his play became stunted and cyclical. The therapist also noticed that the boy was using very skeletal language outside the session. He was only able to ask for some immediate needs or wants. He was not using all the language he demonstrated in Music Therapy in regular everyday life. He was also tantrumming occasionally when he was not getting his point across. The therapist realized she had to look at things closer now. Now, what she did musically was more important than ever. She would have to pay attention more closely. As the boy picked up the car and dropped it, the therapist sang, “Where did the yellow car go?” repetitively. As he bent down to pick up the car, the therapist played an oscillating octave in the bass as she sang, “Its r-i-g-h-t,” and as he picked it up, he said, “It is right here.” Finally, progress was slowly being made into more subtle, less visual areas. Although this little guy loved his animated movies, he also loved the animated accompaniment, the predictability, and the suspense in the music that followed his actions. The therapist used the elements of music, specific harmony in her chords, dynamics, and tempo to follow his lead and to build to the next action. The boy was so engrossed in his activity that the music was accompanying, that he subconsciously began to pick up on the musical transitions to the next action. In his therapy sessions, the therapist was able to use the animation in her music and his specific interests to further attain his attention. The predictability of the animated music that followed his actions, accompanied by the song and its words that were tailored to his interests and abilities, allowed the therapist to get closer to his pace. The elongation of speech sounds through the singing helped him to process these sounds that were paired with his interests. After fully processing, he could not only understand, but predict, reproduce, and use the words functionally. However, up until now, reproduced language was limited mostly to nouns, visible adjectives (yellow car), and a few directional verbs that were relevant to the current play. As the therapist concentrated more on the relating part of the music, the suspenseful invitations, the rising lead-ins, etc., she was able to keep his attention as he was picking up on the process’s auditory cues. Now she would have to leave more space for him to respond. She would have to eliminate more non-musical items from the session. He was beginning to notice and process the finer subtleties of communication. The evidence of this was the use of the abstract word “here.” Also, in between the car play, the boy began to initiate more music-making with the therapist. As the boy hit a drum randomly, the therapist synchronized her playing to his random drum hits, putting musical phrases in between his drum beating. As his interest, strength, and coordination in ability to beat the drum grew, so did the length of his playing. Over time, his random drum beats were turning into responsive musical phrase-playing with the therapist. He knew, could hear, and comprehend, where the phrases began and ended. When the therapist played the effective chords, he would look at her with a great big smile and giggle slightly as he slowly raised his hand higher before playing the final phrase note with her, using all his might. A game-like musical conversation was beginning. The therapist built-in this musical suspense with him. He followed the timing in order to end with her. His beginning awkward motor skills used to hold the drumsticks was upside-down, poking the drum to play it. He had, over time, developed a proper palmer grasp and was holding the drumstick the more effective way. His ability to process and hear the structure, and more importantly, consciously participate in it also developed over time along with this motor skill. This was all developed relationally. No one showed the boy how or what to do, nor asked him to repeat or point. This was all done through spontaneous interactive play. This little boy was allowed, like any neurotypical child, to develop his skills through play. As the therapist catered to his individual interests, sensory characteristics, and time schedule, she facilitated his play in a relatable, yet untangible, structure through the music that could not only be felt, but also could encourage the auditory processing needed. His parents began to report their surprise when he randomly spoke occasional very appropriate complete thoughts. Also, they noticed the ease with which he was handling newer situations. The ability to not only comprehend more of what was going on around him, but also to respond to it appropriately relaxed the little boy’s fears and brought many smiles at home. Antoinette Morrison MT-BC
Does music help a child relate to others? How can music help us relate to others? I noticed an article by Oliver Sacks this week that was very relevant to my thoughts on the subject. The article “The Musical Brain: Novel Study of Jazz Players Shows Common Brain Circuitry Process in Both Music, Language” essentially talks about the brain and the back and forth spontaneous conversation that goes on between jazz players as they participate in “trading fours.” “The musicians introduce new melodies in response to each others musical ideas, elaborating and modifying them over the course of a performance.” I have written before about speech and Music Therapy; however, in order to use speech, one needs to be able to relate, pick up on unspoken cues, expressions of emotional, facial response, body language, and prosody of speech. Today, I would like to talk in layman’s terms about how relating in music makes these perceptions more visible for those who often do not see social cues and subtleties. There are non-verbal kids on the spectrum who can cognitively develop speech through music, and sometimes fairly quickly at that. However, if the therapist only attends to the gains in speech, the child may be very limited in the functional use of speech. For example, the child may develop echohalic patterns, repeatedly recite novel or movie lines, or have the speech, but still not be able to use it effectively with others because they have not developed the abilities to read and process the basic emotional aspects of communication. Remember from earlier blogs the “Jack in the Box” effect where the child learns emotionally by his or her back and forth relating, facial signals, etc, with its mother. The more back and forth emotional signals the baby and caretaker exchange, the more sophisticated the signaling becomes, eventually developing speech. Without this well-developed emotional signaling, a child on the spectrum may still be able to develop speech, but it will appear stuck. The child may be able to ask for basic wants, but not be able to carry out longer, creative, spontaneous conversation. This may look something like “I want blue truck.” The child then sits down by himself, rolls the truck back and forth. A child with a little more language capacity says, “I want red truck.” This is as far as the basically solitary action goes. So how can one, in musical play, facilitate the child to extend this interaction? We don’t need to speak the same language or use language at all to play music with another. These individuals don’t need technical musical skill in order to “play music” with another. Whether we sing, move to, or play music WITH another, it is done in relationship with another. We have to be using those perceptions we learned earlier to relate. Lets use the example of watching a movie. Say you walked out of the room for 10 minutes, and as you were heading back, you could hear the background music and quickly picked up your pace because you could tell something big was about to happen. How did you know this? You missed the movie for 10 complete minutes. You could not see nor hear (lets say) what the characters were doing, yet you knew something big was about to happen. What you had unconsciously learned musically, even though you are not a musician, was that what was behind the movie told you something big was going to happen. Although not a musician, listening to children’s tunes as a young one and the teen music as you grew older, you unconsciously learned western musical patterns that made the music predictable for you. You learned these things without even knowing you learned them and you were able to infer information without knowing exactly what was happening in the movie. You most likely learned this information in your recreation to tunes that accompanied other things that you possibly were attending to. Now let’s get back to the child on the spectrum who has not learned the patterns of emotional signaling well, but does have some speech. Say he says, “I want a blue truck.” The therapist then plays a happy sounding phrase that would sound similar to a child’s speech excitedly saying, “I want a blue truck.” The ASD child pays no apparent attention. As he rolls the truck back and forth on the floor, the therapist plays a tune that mimics this, and then as the boy gets up again, she plays an ending phrase that is typical in western music. The ASD child knows his words and actions are being imitated not only auditorily, but he can also feel the vibrations of the keyboard on the wooden floor matching his physical movement. As he gets up to ask for the red truck, the therapist repeats her “blue truck ” tune, only as she sings “I want a…….” She ends “a…” on the 7th tone (a tone that waits to be resolved as we sing, “Do re mi fa sol, la it – ” Our brain hears “do” even though we haven’ t sung it yet.) She holds this tone as the boy now says, “red truck”. She finishes her original “blue truck” tune. Still the boy continues on rolling the red truck, so the therapist continues the rolling part of the tune. This time, as he goes to get up, she again repeats the blue truck tune. As she gets to that 7th tone, there is a pause from the boy, then he says “yellow truck.” This time, as she reflects these words, he giggles. His rolling activity goes for a shorter period of time. The therapist then reflects this in her music. This time, the boy gets up and says “orange truck.” He looks at the therapist. As she reflects this, he giggles and the truck rolling becomes shorter than before. Is this beginning to make sense? The boy is now more interested in seeing if she will do it again. Someone hears him and is imitating him, playing with him. He was not being asked to pick the red one or label the yellow one; someone was playing his game. This is new and relevant. It is on his safe time schedule to. The music she is playing has enticing excitement, pauses, predictable starts, and stops in it. It has phrasing that starts and stops with his playing actions. She has auditorily introduced a predictable sequence. He knows that when she gets to that 7th tone, she is waiting for him.The interacting has begun. He is at this point more interested to see if she will do it again than rolling that truck. For more information on this, watch for next week’s blog. Antoinette Morrison MT-BC
Last week, after writing my blog, I asked my son to edit it before he left for school. He said, “Sure, but would you get my guitar first?” I thought he was going to take it to school, so I asked if he needed his case. He replied, “No, I need it so I don’t freak out.” Now, those of you who have read my blog through LinkedIn and have seen my recent typing mistakes can sympathize with him. Now as chief cook and dish washer here, I have difficulty sympathizing, but freely admit to the difficulty. However, he reminded me of my other topic on my mind. Both of my sons, commuters at a local private college, came home at separate times this past week expressing their interest and enjoyment at the music their band is writing. The two boys, both of whom are full-time college students with jobs, spend much of their time unwinding in the band with their peers. Lately, I have been pleased on our frequent snow days by the hours of my driven daughter playing the piano in my studio. Last year, I received a new client, a little boy with a speech delay. In one year’s time, the speech was greatly developed in Music Therapy as his delay was upgraded to a spectrum diagnosis. At this point, he has more than speech, and at times, his speech is advanced even for his age. However, he often gets stuck in his back and forth engagement. He resorts to repeated quotes from the screen or books, to accompany his play. Facilitating more back and forth exchanges while trying to avoid the repeated quote has been more difficult than the gains in speech, but when we break through these repeated quotes into further back and forth exchanges, spontaneous melodies flow forth with nonsense syllables “na na na”. They are creative, happy, and non-repetitive. It appears the language we worked to get has to shut down momentarily in order to find an open, free, place to continue growth. This morning, I had to remind my drummer to “let go and play.” My youth choir, whom I have had since they were young elementary children, sang this morning. As my son was getting ready to move on from being my drummer, I brought up a talented but inexperienced drummer to replace him. One day, I played a song in 5/4. The tune went well. When we were done, the drummer asked me the time signature. When I told him, he said, “I can’t do 5/4, I haven’t learned it yet.” To which I promptly told him that he just had. Last week, we pulled the tune out again after a long hibernation. The same drummer, with just as much talent and more experience, goofed a couple of times. This morning, I reminded him of the earlier days and said to him, “Don’t think so much. Just play, use your talent.” We played the song without a glitch. There is always the story of the little autistic boy who did not make a sound. When I had finally figured out to clear the room of all academic materials, there was no more to attend to but the music and myself. At the point where he let go, and danced to the music, he also began the most gentle, sweet, thoughtful sounds I had ever heard. I have often written about what music facilitates in, aids us with, supports us in, and pulls us along. However, sometimes the work we do to further ourselves in life in this busy, multitasking, stressful world can overload us, stress us out, and deplete us of our motivation, energy, creativity, or even choke our efforts. Sometimes, we just need to quiet the thinking a bit, and just play. Music becomes healing for us when it helps us to let go, open up, and allow space . “Playing music” is not a coincidental phrase, but a healthy one. Antoinette Morrison MT-BC
Imagine a world where we asked our kids to do something and they did it right away, happily and without reserve or complaint. As parents, teachers or other authority figures, there are days where one may wonder, is this even possible? Is it possible that kids can move forward and take care of responsibility independently because they want to at any age throughout childhood or teenage years? It is possible that it is worth it to the kids? How do we get challenge or responsibility to be worth it, to be intrinsically motivating enough to the individual to take care of self growth and responsibility without a nagging, constant eye keeping watch over the child? This week, as I was supervising some of my college students practicing experience in a wonderful facility, with deliberate, compassionate, motivated staff, the children that the students were working with were doing well, attending, participating, getting along with peers, etc. As the Music Therapy students continued to work, the children were quietly given a reward that was totally unobtrusive to the session. After sessions were finished, the student asked me if she should be doing that also, giving that same reward. I was so happy someone had asked me this question, my reply was more than ready. I said, “No, you should never have to.” I went on to explain to her, in all that she was doing, she was rewarding the children with something better, more sustainable and with easy access. As she began the session with her plan, but carefully watched each child’s nuance, need, interest, strength and worked them into the session, she kept her ultimate goals in mind but adapted individual preferences and discomforts to maintain not only structure and flow throughout, but she also gave value that could not be surpassed by any item she could hand to the child. She honored their individual identity while simultaneously linking the children’s interest, attention, and efforts to a united whole. In the music she chose, she kept their age, interests, and needs in mind. In the predictability of the session she made them feel safe, but added just enough surprise to keep their attention. In her awareness and slight alteration of dynamics as to what over-stimulated certain individuals and what kept others energized and motivated to attend, she kept the group’s interest. In the roles she facilitated in their individual participation abilities, no child was left behind, but all participated and were challenged according to their individual abilities, not a standardized benchmark. She invited challenging levels of participation from individuals, but did not demand it, and rewarded the kids with the prosody in her voice and the glimmer in the eye contact that she made with them that said, “That is wonderful!’, and lastly, the spoken words of acknowledgment and acceptance that they each needed. Each received immediate reward in the moment-to-moment experience of actively participating in a sensory, auditory, tactile, visual, unified experience, starting, pausing, stopping, and attending in unison. The wonderful thing about music is that, through the careful and deliberate use of it’s elements (rhythm, melody, harmony, and silence), one can orchestrate, order, or change development by slightly altering one element and possibly maintaining another, or by slightly altering more than one element so that changes made entrain or soothe differences but are yet undetectable enough to maintain predictability and a sense of safety. When an individual is challenged enough to maintain attention, but not enough to produce stress and individually receive what they most need, there is reason not only to move closer but to want to come back and continue on. When what we receive is intrinsically motivating, there is no reason to distract with an outside reward. As Maya Angelo put it, “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” Antoinette Morrison MT-BC
I was talking with a college this week about client progress and how sometimes what is visible to onlookers is instantly and so radically different than what is typically portrayed by a client, and at other times, progress is happening more internally and one has to look closer at finer details (body posture, intensity of eye contact, etc). Then, when looking back in time, where the client was and where they are now shows a clear march of progress. These often are the times when those who are unfamiliar with Music Therapy need a little more information from the therapist as to what is happening in the session. One of the elements of music, specifically rhythm, can exemplify similar results to the ones mentioned above, both obvious and finer, more subtle results. Rhythm is one of those elements that I use frequently to facilitate development when a client is at a level that needs some challenge. Rhythm is a major organizing factor in music. It works significantly in this way for individuals and for groups, or communities. A group rhythm engagement is a unified sensory motor experience that all experience simultaneously and in a unified manner. Even when all come to the community with their own chaos happening randomly, if given a little bit of time, with a strong steady pulse, chaos can be organized. Each person contributes their own individual inclinations, and through a bit of organization, inclinations become positive group attributes with individual, unique voices. Individual attribute building relatively impacts individual development. This rhythmic engagement directly and joyfully facilitates positive communication with instant feedback. Rhythmic involvement also provides moment to moment responsibility opportunities for it’s members. Each individual’s contributions is a factor in the group stability. It also provides a secure group support, each member in a unified experience, engaging with others while listening, respecting, creating, cooperating, being aware, and exploring. Individually, for those with some sort of motoric (gross, fine or linguistic) difficulties, a good steady flow of rhythm provides a means the individual can sometimes not provide for themselves, which contributes to the individual’s most obvious difficulties. When the individual has a strong, steady pulse to lean on, that pulse can then begin to facilitate development where it had previously become stuck. So what do these things look like in a session? In the group experience, it may start out looking and sounding a little chaotic, depending on the individuals involved. Each individual brings with them their own tools and baggage. Some individuals may stay outside the experience until they feel secure enough and must watch and listen to find out how steady, how reliable that pulse is going to be. Others may fumble with the rhythm until they are unconsciously pulled into synch, enjoying the kinesthetic experience. This may take a little bit of time. Personalities surface; there are those who like to lead, whether it is an option provided by the group or not, there are even those who sit with a pout or an angry look, to ward off others, until the steady rhythmic vibrations pull and crack that look into a grin, and there are those who will storm out if they are not the center of attention; however the beat goes on. Where then is the gratification of that storming out if the joyful beat continues? There is always a place in the rhythm for that person to return to when they are ready. It is very difficult to argue with a steady, flowing groove. In the individual session, those whose bodies insist on stalling and/or stuttering throughout life, find it just as difficult to argue with the beat that moves in waves steadily forward. Most often, given a little time, the steady pulse will grease or limber the words to release them to the pulse. This happens most often when there is nothing to judge, just joy to be had. The little one whose neurological connections or emotional baggage just will not let the steady flow of words out, lends what ability the child does have to which the pulse, ever progressive, continues to move forward like the wave. Contributing when the participant can, the groove will eventually grease and limber the connections as the child’s contributions become more frequent, clear, spontaneous and continuous like the pulse. Before you know it, the brief contributions here and there follow the attentive spirit to full participation. Just like all unused, rusty machines, the longer the un-use, the more time it takes to be properly greased and ready to roll, but rolling does happen. It is that time in between, when all the naked onlooker eye sees is a continuous, repetitive pulse. But the eye with the viewfinder sees as it is happening and knows, from previous experience, that this is how it works.. Antoinette Morrison, MT-BC
Sometimes, in therapy, there is a display of unpleasant emotions. Sometimes this is exactly what is needed, and other times this could have been handled differently, so that processing of the events happening could have been understood or much needed connections made. When therapy is new, yet inexperienced situation, especially with smaller children, crying and tantruming can happen because of the uncertainty. At those times, it is the priority of the therapist to make the situation as comfortable as possible. This may take some time with certain children. The beginning of therapy is not the time to push discomfort because there is not yet a safety zone for the child. However, when the therapist is familiar with the child, and the child with the therapist, there are times when crying or tantruming is unavoidable and needs to be allowed to occur. There is often a great affective disconnect , a difficulty with emotional signaling that can root from environmental issues such as severe deprivation or abuse or biological factors that limits a child’s capacity to interact fully with others (such as ASD children or children with disability involving motor planning, auditory, visual-spatial processing or sensory modulation abilities.) When there is great emotion and a limited ability to either respond to, comprehend, or navigate and orchestrate through our emotional states, these intense emotional states (emotional deprivation, fear, rage,neediness) are quickly linked to fight or flight reactions which ultimately are directly discharged through action. Learning how to navigate or respond takes re-learning of missed developmental opportunities. Usually,this means nurturing the development that needs to be in place in order to handle automatic upset, however there are times when the child will resort to older, more familiar, more known methods to “navigate.” This may be one of those times when the therapist needs to allow a child their reaction and go through this with the child safely, allowing the child to experience safe, non-catastrophic results. Let’s go back to the “Jack in the Box” learning theory (http://backmountainmusictherapy.com/2013/10/music-play-to-override-developmental-delays/). This theory described how a typically developing child learns in a healthy environment. The baby’s mother turns the handle on the Jack in the Box. The clown jumps out and the baby looks to it’s mother with uncertainty, sees it’s mother laugh with bright, inviting, affectionate eyes. The baby realizes that this is fun, this is a game, see how Mommy looks? The baby giggles back, and the scenario is replayed as Mom entertains the baby and receives affectionate laughter. The baby in turn, giggles, smiles and flirts with Mom to continue this emotional exchange. This turns into a rhythmic, back and forth cycle where the child learns what is catastrophic, affectionate, pleasant, and unpleasant. The more these type of interactions occur over time, the more the child learns what is pleasant or not, and as unpleasantness is greeted with comforting nurturance, the more the child is able to delay, reflect, comprehend, and navigate. But what happens to the child that does not interact with it’s mother when the Jack pops out of the box? Perhaps the child has biological deficits which do not allow this interaction to proceed. Perhaps, due to severe deprivation, depression, or other environmental issues, the mother does not respond. What does the child do or learn? What happens to this child as time continues and needed interactions do not occur? The child develops no ability to process. When overwhelming emotions occur, action immediately takes place (crying, tantruming, etc). By the time this child begins school and can not appropriately navigate, the immediate action (tantruming) is not only inappropriate, but also creates a chaotic and threatening environment to the child’s peers. This child will have to go back and learn this, but most likely not in the same environment as the original “Jack in the Box” baby. Some behavioral techniques may temporarily modify the action taken by the child, but the child still has not received what he needs in order to process further, future catastrophic emotion. If the team working with this child never turns the arm of the Jack in the Box because the child will tantrum, and the Jack in the Box is avoided at all costs, what has the child gained? Perhaps measures have been taken to help this child learn, but the Jack in the Box is part of the daily curriculum. Those working with this child are afraid, and so the child is scooted out of the room each day. Now who is learning what? The child that has been appropriately prepared and is ready, but for this child, leaving the room daily gives him special attention he would like to continue. Therefore, tantruming is now a comprehended tool (and appropriate for the child to learn) to navigate with. It is not appropriate for the situation or others near the child. At this time, cranking the Jack in the box, allowing the child this situational tantruming, then gentle, non condemning, natural consequences, allows the child to learn that he is okay, the Jack in the Box is okay, but tantruming is not. Antoinette Morrison MT-BC
As a Music therapist, I believe one of the most important skills one needs is to be a very good listener. And when we are done listening, we need to listen some more, at a deeper level. What do I mean by this? Let me give a couple of examples. One time, while working with a group of young teen boys with emotional difficulties, one of the boys came in that morning. He apparently had been having a difficult day. He came in displaying impulsive behavior, then immediately began doing what he was asked for a few seconds, then impulsive behavior again. This was not typical for the boy. The boy displayed some more impulsive behavior, then asked for a particular song for me to bring in, saying, “Get the clean version, make sure you look for the clean version.” This was followed by more impulsive, disruptive behavior. Every time I asked the boys to do something, he was the first one to follow through, but then displayed more impulsive behavior. As I listened and watched the behavior, I also listened to the staff member who seemed to be worn down by his behavior, also not typical for this person, who seemed continually ready to extinguish the poor behavior. More time was spent with the behaviors, but was always followed by “straightening up” behaviors that the boy employed on his own. That phrase, “find the clean version, the clean version” was what I kept hearing. The boy, once again, began with the disruptive behavior, was confronted and ended up losing control and leaving the room, probably only 10 minutes into the session. We are all human. I had only visited with this behavior for 10 minutes, unlike the staff member who had clearly been with this all day. It seemed to me that this boy could not get control, but was trying. When I went home, I listened to the song. The message in the lyrics dealt with living with addiction and seemed like a hopeless cry. This was just my own thoughts. The next week was very different. The boy came into the session with much better self control and had earned the opportunity to have his song played. As I was getting the tune ready, I told him I had found the clean version. He proceeded to tell me, in a very serious, respectful manner, about the song,s composer, the history of the tune (which was about a life with addiction), and other tunes on this album and why and when they were written by this singer/composer. This kind of genuine interest, seriousness, and openness was also not typical for this boy. My role in this group was not to delve into individual client history, so the appropriate authorities were made aware of the lyrics and behavior, prior and following. I was very glad that “find the clean version, find the clean version” stood out above the disruptive behavior. There was the 28-year-old woman who had cognitive deficits and, most times, lived in her own little world, not responding to others as she twiddled her fingers in front of her face. As we played music together, she would tell me what she was thinking as she twiddled those fingers in front of her face , unresponsive to those of us outside her thoughts. The characters in her thoughts took the form of Sesame Street characters. She would describe to me how to play what was happening and I would follow through to the best of my ability. After being able to make her stories come to life and tell them,it was reported that she was always more responsive long after the session had ended. This was how our sessions continued for about 2 years. This woman lived at home with her family, and her only companionship really was her mother, whom, because of her cognitive difficulties, she was dependent on. Every year I would see this woman at a yearly Christmas party that her family and my husband and myself attended. When I would see her there, she would be in a room, standing there, oblivious to the rest of us, twiddling her fingers in front of her face. If I was persistent, she would finally respond to me with “Oh, Antoinette, is that you?” (she did not have any visual problems, she was just too removed to see me). Sometime during the second year (this was a long while ago, so I do not remember the details of her story I was playing), she revealed to me, though her stories, she was angry. She was angry toward her mother because she was 30 years old and dependent on her mother. I was shocked at this. It was appropriate for her age, but because of her cognitive disability, I did not ever think about this. That year, when I went to the Christmas party, and walked through the door, I was greeted with an appropriate touch of my arm and “Hello, Antoinette, how are you?” I was shocked (as was my husband who witnessed the same non-response previous years). Although I had listened to her stories through song, and pictured them as she described to me how they would sound, I never noticed the transformation. She had always responded to me in the music room, and her mother had reported to me her responsive behavior after our sessions, but I had never witnessed this without music to accompany her private stories. I have numerous stories of uncommunicative children who come into Music Therapy without eye contact, in silence, or making odd, uncommunicative sounds, or who spend much of their time screaming or crying. Although some of those children did not understand or process speech when they arrived, many could process or comprehend music that was matched to their actions, their rhythms, their sounds, or their behaviors, and have been able to relate to me and others through those kinds of beginnings, starting with listening to where they are at that moment in life. Depending on the setting or situation, some clients have come temporarily for shorter periods of time, and others have been seen much longer. The ones that are seen for longer periods of time often require me to listen to them differently over time. Those are the ones that teach me how to listen better, to adjust how I listen, because as development occurs, so does responsiveness need to follow the same direction. Teachers of young children often teach them to “listen with your ears, and listen with your eyes.” When we listen deeply to others, that is when we learn when it is time for us to lead, follow, or simply leave the space for them to develop more, or be more. response-able. This, for me, requires the deepest listening (sometimes accompanied by careful reflective thought). Listening carefully can help us respond most appropriately. Antoinette Morrison MT-BC
This year’s theme for the American Music Therapy Associations Social Media Advocacy month is This year’s theme is “We are . . . ” centering on exploring and honoring our identity as music therapists and as a distinct and stand-alone profession, unique from other professions and professionals with which we work. At my studio, since coming back from the holidays, we still are not in full swing due to weather and flu season. However, college classes have begun and the Music Therapy clinicals which I supervise began this week. Last week, when the students visited their clinical sites, one of the sites, a geriatric facility, showed the students a short film that they show to new-coming staff or volunteers. It was about accompaniment. The staff that showed the film told the girls that she was sure, as Music Therapy students, they would be able to relate to this. As I watched the film, I thought about how true this was. The skill required most in accompanying is the ability to listen intently and deeply. Also, an accompanist needs to listen reflectively. We need to listen to our clients and our response to them. Like I told my students, for some situations, a plan is good to have in order to give a direction to our session; however, once you are there, a Music Therapist needs to be in the moment and able to take what is given at that moment in time and proceed from there. We often make the clarification about music education verses Music Therapy as the focus of education. It ultimately is to gain in musical skill and the focus of therapy is the process. Music Therapists work from birth to the grave, accompanying in various stages of life. Music Therapy assisted childbirth accompanies not only baby, but also mother in gentle entrance into this world, Music Therapists working in hospice assist in gentle and peaceful departure out of it, watching and listening to the individuals involved and accompanying their process, assisting in a gentle, natural journey. Each individual’s journey through this life is a unique and individual experience, sharing commonalities with others who have similar experiences, yet bringing their own individual past, thoughts, and differences to the situation, making it a very individual experience. A good accompanist has the music and the agenda prepared; however, we must attune to the performer, being ready at a moments notice. If nerves should temporarily override or situations occur that were unplanned, one must be ready to adjust at a moments notice so that the audience’s perception of the performer is nothing less than radiant. So too must a Music Therapist be ready at a moments notice, whether the process is including moments of joy, grief, pain, movement, anger, etc., and accompany that individual in the process to where they need to be, where they are going or where they need to be gently guided. This can only happen by attentive, watchful, concentrated listening and responsiveness to the person(s) involved in the experience. Our musical knowledge, knowledge of the experience (childbirth, autism, disability, brain injury, communication disorder, emotional or mental disturbance, diagnosis, ) can be a resource or a guide to our empathetic accompaniment. Yes, I think the staff that said, and perceived that Music Therapy students could relate to the film on accompaniment, had made an impeccably appropriate assumption. Antoinette Morrison, MT-BC
Hello once again to the readers of Back Mountain Music Therapy’s Newsletter! I had taken some time for the holidays to spend with friends and family and then get organized to work again. The AMTA (American Association of Music Therapy) has begun their yearly “Social Media Advocacy Month” of which I am proud to participate in. This year’s theme is “We are . . . ” and will center on exploring and honoring our identity as music therapists and as a distinct and stand-alone profession, unique from other professions and professionals with which we work. My first post of the near year will be a guest post by another very experienced Music Therapist, Judy Simpson: “We are…MUSIC THERAPISTS!” Judy Simpson, MT-BC Director of Government Relations, American Music Therapy Association When I started my career as a music therapist in 1983, it was not uncommon for me to describe my profession by comparing it to other professions which were more well-known. If people gave me a puzzled look after I proudly stated, “I use music to change behaviors,” I would add, “Music therapy is like physical therapy and occupational therapy, but we use music as the tool to help our patients.” Over the years as I gained more knowledge and experience, I obviously made changes and improvements to my response when asked, “What is music therapy?” My enhanced explanations took into consideration not only the audience but also growth of the profession and progress made in a variety of research and clinical practice areas. The best revisions to my description of music therapy, however, have grown out of government relations and advocacy work. The need to clearly define the profession for state legislators and state agency officials as part of the AMTA and CBMT State Recognition Operational Plan (http://www.musictherapy.org/policy/stateadvocacy/) has forced a serious review of the language we use to describe music therapy. The process of seeking legislative and regulatory recognition of the profession and national credential provides an exceptional opportunity to finally be specific about who we are and what we do as music therapists. For far too long we have tried to fit music therapy into a pre-existing description of professions that address similar treatment needs. What we need to do is provide a clear, distinct, and very specific narrative of music therapy so that all stakeholders and decision-makers “get it.” Included below are a few initial examples that support our efforts in defining music therapy separate from our peers that work in other healthcare and education professions. Music therapist’s qualifications are unique due to the requirements to be a professionally trained musician in addition to training and clinical experience in practical applications of biology, anatomy, psychology, and the social and behavioral sciences. Music therapists actively create, apply, and manipulate various music elements through live, improvised, adapted, individualized, or recorded music to address physical, emotional, cognitive, and social needs of individuals of all ages. Music therapists structure the use of both instrumental and vocal music strategies to facilitate change and to assist clients achieve functional outcomes related to health and education needs. In contrast, when OTs, Audiologists, and SLPs report using music as a part of treatment, it involves specific, isolated techniques within a pre-determined protocol, using one pre-arranged aspect of music to address specific and limited issues. This differs from music therapists’ qualifications to provide interventions that utilize all music elements in real-time to address issues across multiple developmental domains concurrently. As we “celebrate” 2014’s Social Media Advocacy Month (http://musictherapystaterecognition.blogspot.com), I invite you to join us in the acknowledgement of music therapy as a unique profession. Focused on the ultimate goal of improved state recognition with increased awareness of benefits and increased access to services, we have an exciting adventure ahead of us. Please join us on this advocacy journey as we proudly declare, “We are Music Therapists!” About the Author: Judy Simpson is the Director of Government Relations for the American Music Therapy Association (http://www.musictherapy.org). She can be reached at firstname.lastname@example.org
Often this time of year, if you go to a Christmas party there is music playing in the background to enhance the mood. If you go to a concert, there are two parts: the audience and the performers. Although most everyone’s focus is the same, depending on the concert types, there are performers playing, singing, and/or dancing, and the audience who may sing and dance along, or possibly only do that in their head (different protocol for different types of concerts). Lastly, there are the family or community get-together where all participate at whatever their level of musicality is. I have been working with a small group of children ages 5-7 with different diagnoses. The original group of two has changed in the last six months due to parent job relocation. In that time, schedules have changed and so has the session format. Currently, there are now four members (we shall refer to them as Member A, B, C, and D). I began this group with a more formalized structure, thinking the children were ready for this. All could handle this but one child, Member C. C’s schedule changed and he and his sibling, D, left the group temporarily. I then discovered that A and B, although they paid attention, took turns, and answered questions (some of their goals) in the structured environment, gave a more spontaneous, playful response when I only facilitated. Now A and B were not only more excited, participating more fully, but also interacting with one another more personally. A, who usually demonstrates little eye contact and flat affect, was now laughing, watching, and reaching out to others, and making frequent eye contact. B, who loves the interaction innately, but is somewhat limited by his physical makeup, seems not only more excited, but the physical limitations were loosening, allowing B through the pure joy of his interactions, and the assist of the continuous rhythmic flow of the music to more fully participate with fluidity and ease. C and his sibling D have re-entered the group. C had difficulty with the previous structure. He had difficulty and found the structure somewhat threatening. C was not in control, and although the previous structured format had consistent predictability, his fears and difficulty processing all this information at once limited his ability to perceive what would happen next. C, however, in the absence of the group, was continuing to see me on an individual basis. C at this time had also begun some semi-structured classroom situations. Although C loved the kids, he was having the same difficulties in his classroom situation. While working with him on an individual basis, I was somewhat at a loss. He was referred to me because of his severe speech delay and some behavior difficulties, mainly meltdowns. In individual Music Therapy, his speech and communication difficulties had progressed to about where they should be, and consequently, and the difficulties that were a part of the speech delay improved the meltdown situations greatly. I felt lost in the individual sessions. We were finishing up some goals and I was unsure where to go. He of course had age-appropriate developmental areas to work on. We could carry on an age-appropriate conversation, and he was demonstrating the ability to connect ideas through imagination. I continued to support through the continuous flow of music some minor speech needs. The individual sessions did not seem to have consistency lately, and I knew there was a need I hadn’t yet identified. Otherwise, the structured situation should not be a difficulty at his age. I did a re-assessment and found that I followed and supported all his interactions. There was to little give and take. I was very happy with the timing of his schedule change opening back up and my re-assessment results were coordinating together. This small group would be perfect for him. Child A, who does a lot of station work daily in school, comes to life for movement. He comes into the group as, ironically, the least likely leader, and immediately begins to jump on the trampoline, leading the rhythmic flow of the group. Child B, with some of his coordination and fluency difficulties, comes in and joins us in the continuous jumping-facilitated music on the drums. Child C began by standing in the middle by a drum, briefly eying everyone else up, and joining the drumming flow. Child D is the most adaptable, and alters instrumentation and movement, beginning the group in turn-taking, back-and-forth interaction, call and response, and leader vs. follower positions. The children fell back and forth from attending to their own interest and allowing the group to follow to watching and following someone else’s interest. At this point, there was a free flow of give and take, no prompting taking place. All leave the group happy and energized. In my recent reassessments and reflection on my clients, I have noticed a common trend. Several of the reassessments have revealed that my clients are often being followed in their music making and although there are some brief primitive back and forth exchanges, more substantial ones are needed. I have to ask myself if this is all due to my clients. Do I need to leave more space musically and re-examine my musical elicitation methods closer? Do I need to facilitate more subtle musical methods of interaction? Maybe I need to be more conscious of this and look deeper at my clients and myself in order that all can interact and participate to their fullest ability. Antoinette Morrison MT-BC
I do not know if many other Music Therapists share this dilemma with me, but often when I see a client or child that is referred for a particular reason and time goes by and the need becomes met, when the client continues to have needs that are not as flashing red-light obvious, I begin to feel a little lost. What also tends to happen is that as the client tends to mature, so of course does his musical interests and needs. By that I do not mean more age-appropriate music, but rather a new developed way of using music to continue to meet more mature needs. The client, of course, then relates to the music-making we have previously been doing differently. I used to worry and think, “Has this become too stationary or boring for the client?” Over time I have lost the worry and answered the question, “What slight needs to occur?” I cannot always answer this question readily. I often reassess and look at the client’s musical history to see where we have been, what has been consistent, what has changed, where the client is currently, where the client is heading, and therefore, what the needs are now. This month, I had to reassess a little boy who came to Music Therapy and was referred because of great speech needs. Most of the language needs have been met. He has what he needs, although he doesn’t use all of his capacity spontaneously yet. After careful observation and reassessment, I dismissed a couple well-progressed, but not completely met, goals. At three, he talks in phrases and on occasion a complete sentence. He only relates to music-making as I follow his lead. He answers questions in supportive, reflective song to his choice of subject in immediate interest. However, he has just now began to look at me occasionally when answering a question. He does not have difficulty making eye contact, but has difficulty with the back-and-forth flow of relating to one another. In my banished goals, I plainly put that the current goal was not his greatest need and that as his greatest needs were met, these goals would most likely take care of themselves. If not, they would be revisited. As I was thinking out loud, explaining this to my part-time business assistant, my husband, I admitted that this was one of the benefits in this locality of having a private business. Had I been in an academic organization, a goal reorganization of this type would most likely not have been allowed. When behavioral methods and academic ACHIEVEMENT are the only endorsable acknowledged and implemented techniques, what happens to relatedness? It becomes a foreign term, one which, ironically, is one of the founding ingredients for independent positive behavior. In a world where neurological differences are becoming part of our norm, part of our inclusion, doesn’t related need also to be considered in our standards? What good is naming objects, actions, pronouns, conjunctions, if it is an unrelated subject? I would like to acknowledge the development of the IMCAP-ND (Individual Music-Centered Assessment Profile for Neurodevelopmental Disorders), the work of Dr. John Carpente. The IMCAP-ND has been an incredibly invaluable aid in helping me find where my clients need to move on to next and how to get there. Antoinette Morrison, MT-BC
After the Thanksgiving feast with friends and family and then our annual Black Friday shop-til-you-drop marathon, Saturday was time to get back to work. I was reading some fascinating comments after the last mirror neuron blog and some suggested articles from faithful readers when my first client arrived. With mirror neurons fresh on my mind, I worked with a non-verbal deaf 5-year-old with global delays. As she sat in the doll-sized rocking chair holding onto a cymbal with one hand and a drum with the other as I played the piano, sang, and beat both percussive instruments alternately, I watched her intensity of focus and “listening” as she quietly giggled. She eventually reached for the drumstick on her own (something she usually tries to avoid) and began to attempt to beat the drum after watching me. I then moved my foot to the base of the cymbal stand because she was exerting enough pressure on the stand to tip it. As I did, each time she started to move her foot also without watching it. She did this unconsciously each time I moved my foot. She appeared to be concentrating on the vibrations of the drum and cymbal and playing the drum. I thought, of course, “Wow. Mirror neurons?” I had to finish that article on the subject that I had begun to read before sessions started. The new information (new to me) that I read led me to believe more fully in the scientific reasoning of why Music Therapy. The article, “Broken Mirrors” by Vilayanur S. Ramachandran and Lindsey M. Oberman, not only talked about the evidence of the firing of mirror neurons concerning motor actions, but also spoke briefly of such difficulties as interpreting metaphors in children with autism. The article said the “angular gyrus” sits at the cross-section of the brain’s touch, hearing, and vision centers. It also demonstrated evidence of a mirror neuron location. Their claim was that in monkeys, this cross-domain mapping aided complex motor tasks, which may involve such things as conformity, touch, auditory, and visual information to complete the tasks. This article suggested that over time, this information developed into the ability to understand metaphors in humans. After watching the musically unrelated additional response in the little girl’s leg movement, I began to think, “This makes a great case for the importance of Music Therapy, which invites and gives structure to response, which may include not only auditory and visual domains, but also touch. This week, this little girl did not give many demonstrable outward gains in her session, but the intense level of her tentative contemplation was very evident. We eventually moved to the mirror as I began singing about her hands, nose, mouth, and toes (subjects to sing about were chosen based on her actions and sounds she was playing with). Again, as I sang the words after feeling the vibration of the Native American flute I was playing, she not only began to say “mouf”, but also watched my mouth with intensity. After reading this article, I began to think of how lucky I was to be able to realize a medium that not only mirrors and structures, but also touches so many areas simultaneously, such as visual, auditory, tactile, and emotion. Music Therapy, the structure to contain and order the chaos and the flexibility to include all, but also the leading mirror ability to attract attentiveness, the additional features are that the structure and predictability provide a sense of safety, which in turn produces calmer, more focused behavior. Antoinette Morrison, MT-BC
This week as I worked with my client, who was a victim of a brain injury, I was struck by the intensity of her watchfulness as we sang a children’s tune together, pronouncing letter sounds. When I see this client start to fade the specific mouth movements in singing words, I employ this song. Firstly, it is a children’s tune, an early embedded memory. The tune is well-known, predictable, and an old memory (embedded early on). It is also very repetitive,predictable. and gives several chances to see, hear, and pronounce the letter sounds. My client is motivated by its familiarity, pulled by its constant rhythm, and has several chances to not only hear, participate, and practice, but also to succeed. Additionally, I printed a book of the letters to see. I instigate her success as she flips each page when there is a pause in the singing as I list the letters up to that point for her to fill in. Essentially, as a verbal pause occurs, I facilitate the verbal memory by keeping the embedded alphabet fresh. As I was struck by the intensity of her watchfulness, the term that literally popped into my head was” mirror neurons.” As I thought of this term, I had to read some more on mirror neurons. The information found in this blog was taken from two articles: “Being together in Time: Musical Experience And The Mirror Neuron System,” by Katie Overy and Ivan Molnar-Szakacs, and a review “From Music Making to Speaking: Engaging the Mirror Neuron System in Autism,” by Catherine Y. Wan, Krystal Demaine, Lauryn Zipse, Andrea Norton, and Gottfried Schlaug. Mirror neurons, it is believed, fire when an action is executed and the same action is observed or heard. In other words, mirror neurons engage perception and comprehension of motor actions. It captivates higher order cognitive processes, such as imitation. To begin, we have well-established joint attention between the client and myself. Joint-attention is something which language development needs an established affiliation with to establish. Also needed is a level of synchronization in motor representation between listener and speaker Secondly,clear speech perception and pronunciation in my client involves watching my lips and mouth movements. In this experience, embedded are mouth movements, visual perceptions, and auditory perceptions, essentially a multi-sensory systems aiding to strengthen the partnership between the symbols (letters) and their sounds. This of course requires the presence of another and cannot be done with just recorded music. Besides this, the actual music-making information is used to imitate, predict, synchronize, and perform an expressive act. The best part of this, for my client, is that it reduces, or possibly even dismisses, the distraction, over-stimulation, and intricacies of everything else going on int he world around her. She is focused, participatory (at many levels), successful, and enjoys herself building confidence for the inevitable next challenge. She is a person, functioning differently than she had previously. Her brain, at an unconscious level, is understanding actions (letter-sound production) of another. Her brain is not a stand-alone stimulus response machine. Brain function is closely linked with the body. It is so much easier, relate-able, and motivating to synchronize with another human than a recording. And how much more inviting , rewarding and motivating for her! Antoinette Morrison, MT-BC
In my area, Music Therapy is a service that is not well-known. Often, people who have not previously heard of Music Therapy hear that I am a Music Therapist and ask “So, what do you do? Play music to them?” (My clients). I think we are so accustomed to teaching methods that something other than that such as facilitating is hard to conceptualize. Because music is structure over time, what one may see in my therapy room is not what some people may expect. It certainly does not look like a classroom scenario. In fact, upon walking by, glancing in, it may look unstructured or chaotic. A child may be hopping up and down or running back and forth screaming. So what is going on? How can this be therapeutic? Any good therapist begins where a client is, and all behavior (once again) is communication. I may not know why my client jumps or screams but what I do know is that they are communicating something about themselves. I mirror musically anything they do. I do this to play back to them, giving them a musical portrait of themselves. It may not be by typical standards what you would consider “beautiful” music. This a simple musical motif or phrase, something that the client is already doing or communicating that is not only being reflected back but being given structure through the rhythm. What is the point of that you may ask. Our individual development from birth depends on our back and forth relational reciprocal interactions. (For more information refer to Music Therapy – In Relationship – http://backmountainmusictherapy.com/2013/10/music-therapy-in-relationship/). We develop in relationship to our immediate caretakers, by the back and forth interactions of infant and mother. Each reciprocal interaction or circle of communication builds our learning, relating progression. Our earth, our bodies, our seasons, time, and development all happen in a repetitive rhythm – day to-night, sun up to sun down, season to season, year to year, one heart beat to the next continues to build in a repetitive rhythm. When a child can come in with what seems like chaos and have it fit into a structure (rhythm) just as the chaos exists (jumping, screaming, running) and it is okay as it is, we have the beginnings and basis for reciprocity. Life begins and development occurs with the give and take, the back and forth of relationship. What is it that these kids need most? Music is the universal language. Music’s rhythm and repetition provides structural and predictable basis for reciprocity. Sound is vibration which does not make even hearing a necessary must in order for the brain to process music.. In other words music can be open enough to include the ornamental chaos and predictable enough to give it structural basis for back and forth relating. Antoinette Morrison MT-BC
Recently, my family got a dog from the SPCA. I began to think, a therapy dog might a nice compliment to my therapy business. I decided to take my new dog, Charlie, to a trainer. Upon arrival, the trainer told me he was going to teach me about how I conduct myself with the dog (not teach the dog) so that the dog learns how to behave appropriately. As I was working at a facility this week, I was reminded of this. I had a very high-functioning young girl who previously and frequently had meltdowns just coming in to Music Therapy. There have been some changes at the facility, and this year she has made some fantastic changes in Music Therapy. I try to reflect every good deed I see from her, and that seems to aid in the elicitation of very helpful and complaint behavior. I noticed long ago that the girl has difficulty with authoritarian attitude. She seems very sensitive to it, and although someone with an authoritarian personality may try to do all the right things, this girl is not forgiving towards this kind of attitude. This year she has consistently had good days that were thankfully documented in Music Therapy. As I have watched her deal with people in situations when she melts down, she goes on and on and resolution takes a long time. What seems to me to make the biggest difference is not always the actions of the person dealing with her, but their attitude. What does this have to do with my dog? I think, like my dog, kids who may not have had what nurtures good development in life may be handling life primitively, from a “fight or flight” stance. When working in therapy, we have to be aware of not only what we say and do, but also of what we are thinking and feeling. Remember, studies say that only 7% of what we communicate comes through our words. Ninety-three percent of communication comes through eyes, stances, body language, facial expression, the relaxed or pursed stance of our lips, the twitching of an eye, or the furrow of a brow. For kids who have prematurely had to protect themselves or monitor or manage emotional imbalance lack a structure or instability, or worse. In order to stay okay, they are already conditioned to watch and therefore must react from a more reactive and primitive state of being. Those of us who regularly deal with these kids need to be functioning from a much more advanced place. Unfortunately, no matter what our degree is, or how may letters follow our name, there is nothing else but ourselves that monitors this condition. In order to do good productive work, we also have to be aware of what is going on inside of ourselves. It is a very important part of the job. Antoinette Morrison, MT-BC
http://phdinspecialeducation.com/groups-activities/ This week I was thrilled to hear from Sarah Paulson, who notified me that Back Mountain Music Therapy would be featured in PhDinSpecialEducation.com. I was excited about the exposure of my business, but also grateful to be classified along with other businesses associated with the well-being of those in need of special education. It seems to me that quite often a child is given a label and the first lines of treatment include medication and/or a behavioral program to help those with special needs. People with special needs are just that: individuals with special needs, differing somewhat from what we typically see. Special needs individuals are individuals, not labeled specimens. It is wonderfully human to not only recognize the “out of the box”, the “special”, the “creative”, help, aid, activities, therapies, education, and relationships that these individuals need, crave, require and deserve. Often the “special” part is what we receive when our recognition and willingness to relate allows an openness to embrace individuals who do not always function within the typical norm. I am honored to have my service listed with other services creatively designed to share, relate, and seek wholeness as a means of normalization. If you are one of those eager and willing or looking to make the life better of a special person with a special need in your life, but not sure how, take a look at this list of avenues to begin. Antoinette Morrison, MT-BC
Recently, I have had clients make progress in the area of verbally relating to others. The two cases were completely different sets of circumstances, but both clients were headed towards similar areas of health. How is this possible? Most everything in life happens step-by-step. Most every change that we make ourselves in life that lasts happens over a continuum, whether it is a behavior, a relationship, or a skill. We can simply “dog train” a skill by repeating a process over and over again with external consequences and rewards until it becomes a knee-jerk reactive unthinking action. A reaction, however, does not work well in developing a relationship, a way to relate, a way to choose. Choosing freely lets the world know who we are individually and what we want from the world. Few of us, if any, truly relate who we are to people who correct us often, to people who do not relate to us well or to those who consistently ask more from us than we can easily give. So how does successful relating happen? We have to relate with our cognitive mind, our emotional heart, and our spiritual self. You may be asking yourself, “She started out speaking about verbally relating. How does this work with a nonverbal client and/or a nonrelating person?” One must jump in, jump in with the other. To begin this, language is not a necessity. Relating is. To re-quote Dr. Temple Grandin from one of my earlier blogs, “All behavior is communication.” One does not necessarily need to understand all behavior at first, but we need to be willing and open to the fact that our clients ARE relating in ways they know how. Being reflective of another’s way of relating rhythmically, through timbre, melody, prosody, etc., and being cognitively aware and in control of my own relating behaviors is essential. Instead of “correcting” or “teaching” a new behavior, reflecting one’s more subtle timbres, tones, rhythms, dynamics, etc., but having enough self-awareness is a beginning. Out of this, a simple, repetitive, predictable tune becomes a staple of the relationship. The client’s behaviors, reflected and combined with the musical structure, becomes a way to relate. My client’s jumping, his way of relating to the world, is something I can reflect back and structure. However, there is flexibility in this tune. Flexibility through a playful spirit in the tune allows each individual to tweak and adapt slightly as time unravels, and interior and exterior changes occur. Yet that basic, predictable, time-structured beginning gives the relationship stability, predictability, cognitive functioning, something it can understand, and balance. The playful spirit in which it is done allows for change and playful relating to occur. The playful spirit provides safety to try things never tried, yet enough predictability to provide security. As the client becomes comfortable, playful, and cognitively aware that this makes sense, the client plays, the therapist responds, the client responds back. Eventually, short moments of back-and-forth response turn into phrase length, sentence length, and then gain life. This playful back and forth is welcoming, secure, and fun, allowing the brain to understand and sustain this back and forth relationship. This week, parents received from their children what they wanted most: to know what goes on inside. The little boy who climbed into the car somewhat feverish, pale, and cranky answered Mom when she asked him if he wanted to go to music (something he loves). His reply, “No, can we just go home this time?” The 23 year old, who had a meltdown, but afterwards was able to tell his parents why, what he felt, and why he got frustrated for the first time ever. The occurrences previous to the relating may not have been the most positive moments in these people’s lives, but they each were able to reflect and verbalize how they felt and what they wanted: a good sign of health, especially in the ore negative moments of life. How many of us do that effectively? Antoinette Morrison, MT-BC
Last week I wrote about “The Jack in the Box Effect.” (http://backmountainmusictherapy.com/2013/10/music-play-recipe-to-override-developmental-delays/). This demonstrates how infants learn about the world and how to react to it by watching their mothers. The blog talked about 93% of communication being non verbal and only 7% being verbal. Usually, when engaged in my Music Therapy sessions, my attention is on my client, where they are, what they are doing, and how to engage and mirror in a way that will facilitate movement toward a more healthy way of being. However, this week while watching my adult client with difficulties due to a brain injury, I noticed something I don’t usually pay attention to. There was an extra family member in the session with us this week and I was surprised to see that when the music began, how quickly her attention focused on me. I saw her watching my mouth (for word queues) and my expression intently. All she was working on, word and name recall, attending, some range of motion, and relaxation was dependent not only on the music but the music maker also. The music, was supporting, engaging, and focusing her, but she was looking for direction from the the music maker. She watched my face and my upper body posture as I sang E-I-E-I-OOOO with her. She watched to see how loud and how long that O-O-O-O would go. As we each started to run out of air, we would chuckle together lightly and continue on. It is immediately obvious with small children how quickly your attitude is detected by theirs. However, with older clients, the feedback isn’t quite as obviously immediate. When engaging with those with neurological difficulties, the music helps to entrain our rhythms and movements and aides in focusing attention. Then, the music in our stance, facial expression, and eye glance must visually synchronize with the musical language we are speaking. Our patient eyes waiting patiently for a non hurried response and our joy at its reach portrays our inviting relatedness. We can always lose our conscious thoughts in listening to pre-recorded music that is adjusted to our tastes and needs. However, relating to another is what moves us beyond that farther. When relating and music are combined to compliment one another, the effect allows and invites those who must relate differently and moves us beyond our own limitations. Antoinette Morrison, MT-BC
This weekend I attended a conference entitled “Considering Musical Dimensions in Relationship-Based Work” at Molloy College. All of what was presented there was relevant to all of my work and very timely for this portion of my blog on play, particularly the evidence presented by non-musical clinical developmental psychologist Dr. Gerry Costa from Montclair University. In the presentation, he said, “the musicality of the infant-parent relationship and the foundational experiences needed for mental health and peaceful societies.” Stanley Greenspan stated, “affect is the orchestra leader of all developmental areas.” What comprises affect? How do infants learn about the world? Infants learn about the world in relationship, through the back and forth between mother and child. The example Dr. Costa gave was called the “jack-in-the-box effect”. How does the infant learn? Mom winds up the box as it plays the “Pop Goes the Weasel” tune until the jack pops up. The baby looks at the jack, then looks at mom with surprise. The infant watches Mom smile, Mom’s eyes enlarging with excitement and playfulness, and hears the soothing inflection and tone of Mom’s voice as she reiterates pleasant surprising fun in her words and tone. The baby then reflects Mom’s affect with similar facial expression, realizes that this is fun, then giggles as the game is repeated. How did this baby learn this was fun and pleasant? He saw Mom’s expression on her face (visual timbre). He/she heard the pleasant, smooth tone of Mom’s voice and the pitch direction it took with surprise and joy. He/she heard the dynamic of pleasing surprise and the softening tone as the pleasant expression leveled off to try again. This learning all happened in reciprocity, the back ad forth flow of Mom watching baby’s eyes, baby watching Mom’s reaction. Baby then replying in a similar, complimentary manner. The safety and permanence of this came through repetition of the game. The baby did not learn this by watching a prepared movie of her reflection, nor listening to a CD version of it either. The screen nor the recording can completely and accurately preconceive nor time the baby’s reaction of responses. The baby is more securely attached because of its sensitivity to its mother’s affective gestural and intonation responses. The baby’s brain becomes more efficiently organized due to its secure attachment and Mom’s timely responses based on the baby’s reactions. In Music Therapy, “the ability to interact without preparation or a script with another aids in helping to solve societal issues, global issues, make the unattractive beautiful and sought after, and turn the uninteresting into something intriguing and thought-provoking” (http://backmountainmusictherapy.com/2013/09/play-imagination-and-critical-thinking/). “To take part and engage” (http://backmountainmusictherapy.com/2013/09/to-play-the-process-and-progress/). “The structure of the predictable repeated tune (game) holds his attention…”(http://backmountainmusictherapy.com/2013/09/first-words-through-play/) “On first appearances, structure and play often seem contrary to one another. However when they work together in partnership, they can foster some of our most healthy, innovative and creative moments… Time, repetition and continuity have provided safety and security.” (http://backmountainmusictherapy.com/2013/09/playing-freeing-the-mind-and-being-oneself/) “Full participation took only moments. When it was apparent that whatever each individual gave was OK, organization and softened attitude quickly appeared. (http://backmountainmusictherapy.com/2013/10/toplay-music-a-literal-phrase/) (see previous articles for supporting examples) Antoinette Morrison MT-BC
The best part about play is that there is no right or wrong way. Sometimes aid or assistance try to help by saying things like, “You were supposed to…”, but play is devoid of perfection. This means anyone can do it and it is all okay. This week, as the group of musically untrained emotionally unstable boys joined in the pulse with the instrument of their choice, each got a chance to be the “arranger.” This meant that when it was his turn, he could distribute and organize the instrumentation to whomever and however they wished. When the tune began, the kids were just allowed to play. Organization of guitar strums, voice, and drumming did not take long. All those stubborn boys claimed, as usual, “This is stupid.” Full participation took only moments. When it was apparent that whatever each individual gave was okay, organization and softened attitude quickly appeared. As the first boy was selected as arranger, I heard several voices asking for the same thing. I began to wonder if I should have organized this differently. Amazingly, the group, one that usually enjoys purposefully getting under each other’s skin, did their best to accommodate the wishes of their peers. They asked one another for their opinions, and interacted with respect and hope. All played together. Most everyone sang along, some danced, but most of all, they united for approximately 20 consecutive minutes of play. Some structure was provided, but in the absence of judgement. I was pleasantly surprised and my unsaid thoughts concerning the pulse and lack of judgement bringing everyone together were confirmed. (In this group, rules for behavior must be sustained.) Staff had said when they were done that this is the longest they have done anything together all year. Sometimes, when we don’t have to think so hard about what we are supposed to do, what we are supposed to do naturally and pleasantly evolves into a skill we never knew we had. To “play” music; a more literal phrase than we realized. Antoinette Morrison, MT-BC
This week, even the typically developing teens with whom I work demonstrated their very best through play. Their up and down turbulence took a detour, but stayed on a path with direction. these teens did so freely, together, and when they were done were able to recognize their own accomplishments through their play. I think our biggest obstacle to accomplishment is often our own critical minds. Music helps us to take a detour, forget for a while, and de-clutter the fog that the critical mind creates. This week, while working with a group of teen boys who often set one another off in such a manner as the domino effect, play in music aided the boys to free their minds and be themselves. Poor impulse control, tempers, and the inability to ignore others turbulence pervades this group. On first appearances, structure and play often seem contrary to one another. However, when they work together in partnership, they can foster some of our most healthy, innovative, and creative moments. Every session opens with the tune “We’re Gonna Play.” The tune states: “Hey hey, hey hey. We’re gonna play, and what we play is all okay. Hey hey, hey hey. Come join our play, and what we play is always great!” From there, the group members are given the choice to contribute their own way to play and contribute to the group, not once, not twice, but three separate times. The group then follows the leading child’s play. All have the opportunity to choose to lead the play or not. The group looks forward to this opportunity to create each week. This repetitive structure holds the group together. This structure and openness are welcoming, secure, or inviting. Transitioning in and out of the group from one activity to another is always difficult for these boys. This week, the teens had an opportunity to play guitars, which held the status of gold in this group. Because of the way members in this group tend to lose control, guitars can only be used when members are demonstrating gentle touches (on the instruments) and self-control. This week we played “I Love Rock and Roll.” Before gaining a drum, body percussion was the instrument of demonstration. Stomp stomp clap was the beat played. As I watched one boy doing his best to resist anothers invading behaviors, I quietly told him “Great job!” I sat him next to myself with a guitar and told him I needed his help. The invading behaviors were, as intended, starting to affect others in the group. I quickly said,”Okay, strum ,strum, tap,” and continued to sing the chorus. One by one, this caught the others until all but one member was invited to play guitar. I watched the boy who was initially asked to play the guitar lose himself in his playing, moving as if he was on stage. Quietly and in unison, each member retreated to the same freedom while simultaneously staying connected to the group and maintaining positive controlled behaviors. No critical thinking was occurring. No one was being “dorky” or “uncool” in others’ eyes. They all played together except the one child. If there had been more time to the session, the individual who did not gain the guitar would possibly have lowered his defenses and allowed himself to join the group. Time, repetition, and continuity have provided safety and security to this group. I believe more time would have been they key. Although the non-participator was not actively playing, he remained in the group and was not attempting to distract or disrupt the group. He only watched and listened. At the end of the session, he complained that he did not get a guitar, which was met with his option of choosing. Attending quietly without disrupting was a way of testing the safety ( he is also a newer member to this group). The inviting group pulse, the strumming guitars, and the opportunity to play with peers overrode the inner turbulence and allowed the group to focus and play together. When the group was finished, the first boy who was asked to play guitar went proudly to the other staff, telling how he ignored poor behavior (a recent direction often heard previously by staff). He played with the group and succeeded in a difficult goal. He left feeling successful in his own personal accomplishments. Others left still chanting the chorus lightly to themselves, replaying the tune and the fun in their heads. Antoinette Morrison, MT-BC
The boy is now more motivated than ever. The structure of the predictable repeated tune holds his attention as he sees what else HE can do with it. Now his attention to the world around him absorbs him. There is a need or him to be heard. Over time, the boy begins pointing adamantly, as if to say “This one, I want this! See that one, do you see?” Now there are decisions to be made. Choices to attend to. How does he get people to listen? As the music continues, the assistant follows the boy’s pointing. However, at times the assistant is not able to discern what the boy wants. The pointing is too vague, leaving both the assistant and the boy slightly frustrated and wanting more. The silent boy is now motivated to get more. He makes sound to get the assistant’s attention. The tone he vocalizes on is the same one that the music-maker sings at the beginning of each reflected phrase of the boy’s song. The music-maker matches that tone, doing her best to name what he points at. This is even more intriguing to the boy. The more the boy needs this sound to help him, the more he plays with the sound. Now when “ah” is not working or his enthusiastic energy is permeating, he begins to play with “ah” to see what else he can get. “Duh duh duh duh duh” happens often. Again seeking the attack reverberation of striking a drum still slightly frustrated, he moved to the mirror, held a toy up in the air. As he holds it, the music-maker still matching his tone, sings “A-L-L-L (til the toys drops) DONE!” The boy looks to the music-maker, very pleased. He repeats this over and over, intently listening to how that sound is made. Over and over he repeats this process. Now he looks to the music-maker as he holds up the toy, anticipating the words. Each time his mouth opens, he forms the “ah,” but no sound yet. Repeatedly he listens to “ALL DONE!” as he opens his mouth. Finally he says his first word as he holds the toy up. The music-maker sings “ALL -” and as he drops it, he says “done” himself! Antoinette Morrison, MT-BC
Play is literally defined as “without seriousness, to take part or engage in a game” (dictionary.com), the operative phrase being “to take part or engage.” When an unstructured 2 or 3-year-old enters the Music Therapy room with no direction and wanders from thing to thing, moving about like a whirlwind, leaves behind a path of chaos and is not engaged in any form of curiosity or play, the therapist develops a simple tune with a basic beat, following the little boy’s movements. Within the next two sessions, she notices that the basic beat no longer coincides with the child’s behavior but instead its strength and inviting beat coincide with the child’s movements as he slows and begins to notice and play with toys all on his own. In the security of the structure and the rhythm’s irresistible lure. the child begins to make eye contact with the music-maker, listening to what she is going to do or sing as she partners with his pauses. Stopping to listen is not something this boy is accustomed to doing in his whirlwind of activity. This little guy loves the stability. He picks up some drumsticks, looks at the music-maker, and randomly hits the drum with his might and pleasure. To his surprise, it matches: the structure remains, yet follows him simultaneously. He continues to test this structure while also receiving pleasure from the mirrored reverberation of his impulsive strong strikes. Miraculously, no one jumps, no one yells, and no one corrects. The music-maker stays in her spot at the piano, continuing to provide structured, inviting boundaries. Over time, this testing continues until the inviting lure of the beat pulls these strong strikes in the direction of the pulse. As this is fun, inviting, strengthening, and secure, the little boy now joyously seems to beat the drum to the music-maker’s beat. He wants to test this again, so he tries a soft beat (nothing he had ever done in such a controlled, purposeful manner before). The pulse continues: structure and mirroring continue. In between drumbeats, he goes to the toybox and listens as the music-maker sings his name. As he walks over to the assistant to hand over the toy, he pauses and listens for what the music-maker will name it. The curiosity of this game innately propels this listening game to 10 minutes of his attention, then 20 minutes of his attention. These sounds are intriguing. He goes to the music-maker’s black box and pounces with his fingers. Amazing, it still fits that pulsating structure. Over a couple meetings, he gets it. he comes over to the black box and presses one white rectangle after another. He whisks a look of pride at the assistant. If he could, he would say, “Did you see that? Did you hear that? I played that.” Then he claps in self-fulfillment. Now let’s try organizing these rectangles. He plays one after another, going up and then coming down, whisking another glance at the assistant. This play is sooo much fun! Antoinette Morrison, MT-BC
Currently, in most academic fields with young children, the emphasis on “academics” has increased. It is a very good thing that we can now see the capabilities of very young children and can begin when a child is young with the right approach to point a lifetime attitude towards learning into a much more positive one. However, the downside is that sometimes there is an over-emphasis on only the academics and a de-emphasis on play. When academics and play are combined, the results are positive, engaging, amazing, and lifelong. Why is play so important? First, the playful approach using music, results in attentiveness, and the loss of a critiquing mind that inhibits the child and his or her relational interactions. Play uses the imagination, the ability to visualize future possibilities, and the implementation of those possibilities before they happen. At an elementary stage, with haunting “No Child Left Behind” standards, play is almost considered silly and a waste of time, I’m afraid. However, this ability at higher level high school academics is valued, only renamed “critical thinking”. This form of play, the ability to imagine the future and foresee it step by step, “critical thinking” is so highly esteemed that it is a skill tested and considered when looking at candidates for collage. The ability to hear what comes next, to instantaneously perceive what has not yet come: “play” is renamed. The ability to interact without preparation or a script with another aids in helping to solve social issues, global issues, make the unattractive beautiful and sought after, and turn the uninteresting into something intriguing and thought provoking. The best part of this critical thinking is that it spontaneously involves from within. It evolves from the unstressed, enjoyable, innate curiosity. It is amazing to think this could evolve from the ability to hear the tune “Twinkle Twinkle Little Star” in one’s head and configure black and white rectangles in a sequence so the auditory result is “Twinkle Twinkle Little Star.” This is the importance of play, imagination, and critical thinking. More examples will be in the next blog of how this process works. Antoinette Morrison, MT-BC
My kids grew up on the phrase “Freedom and responsibility go hand in hand.” Throughout their teen years, they probably heard this more than they cared to. It was a great measure for me when it came to decisions of “Should I let them do this, should I give them money for that, or should I say no this time?” What were they doing currently and how are they already responsible for this? There is no hard and fast rulebook for this either. It is individualized. What can this teen do? What does this teen need? How do certain leisure activities support a need? I think well-functioning sensory integration looks a little like this. Which sensory areas need attention, or maybe a sensory area needs more when x happens, can be left alone when y is a factor, or needs something entirely different when z happens? Sensory integration is another very individualized plan of action. When music is part of the “plan of action” for sensory integration, music can be a catalyst. What comes form within is usually more effective than something imposed from outside. Music mirrors a child’s reactions and behaviors, helps a child that is not integrated find or know where or what home is (awareness). Music that mirrors a child with a stable rhythm provides a sensory orientated structure, stability, and predictability, helping a child to integrate possible maladaptive behaviors end in unpredictable environment at least into something understandable (trust in self, trust int he world around them). Once that awareness and trust is established, a child may then begin to reach out and test or possibly join the world momentarily. The child who randomly and rapidly wanders the room, picking up and throwing down items, may begin to wander slowly back and forth, touching the symbol or piano, looking at the singer to hear the last sound of the phrase The child who stares blankly into space begins to look or lean towards the music source, displaying not only awareness but interest The silent child lets out a soft sigh at the end of a phrase. The music is not just something happening around him, but something he is aware of and connected to. Musically, at this level, rhythm provides the stable, repetitive, predictable “responsibility.” The child’s actions are the freedom. When they begin to interact together, things begin to make sense and are a starting point for more organization and mature development. Antoinette Morrison, MT-BC
I was talking with my teenage daughter this week as she had just finishing purchasing a purse that she bidded on on ebay. As she was excitedly reflecting, I said to her “You know what is fun when you order on line? Waiting for it to come.” She said excitedly, “I love to wait – it was so much fun waiting to go to the beach last week.” As I have recently began working with children under three, I have noticed that it is much easier to track and note development if you can find several areas of need that may feed the most obvious need. Each week, although working towards the main goal, the most obvious progress is quite often in other areas of development feeding that main need. Sometimes in areas I had never noticed or thought of, I have a couple young children whose main area of need is some type of language / speech development. But with these very young children, it seems like building towards that goal is like taking a pyramid on a revolving plate, and each week hammering on a different wall progressively step by step upwards. Some weeks there is little speech put out (or minimally to meet the objective). However, the child’s intense focus on a fine motor, eye contact, attentiveness, gross motor skill, etc. is incredible. Ironically, as I was working with a little guy on getting through to the other side, his speech was not coming forth as quickly as the emotion to do so was calling. The ability for that language was there, but not the speed for the need. Therefore, there was frustrated crying as he tried to put something together that we just could not understand. As the parent and I tried to help, we could not understand completely what he wanted. Amazingly, after about ten minutes of frustratedly trying, this little guy (who six months before hated cleaning up his toys and had very little understandable speech) began to put everything he was using back in the box and asked for my guitar. After wiping his own tears with a tissue, he began to strum string by string gently as a I mirrored his playing on the piano. He looked up at me a few times smiling and repeatedly whispered “wow, wow.” He calmed himself and we went on to the next thing. As we finished the session, he began to step outside the room. The parent and I discussed a few things. The little guy stepped back inside, looked for temporary entertainment and occasionally looked at the parent to see if the parent was ready to leave. Eventually, through the little guy’s extreme frustration, the much needed verbal expression for help was released without any prompting. This was good to know; however, we were unsure of what kind of help. The most important part of the session demonstrated was the ability to self regulate completely SELF regulate. It seems to me that when we say self regulate, what we are usually looking for is the child following through with a direction we have given. This also is a legitimate skill. However, I wonder how many typically developing children, teens, or even adults feeling that amount of frustration are able to take that level of frustration in their own hands and find a healthy outlet to help them self regulate their own emotions. When my daughter said “I love to wait”, the first thing I thought of was that boy waiting patiently for his parent. I can personally attest that after having three typically developing children and having worked in an elementary school with only typically developing children, that I can name multiple scenes of the opposite. I am having difficulty recalling similar scenes of patience. We rarely measure this by benchmarks, standards, or developmental milestones. But how significant not only to our own emotional and social development but to societies development as a whole. Truly in the day of road rage and addiction, genuine self regulation of emotions and the ability to wait are lost arts. Okay, but how did the Music Therapy assist in this? Let me explain. First, the repetitive mirrored little tune for this little boy provides not only the structured reliable safety and stability (a musical phrase – structure over time), but by it’s repetitive nature, something he can count on and predict. This phrase also mirrors musically back to him his interests and behavior. It is composed by the pitches he makes, the arc of movements he demonstrates, and the timing of his activity level. It’s structured repetitive sense allows his actions to fit into a structure. This structure gives his own movements and actions time ordered direction and eventually purpose. The pitches and vocabulary of his tune are reflected in the sounds he makes, things he is interested in, and are narrative of all he does. This allows him to hear, understand, process, and then fit his actions to the music and also use the words. Through the repetitive and predictable nature of the music, he gains the ability to attend, choose his actions, and use vocabulary to express his wants and needs. As the frustration and anxiety lowers, relationship and confidence increases as does attentiveness. When frustration does occur, there is an outlet Now he has some language to use. When frustration occurs that language cannot express yet, he has learned to use methods that are familiar and safe to help him to relax and lower emotional turbulence and find self regulatory calm. Self regulation and the ability to …. wait, a lost art.
Most all the time the clients that come to my studio are excited to come, smiling as they enter, and often run down the hallway to the Music Therapy room. I like the facilitation of development to occur naturally, unstressed, and to flow ahead. However, there are times whens smiling, excited faces don’t happen, when there is crying and anger. As unpleasant as these emotions may seem, they can be as healthy and beneficial in the therapy as the prior emotions. It is not unusual when I work with nonverbal children that when understanding and communication begin, there is not yet enough to satiate the desire to be specific, and frustration occurs. Of course, more gains take time, and sometimes the frustration of not being able to fuels the progress. However, on the way to gaining more the desire is there, but there is not enough skill, and frustration and tantrums occur because others aren’t “getting it.” The frustration is due to the gains that have been made and the desire for more that has not come quick enough. Development is still occurring in the proper direction. Every now and then with more verbal clients, I have seen something a little different in their behavior, or sometimes nothing at all, and although I am not looking for or trying to get at any deep issues, they spring forth. Most often they are not happy issues, but are issues that have been suppressed for one reason or another. Of course, if the emotion behind it is negative, so is the behavior that follows. Why is this healthy? Usually, the aim of the session is to free the individual to initiate, take a leadership role, free creativity, or handicap inhibitions. In order to gain the freedom, sometimes one has to let go of what holds one back. Facing negative emotions and letting them go, although the result is freedom, can be a difficult or unpleasant process. It is good and healthy for these emotions and issues to occur in a trusting relationship. The therapeutic relationship provides space, safety, and facilitates a healthy direction to unpleasant situations. The music in these cases often aids in bringing the issues forward in a healthy release or paves a pathway for discussion of emotions or issues, or sometimes possibly finding new ways to deal with issues. It is important, therefore, to go through it, to get to the other side, to not stop when the faces are not smiling for the moment. Go through the situation to find a smiling expression that is fully free. Antoinette Morrison, MT-BC
Sometimes part of the process of helping a child progress is validating that they are okay right where they are presently, even though where they are may be seen by statistics, norms, or by others as below the bar. Sometimes a child that hugs the safety of the known needs a little nudging. Other times, a child does not yet have all he or she needs to be “there” yet. Where he is is fine for now. This week the little boy who recently turned three, originally diagnosed with speech delay then changed to autism, came to Music Therapy. We tried having his sessions with just him and myself. However, this was too stressful to him. I discovered just having his parents in the room did not interfere with the therapy nor the relationship, but gave him the safety to relax and play. He could check back with his parents momentarily or demonstrate new developments that he was proud of, eliciting their pride and joy. Afterwards, he would come back and continue his play. As his speech and development playfully made fastidious gains, I decided this was working. Carol Stock Kranowitz states in her book “The Out of Sync Child” “a close physical attachment to one or two primary caregivers sets the stage for all future relationships… Building on the primary mother child bond we begin to reach out to others gladly and comfortably… When we enjoy being near people, we learn how to play, one of the unique characteristics of being human. Thus it becomes possible to develop meaningful relationships.” As the music accompanied the little boy’s movement, from one thing to the next, the constancy of the rhythm and tune aided the little boy in the ability to slow down, investigate the objects, then begin playing. As I narrated all he did and saw in song, his language began to explode. Still with a parent in the room, just ending our sixth month of therapy, the little boy came in to the room this day calling his father over to the NEWLY discovered trains. He wanted help putting the tracks together. He never asks for help, only gestures and calls his parent’s name. I sang “help me, help me, help me put the tracks together” behind his play. He began to use the words himself. I then began to name the color of the trains he chose (in song) until he began to answer the question himself. Gradually, he became more interested in his pretend, moved closer to the piano with his trains, and his father went to the other side of the room. He sat on the floor next to me playing and contently answering questions. I stopped playing for a moment, and he looked up at me and said “play” so I continued, he and I until the end of the session, with his father safely inside the door on the other side of the room. His need for a parent, language, play, and imagination were all nurtured and validated through the music. As his needs and interests of where he was was validated, it gave him the security and confidence to begin, not completely without a parent, but enough to seek out what he wanted from another adult himself. No, Dad did not leave the room today, nor did this little guy follow the adult direction to “do” something. He did however, initiate moving to the adult who had what he needed. He did find and begin to develop his own interest and play and most of all he listened – isn’t that what he needs most? Antoinette Morrison MT-BC
Last week’s example of validating through music is vastly different from this week’s. Last week, validation was done at a sensory level, where that child is presently. This week’s examples are initially made at verbal, cognitive, and emotional levels, backed up and made more alive through music. In working with a group of performing teens, all with their own unique needs, the eldest in the group and the newest member has the least security in the group. The group has functioned together weekly for many years. Each member has his or her own strengths which are utilized in a leadership fashion. These strengths are then supported by the rest of the group musically. The newest member has not yet found his leadership role and is trying very hard to find his place. He points out others’ mistakes, corrects, or engages in persistent arguing. His efforts often appear bossy or controlling and are the negative attempts he utilizes. He has not yet learned where or how to fit in and is trying methods with which he is familiar. This is a tricky group. They are all high-functioning and not at all strangers to one another. Several are related. In order to avoid emotional fog created by early baggage and messy boundaries, the musical “playfulness” is essential. As the group was practicing some pre-composed tunes, this boy suggested we insert “oh” at the beginning of a certain phrase. It was musically and linguistically appropriate. I told him it was a great idea, and wrote it in to everyone’s music. His positive efforts will be replayed over and over as the group practices and performs. He was validated verbally, but will experience the results of positive efforts repeatedly. In another instance, a little five-year-old, a very verbal and imaginative boy, tends to work through issues he cannot fully comprehend due to his age through repeated pretend. In this case, music is used to accompany his pretend, giving a more vivid life to his imagination and also functioning as a container, helping him to slow down enough to fully process his thoughts. As the music began to reflect his pretend, the pull of the ostinato rhythm grabbed him as he began to rock side to side. The constancy of the rhythm helped him to slow down as he pretended and beat a drum. The drumsticks turned into a conductor’s baton. His talking ceased for a bit as his facial expressions portrayed a still vivid functioning imagination while conducting. He began to slow his rocking and then again turned to verbal pretending at a slower rate. Six months ago an older relative of his was taken to a nursing home and passed away. Although this little boy was equipped with the age appropriate facts of what happened, fully comprehending this was not only difficult but a little scary. As the rhythm remained steady and accompanied his play, the music not only enlivened his play but also allowed him to gain better motor control enabling him to process and ask questions. The music resumed as the boy was able to make sense of what happened at his own level. He then, for the first time ever joined the therapist at the piano. The two slowed together as the music ended and the session closed. Antoinette Morrison MT-BC
I recently read an article by Southeast Psych entitled “Verbally Validate to Help Kids Manage Their Emotions” (http://blog.southeastpsych.com/?p=5001) which made me think, “Wow, We do that on a regular basis at a very deep level, which goes beyond words in music.” If one were to make a generalized slice through the brain, and generalized it from the outer brain to the inner brain, the outer brain, the neocortex (http://www.ted.com/talks/simon_sinek_how_great_leaders_inspire_action.html?source=facebook#.UeqN_eKrVAZ.facebook) is responsible for a more formalized language and analytical and rational thinking. However, the limbic brain is responsible for our feelings, behavior, and our instinctual abilities. This is also where our decisions are made. No lingual thinking happens here. When we begin using music to validate, we always start where our client is. Although some of our clients might present significant delays, they still have an outer and inner brain. This week’s example of validating through music begins like this. Little “Mary” is a six-year-old girl with global delays. Her chromosomal diagnosis leaves her unable to ambulate on her own, talk, hear, or provide much sound. She is able to feed herself. After little “Mary” came in, the hello song began. She looked at the therapist and began to clap (emotion that was pretty significant for her 6 months ago). The therapist matched the bass ostinato to her clapping. She demonstrated her excitement of this validation through faster clapping, better posture, smiling, and quick leg and foot movements matching the rhythm of the bass ostinato. She smiled as she watched the therapist sing. Soon she began to bang at the piano to match the exuberant music (just 4 short months ago we were hoping for some sound as her motivated but weak fine motor skill attempts were made to push the piano keys). As she was consumed by emotion and movement of the music, she began to isolate fingers to play with delicacy. The therapist immediately gave her the musical space to do so, to be heard as the therapist adjusted the mood and dynamics of the mood to soft and delicate. As “Mary’s” fingers and arms tired, she resumed her clapping. The therapist sang the tune reflectively about “Mary’s” actions. “Mary” watched the therapist with a glowing smile and then did as the therapist initiated the prior week. “Mary” put her hands to the therapist’s throat to feel the sound. Her intense, thoughtful gaze portrayed acute concentration. She again looked to the therapist’s eyes, smiled, and began to vocalize to her best ability tot he tune, following the melodic step-wise motion of the music. This went on for some time. Again, “Mary” resumed her clapping. Now intently listening more than ever, she grabbed the therapist’s hands for the therapist to clap. The therapist continued the simultaneous clapping and singing as she once again saw “Mary’s” intensely concentrated look. Matching sound, vibration, and rhythm seemed to be the theme for the day. The therapist wanted to give more to the eager child, so she pulled out a hand drum and a mallet, and instead of clapping, produced slightly more concentrated vibrations. Immediately, “Mary” put her palms to the drum. The therapist had been trying for months to get “Mary” to grab the drumstick and hit just two times. Today, “Mary” grabbed the stick on her own and began to beat where the therapist left off. The therapist supported “Mary’s” arm so that Mary could achieve the same concentrated vibration. As she played repeatedly and her arm tired, the therapist got a new idea. She pulled out a cymbal, continued singing, and put “Mary’s” palms on the cymbal. When the music paused, “Mary” would giggle with delight, and fueled by her emotions, began to happily squeal. This time the therapist tried her feet. As the therapist reached for “Mary’s” feet, “Mary” curled them back (a reportedly typical response). However, once “Mary” felt the vibration through her feet, she put her feet back on her own with certainty. Again at the pause, more giggles. As the halfway point of the session passed, the therapist put “Mary” on the therapy ball, stomach down, face against the ball. The therapist bounced “Mary” to the beat as she continued to sing into the ball as she continued to sing into the ball, her voice amplified by the ball to “Mary”. The session slowed as the tired little girl, smiling, began to rub her eyes. The music had spoken to her, with her, and was received by her in a way she could comprehend best. “Mary” responded with exuberance, and although tired, left heard and being heard, smiling. Antoinette Morrison, MT-BC
I have been asked a few times “Yes, but do they (my clients) carry that (progress) outside the music room?” Sometimes, especially now that I have a private practice and contracted jobs where I don’t spend a lot of time in the facility, I only see what happens in the Music Therapy room, although I see the regular documented progress. Sometimes I do not realize the impact outside the Music Therapy room until it is reported back to me. I think the reason for this is the process orientation, responding in the here and now, moment to moment to music. Ironically, this, it seems to me, is what brings a client along without stress, with ease, and moves them from the immovable to new stages of development. This is also the source of the lack of funding. Because I am a Music Therapist, when it came to my music and my kids when they were young, the musical approach was the same. I instructed only the very basics, but spent more time “playing” music with them. It was always a special, quiet time with them. It was relaxed and enjoyable. However, the minimal instruction always left guilt. With the years of my musical training, maybe I should have instructed more. Two weeks ago, my husband and I went to watch my oldest son’s college band. All the members except one were engineering students, and from what my son has told me, most of them had similar childhood musical experiences. Most of them were in youth choirs and had a parent who was an active musician. As I watched these young men play, with each one of them, what went on outside the music-making was left unaware. My son’s drumsticks moved so quickly that they looked like pages turning, yet his body was completely relaxed, as his legs, arms, shoulders, and torso moved in contentment to the beat. As the group finished, an audience member made a comment to my son about how playing like that was as easy as trying to brush your teeth with your hands behind your back, but it looked like so much fun! As I watched these young men get up and switch instruments around, I wondered who else danced around the kitchen with their parents as toddlers. Which of these young men were once little boys that just “played” and danced to the music as children? I watched the effortless, comfortable, relaxed, and keen focus of these young men as they played. Did all this begin as a seed of the ease in play of responding and relating with musical play? This was the fruit of the tiny seed that had been planted and nurtured simply by responding. It has its own life now. That same week, a client whose attendance has been irregular due to hospitalizations had come with his mother. We recently had just gotten back to a scheduled time after a lengthy hospital visit. I had been shocked when the mom told me how others outside her family, community members, had commented to her on his recent noticeable speech progress. I was shocked that just within a couple weeks of the schedule, the progress was that noticeable. Music does not convey a specific idea as words do. However, it can reach a much deeper place inside each of us. When we are given an opportunity to respond to that moment, all we need to do is be attentive to it. The results can last a lifetime, change a life, or grow a life of its own. Antoinette Morrison MT-BC
This is a true story. As I discussed this situation, I thought immediately that I should be writing this down. I have a young adult client named TJ. I also have an old guitar in my studio. I’m not exactly sure where it came from, probably a relative whose attic needed cleaning. I took the nearly useless guitar, thinking that even if I couldn’t use it (which I thought I probably could) as something that could take a beating, I would utilize it as a wall decoration. It was missing the bridge, and after I re-glued the bottom and a crack in the body, I asked my son to restring and re-engineer it, telling him know not to sink much time or money into this. After all, its best possibilities were wall decoration or an item to pluck or strum for fine motor work. There was little hope for sound. After my son engineered it to functioning ability (for fine motor work ONLY), the strings vibrated so much that no string had an actual tone. They all just rumbled, although it did go well with my decor. My client TJ has learned to enjoy trying new things and often scans my room for any new instrument to explore. His exploring is true musical exploring, not a childish whim. One day, possibly a little frustrated at the lack of new instruments, he asked for the guitar on the wall. I have plenty of guitars for him, from acoustics to electrics to acoustic-electrics, not to mention the same variation of basses. I handed TJ the guitar, warning him about the sound. After he strummed it once, I tried tuning it to see if this might possibly help. Tuning this guitar was more like a “general approximation” of a pitch. That day, TJ began to refer to that guitar as “Grumpy Guitar.” Since then, TJ has asked for the guitar just a couple of times. Each time, it was “tuned” first and played briefly. The only time it was ever heard was at TJ’s request. This week, TJ asked again. I went through the same routine of “tuning.” The 4th string gave me some trouble. I waited for the string to fly off as I used all my strength to turn the knob ever so slightly. Surprisingly, each string tuned to the note. It wasn’t perfect, but for the first time I could play chords of the Grumpy Guitar. TJ repeatedly said to me, “But why, Mrs. Morris?” as he constantly refers to me. ‘Why is it working now?” I replied, “TJ, I guess it just needed someone to allow it to sing a little.” The guitar felt a little better each time. I told TJ that the Grumpy Guitar could now sing, thanks to him for giving the Grumpy Guitar a chance. TJ still insisted repeatedly that it could use a coat of paint. Antoinette Morrison, MT-BC
Brace yourself: the floodgates of my frustration have been opened today. Last week, I talked about giving processing time: giving time, not a recent societal norm. In the area in which I reside, it appears to me that change is not only not a societal norm, but any attempt to try is met with my favorite display of intelligence (please excuse my sarcasm), “Why would we do it that way? We’ve done it this way for thirty years!, or, “I’ve been teaching this way for thirty years!” There is conformity and a great amount of grounding in routine. However, when routine becomes the only way after so long, we become stuck. Routine is then a stagnant atrophy. One excellent example and reason for change is obvious in the recent developments in brain plasticity. This recent exploding research has been opening many new doors for those struck with what some consider learning disabilities, various brain trauma, or degenerative diseases. This research indicates that using some creative thinking, we can find different routes to the same location. We can engineer old strengths and create new ones! We can utilize pathways and areas of the brain that once functioned one way, and create a new different way, allowing inhibited or lost skills to flourish differently. The research in development and rehabilitation show us that these possibilities exist. Instead of frustration and closed doors, we can be creative and try new ones. Re-purpose with good chances of success! However, we need to allow time to be a player in the equation, which may be a difficulty for some. We have to magnify what looks small on a general scale, but what is tremendous on an individual one. Use something a client already has and build on it, or re-purpose the function. For example, when nonverbal children have a need to mouth objects in Music Therapy, I replace the object with a recorder. This accomplishes two purposes: it feeds the sensory need without frustrating the child, and it gives purpose and function to that need. the child can now learn or begin to learn how to control those oral muscles in order to make a sound so they may continue the enjoyable musical interplay. Thirty, fifty, or a hundred years of experience cannot only be extremely useful, but some of the best resources we have, IF the experience is accompanied by openness and willingness to learn more. The picture in this newsletter is another example. My 150 year old small grand that I have had longer than I have had my kids and has moved with my husband and I 9 times has ended its days and had to be replaced. Few items hold sentimental value for me, but this instrument followed us everywhere. Its means for being had become permanently inhibited. It had been the main instrument in aiding my clients’ development. Remaining open, it is still part of my life and my clients’. It holds their past (their written records) and resources for future development (books and props). Antoinette Morrison, MT-BC
Unfortunately, without machines there is no scientific way of measuring processing, at least not that I know of. We have to use our own human observance skills and become familiar with the signs. It is most definitely the space between the notes; unseen, unheard movement forward. It is a little bit like when you know someone well enough and you can see by their facial expression, their posture, their eyes, and their movements that something is wrong, even though they do not say so. I have become fairly well-adept at being able to identify when processing is occurring in most of my clients. It is almost always a period of very little demonstrated progress. It is usually a quieter time. However, by knowing my clients and watching their facial expressions, movements, and eyes, I can usually identify what’s going on. The confirmation comes out at the end when something new evolves. In fact, with my youngest clients, who have a few objectives that they are working on simultaneously, some months they will demonstrate progress or attention to one or possibly two areas first, and then switch to another area of need. Processing occurs, followed by the finale of a new overall developmental skill. We then begin the process all over again at a new level. In our society today, we put very little emphasis on processing and almost view it as wasted time. This appears to be because nothing apparent seems to be happening. No demonstration of development, no producing. However, without processing, we only produce confused chaos. Without the space between the notes, movement is stagnant, confused, and undeveloped. All we have without the space is one large cluster of notes. The space between the notes is visible on paper and heard with slightly more acuity. Processing is much less obvious and much harder to measure, yet processing can end up producing the best results afterward. My example happened very recently. It was my very last session, in fact, before writing this. This time, however, my processing visibility was very low. I was working with a little 6-year-old girl with Duplication Three Q Syndrome (a rare genetic condition caused by having an extra part of one of the body’s 46 chromosomes). The syndrome leaves globally severe developmental delay. Along with her delays, she has metopic hypostasis, ventricular septal defect, and suspected bilateral hearing loss. The little girl is now sitting up on her own and is beginning to walk with supported assistance. At this last session, it started as usual with her usual exuberance at playing the chimes. This exuberance remained a while, and then began to slowly fade. Next, I put her under the piano where she usually rejuvenates again as she attends to and absorbs the vibrations. However, this day I was seeing little change in her energy level. I tried changing up the music and attempted to send it in different directions of development. She began to clap in order to direct the timing of the chord changes in the music (previously an objective, bringing her hands to midline). This time I set out three drums around her. She took the clapping to the drums for the first time. However, the energy level was still declining downward. Although it has been reported to me that she often babbles and vocalizes at home, she does so rarely in Music Therapy. On the rare occasion when she does, we play a game where she vocalizes a short “a” and I reflectively sing and play the pitch back to her. Usually she is too busy listening to the music to vocalize. You may ask, “How is a girl with severe hearing loss ‘listening’ ?” Well, if listening is our brains’ organizing and making sense of sound vibrations, then she is listening. This is demonstrated as she sits under the piano and visually tracks the up and down movement of the tune. It is also apparent in her responsive actions to the music. However, this day, as I began to see sleepy eyes, I thought it was time to play “Goodbye”. Now, I have seen this little girl get tired before, and she usually tries to fight it. But today it was different. I thought I was not reaching her like usual. As I began to play “Goodbye”, she began her vocal game, having me match pitch. Pretty soon, “aa” turned into “by, by.” I didn’t know if this was accidental. Her hands were down by her sides and I could not see them, but her grandmother could. She told me that her fingers are wiggling; she was waving goodbye. Antoinette Morrison MT-BC
This was a very hectic week, with many cancellations and rescheduling of appointments due to Memorial Day, Baccalaureate Mass, graduation, state volleyball playoffs, and an elementary school fire. In the middle of the week, I began to think about what I was going to write about for this blog. I wasn’t even sure what day it was! Towards the end of the week, I got a text from a parent of a nonverbal client stating, ” ‘Josh’ was watching Madagascar 3 and there was a girl singing in French. ‘Josh’ is singing along with it!” “Josh” and I have been working on producing vowel and consonant sounds with fairly good success. It is carrying over well. Without the music, he is able to point to items and frequently say the vowel or beginning consonant sound. I have heard pop-out words over the years, but now “Josh” is able to consciously produce portions of words. My reply to the text, “Wow! Amazing! Hope this means I don’t have to learn the French alphabet.” What is my point? Did I plan, or ever have any idea about the French? Certainly not. I don’t know anything about French. Is it immediately functional, useful? No, he is not in France. No one speaks French in his surroundings, at least not to my knowledge. So why mention this? It is a strength. It demonstrates that this previously silent boy can hear and produce meaningful sounds. It proves there is motivation to do so (especially when accompanied by music). Is this a case of anything goes? Yes, it is. Anything the boy can give and develop is another puzzle piece to take beyond to the next step. is this little guy following steps in a procedure? Yes. He is following his steps and is making progress. It is my job to fit those puzzle pieces into the pattern and help him to put them together in a logical order. Do I know exactly what I will get? No, but I know the direction in which we’re going, and I can see that each piece given is a step in that direction. Why else mention this detail? When we expect these children, who process the world differently than typically developing children do, to demonstrate that they can do these things in the same order as their typically developing peers, we set them up for failure. We say, ” No, they can’t do it. They don’t know it.” Who is it exactly that does not know, does not understand? Do those of us with typically developing children know where it is all going, where its leading? As a mother of three, two of whom have graduated from high school, I can say the path is similar. The puzzle pieces through toddler, elementary, and high school years do not all by themselves make much sense. When all the pieces are put in a timeline, they make perfect sense. The same can be said concerning a piece of music. If one takes a single note at a time, can we see or hear where it is going? No, it all has to come together. It needs to go in a direction. For example, the church choir I play for sometimes really dislikes what they hear, especially when they stop and listen to two parts that have adjacent notes. They do not like the clash they hear. Notes are a part of a chord, a chord part of a progression, leading to one of numerous phrases that make up the conversation we call the song. When they hear the piece in its entirety, up to tempo in context, all harmonies and chords working together to give it its pleasant sweet sound, they then come to love the piece. Another example, when learning a beautiful tune that changed the meter from 3/4 to 4/4 and then back to 3/4, there was a great lack or clarity amongst the group. It appeared to them that the direction changed, but all they needed was to keep the pulse continuous in order to keep the flow of the conversation to secure clarity. However, when they group slowed the tempo and began to break it down to learn, they could not hear the pulse, the direction, the flow. In stopping the song in time, the story became confusing and erratic. They needed to hear the whole of it to feel on board again. The beauty that we are able to appreciate comes as the patterns are put together vertically and horizontally. The composition doesn’t make much sense until you hear it in logical sequential order. No two pieces, songs, or children are exactly alike, but they do make sense. Sometimes, when we look at the pieces, we need to be able to stand back and see the pattern to understand how the piece fits,. Music is a kaleidoscope of patterns, Our brains love patterns that repeat. Our brains are sometimes more flexible than our personalities. Within the musical framework, this nonverbal child’s brain was able to not only focus on or make sense of the sound, but then also learn how to put it together and produce it in a new way. Pitch, tempo, meter, individual sounds, and sentences, all put together in a new way, all within a musical context or framework, a kaleidoscope of patterns. Antoinette Morrison MT-BC
My off-the-cuff “Hip Hip Hooray” motif this week was an eye-opener for me. The three-year-old autistic client’s mother told me that never before had they gotten him to wave his hands in the air like that. That was not my intention, nor was it a need of which I was aware. I was simply keeping the little guy motivated and excited about what he was doing. As I repeated this “Hip Hip Hooray” motif after each spongy letter he pushed back into its spot in the puzzle, the initially poor fine motor skills quickened to get the letter back in so much that I had trouble fitting in all the words to the little tune to keep up with his pace. Once again, when it was time to clean up (a non-preferred task), as I sang “Hip Hip Hooray” after each item, the pace quickened. The little boy went up to the mirror with a great big smile and continued to praise himself until he left. When it comes to stickers and stars, they cannot compare or come anywhere close to intrinsic reward, nor do the effects remain like intrinsic reward (pride in one’s work). The next day, I thought I would reuse this free light-weight motivator with a four-year-old who suddenly showed an interest in writing letters (reportedly a boy who doesn’t ever engage in this sort of activity and hates coloring). After each letter that was written, another “Hip Hip Hooray” motif was sung. This led to forty straight minutes of the game with a little boy who initially started with fine motor skills as a need. Earlier in the week, when I was thinking of my topic for this blog, I remembered very early in my career a lesson I had learned quite unintentionally. There was a little boy with whom I worked who displayed developmental delays due to socioeconomic conditions. The boy was the last of four, all of which were in the same school for the same reasons. When an individual in this family was brought up in conversation, it was rare that someone was being praised. I was new and only worked with the youngest boy. His behaviors challenged me greatly from the start. By an act of pure will, I was bound and determined to find something positive in order to counteract the frustration I was feeling. Eventually, this boy became on of my most beloved clients whom I discovered had a wonderful sense of humor. After I had finally turned my own eyesight on and could see this, I truly enjoyed working with this little guy. His mother, who had never even been witnessed smiling and had barely ever spoken a word or shared anything at all with this school throughout the enrollment of her four children, seemed to also only see the negative with the little guy. When she came in, I came up to her and told her what a great little guy he was and how humorous he could be. There was no intention behind these comments at the time other then a release of my own joy from the work with this boy. What followed was the lesson that I retained: she smiled and looked at her own son with new eyes. This was visible for the rest of his stay at the school. “What if” (a phrase we should never outgrow) we came to parents and not only saw, but also presented to them their child’s best traits? Would learning be easier? Would frustration levels be erased? Would our working relationship with parent and child be something to look forward to, something delightful? Would the family’s home life be happier? Sometimes “what if” sounds childlike, new, or different: isn’t it at the very least worth consideration? Antoinette Morrison MT-BC
My last article was a little reflection on my own daughter and music, my gifts, and “my wish.” In my conversations in recent weeks with parents of clients, I wanted to write a little on professional dealings with parents. Last week, you got a glimpse of one of the “twinkles in my eye.” In conversations with parents, we must remember each child is the “twinkle” in each parents’ eye. Parents often begin the process knowing something is not quite right. Giving a name or a label answers the question and can be a starting point in a better direction, but may also be a point of plummeting devastation for shocked parents. A parent who does not have a child with autism, aspergers, or some other diagnosis has in most cases only ever heard the name of the diagnosis, if at all. The name, the diagnosis, often represents to a parent an unknown dark cave. In this day and progressive age (especially concerning recent developments in neurological brain processes and brain plasticity), I continue to be astonished at comments of professionals such as “your child will never…”, or comments on predictions of inability due to a score. These scores, based on abilities of typically developing children, will generally give a parent an idea of all of the things in which their child is deficient, how far behind their score puts them on that day, or a generalization of their abilities, all this due to a score based on something that they cannot yet DEMONSTRATE. There is nothing like taking a parent’s dream of possibilities, crumbling it up, throwing it down, and stomping on it. There is nothing like taking a child’s greatest strength, a loving parent, and ripping a path of determined possibilities, openness, and a will to progress, and yanking it away, unplugging life support. Teachers, doctors, and health professionals; we are not trained psychics. We cannot read futures. We make mistakes, we are better at somethings than others, tests do not tell all, and do not factor in a parent’s determination and spirit. Is it possible that the lack of development in children prior to the one we are discussing has been limited by our own narrowness and our own skills and lack of will, education, or willingness to try new ways? It happens all the time with typically developing children. Parents need to have a name: a starting point, not an ending one. They need to hear, and we need to see the strengths their children do have. Then parents need a helpful direction in which to go to continue their child’s development in weaker areas. Parents need to see and hear that there is possibility. I wonder which is easier to say: “This is what your child can or can’t do”, or “this is what i can or cannot do for your child, this is the limit of my abilities.” To each parent, each child is their wish, their gift. To end the possibilities for a parent is to end the possibilities of a child. If we are in the profession of development, limiting a child to what they can do defeats the purpose of the profession. For a list of famous people with diagnoses who have done great things for society, check out http://www.disabled-world.com/artman/publish/article_0060.shtml. Antoinette Morrison, MT-BC
My sincere apologies to all my faithful subscribers, until recently, I have put out a newsletter weekly. I have acquired some new work and have two children graduating this year, which has required my presence at many different functions. In light of that fact, I thought I would give you a glimpse of how music functions in our family. This week, as I sat working, my daughter needed to use my computer and had an assignment to write. “Give a tittle of a song, and what that songs means to you; Here is what she wrote: As some of you may know, my mom is a music therapist so I am constantly hearing various genres of music all day long. She has a passion for music and shares her passion with my brothers and I. I listen to her sometimes decent music, while other times I have to put my own headphones on while she is listening to music that is suitable for her younger clients. Even though, we don’t always agree on what is “good music” I bite the bullet and listen to her music as she does for me I am not particularly the biggest fan of country, but the song “My Wish” really relates to my family. The lyrics stood out to us and were full of meaning at the point in our lives when this song was popular. At the time, the school I was going to since I was three years old closed, my brother was going to high school, and my mom was starting a new job. (at this point in our lives, I worked at the school my children attended) The lyrics state, “…if one door opens to another door closed I hope you keep on walkin’ ‘til you find the window” were extremely appropriate at the time. Even though I was upset, my window opened when I came to Saint Nick’s and met new friends and teachers. My brother’s window opened for the same reason. My mom’s window opened when she left her job as a preschool teacher and found her original passion of music therapy. The lyrics in this song remind people that everything happens for a reason. Even if it may seem bad at the beginning, things will get better. Sometimes things don’t go the way we want and we can’t find “the door” so we all have to look for the open window because it will always be there. We should all take chances and don’t regret them. This song also portrays the meaning of a family. My mom and dad want what is best for my brothers and I and the lyrics in this song clearly apply to how all parents feel about their children. I know my parents will support me in what I do and will be cheering me on at the finish line. Whether the load is great or small, a family will be there to help you through it all. We don’t always know what are children are picking up , verbal or not. A nice little reminder for me. I hope you don’t mind me sharing a glimpse of “My Wish” with you! http://www.youtube.com/watch?v=xz32I_GbpeU Antoinette Morrison MT-BC
When a child, or for that matter, an adult, devises an unhealthy or negative behavior and utilizes it to get what they think they want or gain control, what do we do? What happens afterward? What is the end result? First we have to know what it is that the child really wants. If we give what they claim they want to them, is it helping them to function better now AND later? For example, if a child cries because someone else gets the lollipop that he or she wants, if we give the lollipop to her, it is true that the crying may stop. Is that what we want? What happens the next time? She repeats the behavior. If this method has worked for her before and we don’t give it to her, what does she do? She cries louder and carries on more. If this has been a foolproof method for her, guess what? If you are the one who doesn’t give her the lollipop, she will have to escalate that behavior to full throttle should this go on. The question is, do you want the crying to stop immediately, or do you want to prevent the behavior from recurring? We all will answer the correct answer; however, what do we actually do? Are you able to not get that desired behavior that day? Maybe not. However, over time, with repeated “this method is not going to work,” “protocol,” the child will begin to deal or ask for what she needs. It is the professional’s job, in my opinion, to see it through. ignore the tantrum (safely), deny unwanted choices, and then help the child to make better ones. One method of doing this is to make the group work irresistible. When the child ceases his or her tantrums and participates, many times I say nothing. I allow the child to enjoy the healthy process. Then, at the end, I tell the child how glad I was that he or she decided to join us. I never try to coerce the child to join, remind the child of how much they are missing, or remind the child that it is going to be over soon. Believe me, children know this. Who are these comments really helping? In my opinion, when a child is repeating a behavior for long periods of time and staff or parents are doing all that they can to avoid the situations where the child might tantrum, this is only prolonging the inevitable. The negative behavior will never go away this way. As the adult in charge, it is time to set the limit, time to help the child change their method. Go through the process, do not avoid it. Even more important than eliminating the behavior, this helps to build trust and security in the child. This is what children need to continue to make healthy choices when the adults are not there. Children are not equipped to be in charge. it is up to the healthily functioning adults to set the limit, see it through, and oversee that behavior leads in a positive direction, even if that means dealing with the fallout of unhealthy functioning. When a child knows that adults will handle what the child is not equipped to, this builds a safe world for a child to be a child and builds steps towards healthy behavior and independent functioning. Antoinette Morrison MT-BC
Often those on the autism spectrum present behaviors which may seem odd, antisocial, or nonsensical to us. In order to help these individuals, the well-meaning urge for many to correct these behaviors comes to the forefront. Today I would like to delve slightly deeper into why correcting these behaviors instead of accepting and relating to them may be a mistake. We know that children on the spectrum have sensory integration difficulties, and therefore, perceive the world very differently. This thought is a key component to this conversation. Our perceptions ignite our opinions, our interests, our choices, and ultimately our behavior. Judging a child’s unusual choices of behavior can be a huge detriment to our work with these kids. Think about this. Our own perspective on others may be incorrect at times. Here is an example. Recently, a person our family sees weekly at church walked by my early-teenage daughter without speaking. Later, she confessed to my daughter that she did not recognize her and had assumed that she was someone else. The church member’s difficulty was a perception problem. Her perception of my daughter is a continuation of how she has known her as an elementary aged child. Although this person is a typically functioning adult, her thoughts on who she would see as my daughter overshadowed the person she actually saw. How many of us have worked or interacted with children? The interaction or work ceases for a period of time as we move on, and we run into that child a few years later. What we see is unbelievable and incomprehensible as to who this person is now because the image of the child we knew previously looks so different from the aged one we see presently. Our schema of the person is wrong, due to the fact that we perceive the child as we last remember them. Time has continued, and growth has occurred, but our perception remains the same. Since children on the spectrum cannot count on what they perceive to be reality, the ability to think abstractly is absent. if one cannot conceive what comes next because it is an abstract perception, then transitioning from one activity to the next may feel like stepping off a cliff. For example, this week, as I worked with a non-verbal autistic boy whom I have worked with a couple of years, he came to my studio. I had used my baby grand piano weekly with him. My piano needed to be replaced and was replaced by a much smaller digital with a different size and shape. For him, this change occurred between one session and the next. Baby grand, no baby grand. He came into the session and sat down. As I began to play the guitar, his usual request by gesture, he began to get sad. I was not sure what was wrong exactly, but he did not appear to be in pain. I went to the piano and reflected his sadness musically. His crying became deeper and more profound as he pounded his fists on his seat, but as we continued, he got to the other side of his crying and seemed to recover before the end of the session. The following session is a small group session, including another child and himself. We left the studio and invited the other child. As we walked back into the studio, he took me by the hand and led me to the piano to play, putting my hands on the keyboard. He was now demonstrating energy, enthusiasm, happiness, and eagerness. This was a completely different mood from the last session. Was he sad about this instrument that he could not recognize in its much smaller image, or was it something else? I may never know. This change of mood was certainly not a typical reaction for this little boy. When we honor a person’s behaviors, whether we understand them or not, and make the attempt to understand through their perspective, their way of functioning in the world, we open a door to a relationship where communication can occur. After all, is this not the main difficulty with autism? The first criteria for autism (as referred to by the DSM IV) “marked impairment in the use of nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures and gestures to REGULATE SOCIAL INTERACTION.” If we use these behaviors displayed as a way to get to know these children from their perspective, haven’t we already taken the first step to aid in forming social interaction, a relationship, a communication of “I hear you”? This may lay the groundwork for more back and forth interaction. Is this not the real difficulty in autism? If our systems allow us to regulate ourselves, aren’t we the ones responsible to allow a different way of being and attempt our best to negotiate a relationship and social interaction? How can a continuous flow of social interaction begin to affect the neuroplasticity of knowing what comes next or abstract thinking? Antoinette Morrison, MT-BC
I have written many articles on subjects such as developing children’s strengths http://backmountainmusictherapy.com/2013/03/the-amazing-power-of-building-on-a-childs-strength/ , achieving regulation, http://backmountainmusictherapy.com/2012/11/part-4-achieving-self-regulation/ , significance in an individual’s development http://backmountainmusictherapy.com/2012/04/recognizing-development-and-its-significance-in-each-individual/ , and sensory integration http://backmountainmusictherapy.com/2011/11/sensory-integration-meeting-the-need/ . On a day-to-day basis in my professional work, I have frequently been complimented on the degree of patience others have noticed. Most times, I truly have not felt like I was being patient. I think that if I were to take all these categories and boil them down to two ingredients that make all this possible, it would be asking why and honoring what an individual does give. Whether I am interacting or working with children on the spectrum, those with delays, or those with emotional or behavioral difficulties, I always automatically look at what they present and ask why. Why do they do this, what is it achieving for them, and why this method. What is it that the child really and truly desires, and ultimately hopes to achieve? For example, we have all heard “negative attention is better than no attention.” This is an easy fix: just find the positive and accentuate that. One time, I had a class of about 10 school aged children. A boy with aspergers, a little more academically talented than the rest, was continually interrupting, coming up with newer and better ways to do things. For some reason, this boy had a need to dominate by his continuous better ideas. This particular group of kids had to first achieve organization before going on to anything elaborate. Finally, I brought a small tablet and gave it to the boy. I told him that we had some things to do today, and if he had any good ideas to write them down and I would put aside some time at the end to hear them. That is what we did. The next class, I implemented his idea. I continued to bring the tablet, but the ideas eventually ceased and the boy participated with the group fully and politely. It seemed his need to be heard was validated appropriately and his need to dominate was replaced by being heard: his ideas honored. Sometimes we don’t have the complete why, but power struggles also happen for a reason. We may not know the reason, but want to avoid the struggle. For example, they young boy who comes in to Music Therapy and plainly says, “I’m not going to participate, I don’t like music,” has every right in the world, since it is not a required academic class. This boy has a right not to participate, just to behave appropriately. However, his statement feels more like bait to a power struggle. He tries not to participate some days and others he just can’t help but participate. What did he give? A simple question, “Could we use the animals again?”. The class had done a drumming story with animal puppets as props. The kids loved it. They used their imaginations and participated with ease and pleasure. I wrote his statement down so I wouldn’t forget it within the next ten minutes. I planned the next couple sessions to include the puppets and addressed him as soon as he came in. “N, guess what I remembered to bring today? The puppets”. He not only fully participated, but behaved better than anyone else. His desire and request was honored – he was heard. That was all that was needed. There was an elementary aged girl who every class had the need to correct and rule over all her male classmates. If she did not get what she wanted immediately, or if one of her classmates did or said something that she found irritating, she was out of there! The only exception to this was in the opening circle, which welcomes all and gives everyone a chance to express themselves in a call and response manner with the rest of the class in any creative way they want. This activity she would stay for. She presented a strength one time and asked if she could sing a song for the class. I agreed. Not only has she never left the class again, but she has also become pals with one of the classmates that irritated her most. Her need to take over and correct others has turned the corner into a partnership with her fellow classmates as each week they take turns sharing their musical talent as the rest of the class supports them musically in one way or another. There are also the children who do not communicate. What do they present for one to honor, and why do they do what they do – a very important question. We usually reach out for what we need in one way or another. We may not always reach in the healthiest way possible. However, the reaching out needs to be noticed and honored. I cringe when I hear a staff member tell a child to stop spinning my cymbal, stop stimming, stop clapping, stop flapping. In a sensory world so different from our own, with circumstances different from how we perceive the world, is this our right? Certainly there are behaviors that are dangerous or socially unacceptable. However, in the right venue, maybe some of these behaviors can be honored in an appropriate manner and navigated for use. I have written various articles on utilizing tapping and clapping behaviors and channeling these behaviors into forms of communication, and in some instances, speech. A mother recently told me her little well behaved son began to initiate, running into others and saying “excuse me”. Bewildered, she mentioned it was not done in an aggressive manner. I mentioned to her to give him opportunities for that at home in an appropriate manner, and to then instruct on the social. Give him a therapy ball (as I spoke, he went to town banging on my drum full throttle), or circumstances like this I said that are appropriate. This little boy can communicate, but probably can’t tell us why he does this. It is meeting a sensory need. Children who jump or bounce, incredibly helpful actions for vocalization, come into my studio and utilize the trampoline until the need is gone. After the need is gone, the trampoline gets used as a place to sit. The non-verbal boy I initially bought the trampoline for never uses it anymore except as a couch. However, when he is working hard to get a particular sound out, he stands up, jumps, and waves his hands before vocalizing. His jumping aids his vocalizing much like taking a deep breath for a singer before reaching for high note. Kids on the spectrum do not have only speech needs, occupational needs, or physical needs. If they did, their diagnosis would be different. All aspects – motor, behavioral, cognitive – work together. As a human and a professional who can navigate this world in a meaningful acceptable way, I see it my job to take what a child presents and find a way to utilize it to help. In my opinion, evaluating these children by typical standards is backwards, lazy, and unfair. We are asking these kids who perceive the world very differently to do things our way. Stop spinning that cymbal and behave our way – the way we know. Would we ask a high school student to operate? No, of course not. Maybe some day, but they need the skills and the proper education first. As professionals, it is our job to look at behaviors, honor them, and ask what purpose do they serve. How can I help this child navigate the world more appropriately without jumping five to ten steps beyond what they can already do? How can I use what they already have, understand, and behave to help them? Honor what the child possesses, then ask why and implement the how. I am not being patient, I am looking, asking why, and then taking the responsibility to find the pathway of least resistance for that child. Antoinette Morrison MT-BC
As I reflected on my busy and varied week, working with kids of all ages, I stopped to think what theme pervaded my week. The children displayed many strengths, but often, as adults, we don’t look beyond the tip of the iceberg, and just see them disguised as weaknesses. Why do we do that? I thought of the near-teen boys in the group of 30 or so kids with which I work who are always throwing out silly comments from the back of the group. That silliness, capitalized upon, encouraged genuine leadership. The boys led the others in song- yes, song! These typical pre-teens were singing in a group they did not choose, teaching one another valuable life lessons. The freedom of energy exhibited in their silliness – what a refreshing attitude! The boys’ attitude, energy, and freedom brought the energy level and freedom of the group up to where the boys were at and dispelled the anxiety-ridden seriousness of the group. The non-verbal four-year-old who made every attempt to escape the new adult’s wishes stayed at the piano as I reflected his antics. The boy got on the trampoline, began to jump, and watched himself in the mirror. The rhythm of his movement, reflected and contained by the music, brought a joyous smile as he got off the trampoline, went to the mirror, and repeated the phrase, “in the mirror.” The tiny non-verbal five-year-old, who would spend an entire session pulling items out of a can and putting them back in, began to make sounds, eye contact, and smile by my reflecting and encouraging this curious behavior. No longer was this an isolating behavior, but a jointly played game. As his energy level rose, so did the force he used to put into this action, which brought forth more sound. The more sound he made, and the more he heard the lyrics, “put it IN, take it OUT,” the more the sound took shape reciprocally of the vowel sounds IN (a held tone) and OUT (a held tone). The boy who walked in looking tired, weak, and limp walked out smiling with energy in his sure-footed step. The group of cranky pre-teens who always limp, complaining at each other’s throats, are intolerant of every little difference. By listening and using their individual ideas and seating the kids physically closer, the children now help one another. The previously cranky kids come in and look forward to working together. Sometimes, they are put into small groups, as a therapist works with only one group at a time. The other group stays productive while getting along, not solving their own problems, but those intolerable differences just aren’t noticed anymore. Then there is the older teen who is always responsible, listens to adults, and does everything she is told or expected. However, she has no voice of her own, but only parrots the adults who surround her. By encouraging her true voice, not one that mimics others, she began to show some confidence. Now, not only is she beginning to find and use her beautifully gentle yet clear voice, but sometimes the words that come out are those that belong to her, not someone else. She has the courage to say, “I will do that,” instead of “I’ll do that if you want me to.” Each of us is born as an individual, having individual genetic personal makeups. We each have our own energy and rhythm whether we are male or female, child or adults, disabled or not. When we as facilitators, therapists, teachers, parents, or friends value that enough to nourish it. Whether we understand it at the moment or not, that is when amazing things begin to occur such as, growth, healing, development, or simply genuine moments of happiness. The key to finding these strengths is to look at exactly what the child presents to us. Antoinette Morrison, MT-BC
In observing some of my newer clients and reflecting on some of my older clients this week, I saw the importance of coming in the back door, or shutting off the critically thinking mind, even in adults. This is when some productive, and more importantly, more permanent learning can evolve. Don’t get me wrong; there is a need for that critical thinking mind, but today I would like to focus on play and shutting the critical mind down. I watched two new clients this week, the first a little non-verbal autistic boy whose attention was instantly grabbed by only the physical piano. Before the session began ,he went to the bottom of the keyboard and began to play a bottom note or two. He made our first encounter easy as I joined him with a little repetitive structure which immediately connected us not only with the music, but also by eye contact. he would leave the piano and joyously move and vocalize to the music as he investigated the room. I offered him a couple instruments that he had not seen, and he openly accepted and tried them. We had instantly formed his song and used it to give structure to all that he did. Every way he moved, and all vocalizations he made. There was an instant continuity in the session. The chord structure was basically a V to I cadence, a recognizable structured boundary or ending. As his play evolved, so did mine, reflectively and easily. When I gave him the harmonica, I left the piano and sang, “my turn”, then handed him his and said, “your turn” in a sing-song manner. I did this only a couple of times, and then he again went dancing around the room, playing the harmonica. As I got back to the piano, I played the V chord as he played the harmonica. He paused, and I went to the I chord and played my harmonica while continuing the piano accompaniment one-handed. My voice, which ha previously sung “my turn, your turn”, fit into this cadence rhythmically, although I did not repeat the words. We continued this back and forth play without gesture, singing, or written direction, as he danced, played, and vocalized with me. The two adults watching in the room commented, asking how he knew when to do this, seeing as this was only our first meeting. My question was, “How did the adults know this?” I did not give a direction: we just played. This play was grounded by a predictable, structured, repeatable pattern or sequence. The definition of cadence is “the rhythmic flow of a sequence of sounds or words: for example, the cadence of language” (dictionary.com). Since this boy ,although non-verbal, can already make definite sounds, my direction with him will probably to first facilitate purposeful vowel sounds or the production of words by harnessing his play with musical structure. Maybe this little boy’s creative mind will take us another direction of which, at this very early point, I am unaware. The second little boy I worked with was one that I had already worked with a year ago at that time, undiagnosed. No one could guess at the problem. The little boy was just extremely low functioning, mostly unaware, inactive, uninterested, and very physically tiny, weak, fragile, and silent. Other staff was eager for the little boy to go to Music Therapy because working with this boy was very frustrating. Nothing seemed to “wake him up.” He had so many needs that it was difficult to prioritize. Music Therapy worked: it woke him up. Staff did not want him to miss Music Therapy because it made their job easier. Funding ran out, and about a year went by. When I was re-contracted, the little boy was on my schedule. When I read his IEP, I saw he now has temper tantrums while doing non-preferred activities. I was excited and impressed. This meant that awareness had taken root, he had an opinion, something mattered, and he was not only aware, but acting on this awareness. This was a big, big important step for this little boy who had basically just been existing and being transported from one activity or therapy to another in desperate hope. Soon after he entered the room (which was in a different location than before), he did not appear to recall me or the Music Therapy routine. This session was at the complete opposite end of the spectrum as the previous one. Now he was able to beat along with me (he previously was unable to do so, due to lack of muscle strength and inactivity), but still did not seem too interested. He did appear very interested in my instruments and how they worked. He began to spin my cymbal, which I played to as we kept together, but I was still not seeing any significance here. He spun to the music, but still seemed somewhere else. As I watched, I had forgotten how this little mind had interest f its own. I would have to work harder and follow him closely. He found my drumsticks and began pulling them out and putting them into a container (he always did have an interest in gathering my drumsticks). I was still playing and singing to this, but still not breaking through. The spinning of the cymbal and putting the sticks in and out, appeared to start as an interest that allowed him to get lost in his own mind. I did notice and remember that as his little arms reached up, I heard sound from him. I remembered physical push and pull activity (which this boy had discovered and enjoyed) that took his little boy effort, brought about sound, and seemingly a little more awareness. When I saw him a year ago, I nurtured this with ramps and weighted beanbags, and, of course, music. This day I did not have anything but the music. I handed him a cabasa after running it back and forth on his hands. There was a keen interest in how this (weighted) cabasa worked as he rolled it and gently separated each string of beads. He turned it round and round and looked and investigated to see how this worked. I realized I mustn’t try to interrupt this “why and how”, but nurture it and give it structure. This was a little person who was going to avoid me by getting lost in his own mind if his choice was not nurtured. There appears to be some big trust issues here. The escape route is passiveness. In passing to this safe place, this little guy is taken somewhere else. My job will be to not only nurture those playful interests, but to also come in trough the very back, hard to find closet door via a deep, subtle, grounded, stable, sensory, and reflective experience. As I continued to play to his investigation, he began to play to my music and his energy level became greater as the tempo did. Both of these boys took a slightly different route. One found that once his own interests were given instant reflective structure, play was easy and productive. The other boy, having little trust, played and escaped. Trust and growth needed to be nurtured through gentle, stable grounding, provided by repetitive predictability. Whether it is autism or trauma of some sort, both boys needed to be met at a playful place and gently, reflectively cradled by a nurturing, grounding, stable structure that music could provide. Antoinette Morrison MT-BC
Last week I talked about rhythm – the most basic element of music – and how we are born to live rhythmically. We are born with a basic beat, a heartbeat, and live our lives at regular intervals, minute to minute, hour by hour, day and night, month to month, year to year. Rhythm sets us up to predict: we pretty much know what comes after 1, 2, 3, _. But what happens, although we continue to have a heartbeat day and night and year to year, when we live our lives with unpredictability? What if we go to school and come home at the same time every day, but we don’t sleep or eat at regular intervals? What happens when Monday through Sunday, day and night happen at regular intervals, but the events, or our perceptions of them, don’t occur regularly? How do we count on what will probably happen next? How do we learn to trust ourselves or life? How does this affect our brains? Life is full of unpredictability, but we as humans count on the large amount of predictability to organize, to feel safe, to trust, and to be able to move forward. Rhythm, the forward movement element of music, is the element of predictability of regularly scheduled output. It only makes sense how a very natural element of life can be used to heal without bringing any foreign chemicals in to alter the healthy functioning that already exists. I have noticed that groups of children who live with unpredictability of one kind or another thrive unpredictability. When the children with chaotic lives are put together in a group, rhythm becomes my magnetic, magic wand, pulling everyone the same direction. For example, the two day-and-night autistic brothers, one who craves calm and serene, the other craves loud excitement and activity, have obviously different needs and strengths. As I play my guitar to the grounded swinging of the swing of one brother, the other comes in unannounced, hops on a swing, and automatically, the boys are swinging in sync, going at the same rate, the same direction, the same time to the guitar beat (http://www.pondscienceinstitute.on-rev.com/). The music alters back and forth from major to minor keys to delight each boy’s craving, yet the magnetic beat stays the same, pulling each boy’s focus towards myself and towards one another, and even pulling the swings in the same direction. This happens frequently. How often do you see children on swingsets that are swinging at the same rate? When I work with children who are born into this world with brains and bodies that perceive the world around in a predictable fashion, but the world around them does not provide that predictability, the result is chaos. Once again, my pervading, magnetic wand, providing the repetitive, predictable sequencing these children need, becomes the leading force in this group. The basic rhythm either energizes or calms, providing containment for the group. The rhythm pulls their attention together and their bodies and minds into synchronized focus. Sometimes only briefly, but over time they do it on their own. They need a predictable healing agent before they can behave like “expected.” “Expected” isn’t that based on prediction, what we know is going to happen. Children need predictability over time in order to experience “expectation” and understand it. I find the amazing thing about rhythm is that it is so strong of a healing component, that if I have a new group of children with little experience of predictability, and I am, at the moment, the only one providing it, it takes a little repetition for them to be able to experience, understand, rely on, and then act in sync with expectation (or rhythm). However, if this same group gains enough experience with predictability and rhythm, and a new child, filled with chaos and unpredictability, is introduced to the group, the pull of the group rhythm makes the experience time shorter for the new child in order to fall into focus with the rest. I find that predictability-experienced children, after they have learned how to act with expectation (or respond to the beat), can then tolerate and respond quickly to layers of the elements placed on top of the rhythm, such as melody, harmony, silence, and the variation of rhythm. When new children are introduced to the group, the layers, if any, need to be then highly predominated by the pervading wand of rhythm. If rhythm can be such a strong healing agent, then can we expect to place a metronome in the room with the same result? Do babies thrive when they are placed in a playpen, fed, and changed at regular intervals, but have little human contact? Of course not. Rhythm is the element, but we, as Music Therapists, are the agents who provide the element in the proper dosage. Antoinette Morrison MT-BC
After taking a coarse from Christine Stevens entitled “Music Medicine”, one of the concepts brought up in her coarse specifically, I had begun to look at , ignited reflection on the work I do, the concept of rhythm. Rhythm- the measurement of pulse, a regular scheduled timing of continuous sound and silence, movement and rest. Rhythm, the element that contains its players and grounds and supports them. It is the glue that holds the group together, while simultaneously moving them together. We start out life with a heartbeat, a regular pulse. Everything else develops from there and is grounded and supported by our own heartbeat. The wonderful thing about rhythm is that it is absolutely non-discriminating, pulling anyone along despite age, race, background, or cognitive capacity to itself. It is an incredibly easily accessible and powerful tool in therapy. Even those who live seemingly unaware of their surroundings can be pulled by it, and often demonstrate for us one facet of their world in rhythm by rocking, flapping, pacing, etc., in a rhythm of their own. We can join them in their world and in their rhythm when it is not yet possible for them to join ours. Rhythm accesses lower-functioning parts of the brain which means its magnetic pull is accessible by all. The possibilities to move, adapt, remove negative, pull positive, balance, increase, or decrease a skill, a thought, or a place of being “stuck”, all with a single tool. Rhythm is endless. How can you use rhythm to enact change? Even time moves itself in an even rhythm, changing slowly, day by day, to the same continuous pulse. Rhythm is free, with no invasive foreign chemicals being added to our body. We are all born musical beings, moving through time, days, nights, months, and years at regularly scheduled intervals. We are all pulled by this pulse without realizing it or even stopping to choose it, most of the time. The most basic element of music- we are all born to it. Antoinette Morrison, MT-BC
Recently, I have been concerned with my client “Frankie.” Concerned because I haven’t been seeing outward growth behavior demonstrated. “Frankie” is so intensely connected to the music that after sixty minutes, when I put the guitar away, he runs screeching because it is being put down. I see progress, then often no outward demonstrating behaviors, quiet, and stillness- yet intense listening and connectedness. I even warn parents, especially, when I hear pop-out words often – then silence. This happens frequently. A child needs time to process, so we have to wait and see what happens next. This is the part that makes me question myself often, although it happens with almost all of my clients, yet the lack of evidence of producing growth makes me uncomfortable. I keep falling prey to societal expectations. I forget that some of the most powerful moments in music are preceded or cause by “rest” or silence. Although “Frankie” is intensely connected to the music, showing me this in his swinging, facial expressions, and reflection of the musical mood, I still become uneasy with the stillness. I forget that the spaces where notes are not played are as important as the spaces where they are played. A balance is always needed between activity and rest. Rest adds strength to our body and is needed. In music, the silent “rest” adds strength and stability to continuous rhythm. Before “Frankie” can demonstrate the “next” step, he needs the chance to absorb what he is gaining. He needs the strength and stability gained from perceiving before moving on. Although “Frankie” appears somewhat still, he is “connected to the now” through the intense listening. Truly, how often of how many of us are connected to what we are doing now? My own kids will gladly attest that I ask them the same question a zillion times. My head is too busy to grasp everything they are saying to me at the moment. My consistent reply to them is, “I’m sorry I didn’t hear you, I was thinking too loudly.” If I watch “Frankie”, a naturally anxious child, he is free of worry simply listening and feeling the vibrating frequencies. He can hear the guitar, my voice, and his own voice as he gently hums. And why do I miss the humming altogether? Because my head is too busy thinking about how to lead instead of watching him as intensely as he stays connected to the music. I cannot see what neurological pathways are being ignited, redirected, or growing, but after all these years of falling prey to the same anxiety and then seeing the outcome when it comes, I still fall prey. “Frankie” is finding his voice at his pace, not mine. I am so busy in my own head that I am missing the subtle signs that the boy is delivering. He is finding his own inner voice and beginning to gain control over his outer one. The pop-out word, as often happens on this developmental pathway, are fewer and farther in between. But pop-out words are just that: unregulated. Soft humming, following intervals, matching pitches is more controlled and regulated. The more it is practiced, the more accurate and frequent and developed it becomes. Typically developing children that are learning to speak don’t produce, produce, produce. It is a gradual relaxed play with sound supported by cause (the sound produced) and effect (the reaction from others). So who is it at this moment that is the more attentive, more authentic, more directed, more focused? Is it the client or the therapist? Sadly, at this moment, it is not the therapist. She is too busy thinking. Antoinette Morrison MT-BC
The wonderful thing about a drum is that there are no wrong notes. This makes playing successful to anyone who tries it. Who would ever think that giving some drums to a small group of chaotic, unfocused, hyper children could actually pull their attention together and help increase their social skills. Knowing that children automatically speed up and automatically want to bang away as soon as they get the drums, stir some doubts. But with careful management, the magnetic pull of a good beat pulls our brains in its direction. Watch a classroom move in sync as a good beat is pumped into the room. Most all children will move in one way or another. They may all move in a different way, but their movement and attention is pulled to the same direction at once. All are moving at the same time: they can’t help it. Doing this in a fun, game-like way is much easier than trying to “teach” them how to follow a beat or pay attention. “Teaching” requires too much attention on “getting it right,” while playing puts us all on automatic. When children are all beating together, the social skill possibilities are endless; impulse control, attending, focus, listening to others, sequencing, turn-taking, and the list keeps going. Drumming in this way build self-confidence and self esteem and allows safe nonverbal communication. Drumming in this manner simultaneously raises the level, focuses, and contains the children. The added plus to the scenario is that it leaves little room for interruption and will likely continue in their head after the session ends. Rhythm now creates organization, actually changing a neurological pathway and helping the child focus. There are also children who have such poor fine motor skills they can barely hold a drumstick. many of these children who are slower at developing these skills are pulled so by the beat that they continue to try until they gradually get there. I have often seen children who begin poking a drum occasionally with the wrong end of a drumstick because of such fine motor delay, hat within one or two sessions are pulled so by the pulse they they are using an alternating hand pattern and beating the drum the right way with delight. Some of the children’s muscles that are too rigid and tight to beat a drum find that an accompanying beat pulls their bodies and arms to move in the direction of the beat with significantly greater ease. Drumming helps us get out of our own heads. Drumming gets us to play. We are moved to play through the pulsating rhythm. It can not only facilitate physical, but also emotional, cognitive, and neurological change. Playing a beat, coming in the back door, effecting change. Let me know your experiences, how has drumming changed the lives of others? Antoinette Morrison MT-BC
Think about it. What happens if I sing “A, B, C, D, E, F… ?’ What do you do in your head if I play seven notes of a scale ” Do, Re, Mi, Fa, So, La, Ti… ,” and I leave out the last note? Do you not fill it in in your head? What happens when you hear a significant song from your teen years? Do you go back in time in your memory to either a particular event, time, or emotion? Everyone who works with children with speech and language difficulties knows to use visuals, visuals, visuals, Yes, they certainly help. Using another sense helps not only to integrate but also distracts from the pressure we put on ourselves to get it right. When you couple a visual with a repeatable, predictable tune, its effects can demonstrate a quicker response with much less effort. Did you know it has been proven that when you put a motor task, such as exercise or appropriate music, reduces the effort the individual needs to perform the task be 15%? Talking is a motor skill. Why not utilize music, then? We are all musical beings. From birth, we hum first, vocalize next, babble, then talk. Toddlers with absolutely no training spontaneously compose their own songs often. Shut off the critical part of your mind and just try it. Use a tune to help your child or client get the words out. This lessens their effort by 15%. Allow the child to automatically have the last word. I often play with young children who have speech difficulties, singing the same tune over and over in their play, and then begin to leave out a single word. The child uses the subject, the play, and I insert the tune. As far as the child ins concerned, we are just playing together. A simple tune adds to the playfulness. Pretty soon the child is using words, putting phrases together, and as time goes on, we drop some of the music so that now they can use this language without even realizing that they have learned it. I often call methods like these “coming in the back door.” Come in the back door sometime. It is less formal, and has nor worries. Let me know how it turns out. Antoinette Morrison
Many things happened on this quiet snowy Martin Luther King Jr. Day. My husband left for work, and my oldest son for college. My younger son was still sleeping, not yet starting his schedule of activities, and my daughter at an overnight. I had the choice today to start out and go to my first session, or wait until four o’clock, our scheduled time. I decided to start my day with the session. I went to the house of two autistic brothers. Upon arrival, I climbed the steps to their “room,” which is a fairly large empty one with three swings hanging from the ceiling. Being a Cape Cod home, the boys’ toys were in their labeled coves inside the rooftop. Today only one autistic brother joined me. However, a third sibling, typically blonde-haired, blue-eyed, happy, and three years old, joined us. I started the session with the Hello Song, as always. Each boy was asked to tap “hello” back to me on the drum. “Frankie”, the non-verbal autistic eldest brother, watched comfortably as his younger brother was included in this activity. As I started to play “Frankie’s” two-chorded song and sing about all he did (swing back and forth), I started to hear a very light, low sound now and then. As I listened, I realized it was “Frankie” humming. I met his eyes and began to sing about his singing. Just as I did, “Jay” the typical brother, got out his toy drum. He banged away and then quickly fell into “Frankie’s” and my groove. The three of us, drum, guitar, and hum, all played together in our own way to the same single pulse, sharing smiles and glances as we continued. “Frankie” stopped his swing and switched positions. I was sitting on my ankle, which was beginning to hurt, so I stood up by the window cove in front of where “Frankie” was. Without being asked, “Jay” retrieved my various small instruments and brought them over. I had brought “Jay” a small guitar to play. He joined us on this guitar for a while. By this time, “Frankie” and I were humming together, sometimes hitting the same pitch, and sometimes hitting a fourth or a fifth apart. “Jay” picked up a harmonica and played along with us. When he put it down, I instructed him, “Now give “Frankie” a turn.” “Frankie”, still swinging, picked it up ad played a couple continuous phrases along with my guitar music. “Jay” then picked up my hand drum. I said in a sing-along voice, “My turn,” hit the drum, “now your turn,” which he did. “Now Frankie’s turn,” in which “Frankie” also participated. This rhythmic turn-taking, accompanied by guitar music, was interrupted only by “Jay’s” laughter as he proclaimed, “He did it!” (about his brother’s participation in the song.) “Frankie” and I continued the heart song of our voices to the accompanied beat of the rhythmic swing and the harmony of the guitar. When “Frankie” was done, he walked away and “Jay” helped me pack up the instruments. What a great way to start a quiet, peaceful day. Yes, we had communicated some, but even better, we all played, sung, harmonized, and were energized and calmed together. Each of us shared what we have in our own way, all united to the monotonous back and forth pulse of the swing. I don’t know which was more rewarding, the delighted giggle of the youngest family member and spokesman, or the eldest sibling who grounded the small ensemble with his steady rhythm and sang with the other members with intent listening and joy. That is what I love about Music Therapy. Antoinette Morrison MTBC For more music advocacy please click here.
Music Therapy Advocacy month has arrived! As part of this community this weeks post is written by guest blogger Naomi Esterely. Naomi Esterly is a stay-at-home mom to two rambunctious, yet adorable, little boys and a newborn baby girl. In her spare time she balances writing freelance for 1800Wheelchair.Com and coaching her community’s little league. As society has evolved, so have our abilities and know-how when it comes to special-needs children. Years ago, children with special needs were completely misunderstood and almost completely seen as a burden and shame. Medically, these children were hurt more than helped in many cases. Today things are much different. Families no longer live in shame while trying to hide or discard their special child. Doctors have found much more effective ways of understanding and treating these little ones. We have learned so much, while continuing to learn more every day. One such emerging discovery in treatment has shown great promise – music. This non-drug-related option has only recently come to light as a tenable option, worth some facilitation. How is music helpful to a child with special needs? We are still learning about this, but we do know a few other things on the subject. Music is said to be the “soother of the savage beast.” In other words, music is a universal language of sorts. No matter your race, sex, mood, inhibitions, or special needs, music can reach out and touch where other things cannot. Even if language is not understood, research has long documented the effects of music on the listener. We can understand a song to be mellow, up-beat, or even progressive without us understanding words, or words even being present. This concept is indisputably universal. Apply this concept to special needs children, and you get the same results. Today, there are emerging music therapy providers who’s clientele ranges from, young, old, troubled, special, and even those without issue. This is what we are starting to see. How this concept works is also becoming more clear as we see it applied, and observe the effects. Again, this fares no surprise for many. A child with special needs such as ADD, ADHD, or anxiety disorders can find comfort and a slow-down effect through calmer, mellow, yet happy ballads. Other special needs conditions such as emotional disturbances or those that would cause reclusiveness and shutdown may need a different approach. We are finding these often helped by exposing the child to carefully selected, happy, positive music. Each situation or condition can call for a different type of music. Volume levels and listening frequency can also be factors needing consideration. Again, not surprisingly, many children can be “felt-out” for how they respond to different types of music. Whether treating in home or in a professional setting, it is often productive to play different types of music first. From here, further judgement can be made as to favorable responses. If the child is highly cognitive despite their special need, identifying the “right” and “wrong” selections may also be considerably affected by the child’s moods. In addition, many of these therapies involve the child actually playing music and making sounds. Musical instruments are provided and the child is able to play with any they choose. This is showing marked effectiveness as well. The concept of therapy through music is very simple and not a matter of deep surprise to many. Special-needs children are just like any other person. We are all fairly similar at the primitive level; we all want love, company, and life-comforts. How could music, the uni-lingual force of expression through sound be any different? This is what we know so far. Stay tuned, the future is bright.
Introduction: Advocacy –> Recognition –> Access Since 2005, the American Music Therapy Association and the Certification Board for Music Therapists have collaborated on a State Recognition Operational Plan. The primary purpose of this plan is to get music therapy and our MT-BC credential recognized by individual states so that citizens can more easily access our services. The AMTA Government Relations staff and CBMT Regulatory Affairs staff provide guidance and technical support to state task forces throughout the country as they work towards state recognition. To date, their work has resulted in over 35 active state task forces, 2 licensure bills passed in 2011,1 licensure bill passed in 2012, and an estimated 7 bills being filed in 2013 that seek to create either tittle protection or a licensure for music therapy. This month, our focus is on YOU and on getting you excited about advocacy, so I thought I would start out the month by telling you about my very first client. After receiving a bachelor’s degree in Music Therapy, in order to take the certification exam, all music therapists are required to do an internship for approximately three months upon receiving the degree. I interned at a developmental center that trained in Nordoff-Robbins Improvisational Music Therapy. Being a classically trained pianist, I learned here how to improvise. Not only was I able to help my clients find a freedom from their restrictions, but I also found mine musically. The first client who had not yet been seen by either my supervisor or any other interns was “William.” All the people in the developmental center had spent a major portion of their lives living there. Many were older people who had been there most of their life and had lived at a time in which much less was known about disabilities and were often “housed” instead of treated. “William”, however, was only 28 and nonverbal with autistic-like mannerisms. He was considered mentally handicapped. I was nervous after reading his records because “William” was described as having somewhat aggressive tendencies, such as hissing, spitting, and hitting. Any change seemed to bring about these behaviors. The music therapy room in that building was also in an empty hallway on the opposite side of the wall of his classroom, which did not soothe my worries. “Follow the client” had been the mantra heard through college. So as I, the new person in “William’s” life, took “William” out of his routine to a new setting, I saw on the walk to the classroom the hissing, spitting, and hitting. These behaviors seemed to be more of a warning to me, one that I heeded. “William” spent all of each and every day either shredding his socks in a very artistic manner or creating painting strokes with a paint brush and no paint up until that point. He always sat in the corner, away from other people. He never joined in, and warned anyone who got too close with his hissing, spitting, and hitting. I began our sessions on the walk down the empty hallway, reflecting the hitting with clapping or tapping as “William” slapped objects. Once in the room, ‘William” set in the chair, positioned to shred his socks, but I did not go away. He continued to hit objects as I reflected this on the keyboard. This very quickly interested “William” and connected us. “William” was hitting or tapping objects closer in proximity to me, mainly to test how long I would keep this up. He picked up my foot and hit the bottom of my shoe lightly. When I reflected this musically, he began to laugh. “William’s” laugh, which sounded a bit like the laugh of the Disney character Goofy, put me at ease and made me laugh too. I continued this form of communicating with “William” as he, quite amused, tested just how long I would keep this silliness up, always looking for something new and unusual to hit. At one point, he stood me up, put my hands on his hips, and demonstrated to me that he wanted me to do the famous chicken dance. he laughed hysterically as I complied. The only bathroom in that part of the building was on the other side of the Music Therapy room, so staff frequently came through to use the facilities announced. “William” would then resume his sock-shredding position until they left. My supervisor was in one time to observe me. He eventually got used to her sitting quietly in the corner and did his usual thing. Suddenly, I requested something, and clear as a bell, “William” announced, “No, I don’t want to do that.” When the session ended, my supervisor told me to ask his OT, who had worked him for seven years, if she had ever heard him speak. The answer was no. I was never sure just how accurate ‘William’s” eyesight was. he never had am problem getting where he wanted to go, but his eyes were a little crossed and it was hard to tell if he was looking at you or not. However, he was beginning to show me a rhythmic form of tapping (communicating) which was becoming very successful. The team of therapists who worked with William were present for his annual meeting at which he also attended. he was talked about as if he did not understand. When it was my turn to contribute to the meeting, he began to subtly tap underneath the table and giggle. As I whispered to my supervisor, “I think he is talking to me”, I responded by doing the same. His subtle giggle turned into laughter. It was later reported to me towards the end of my six months that as soon as “William” heard the piano music from the other side of the wall (my supervisor still used the room), he got up on his own, walked over to his peers, and joined them for the first time ever. Part of my assignment was to choose one client and give a presentation to his team and classroom staff at the end of my internship. I had chosen “William” because he had never been seen for Music Therapy before. The timing of this presentation was perfect. His entire classroom’s staffing was being changed. None of these people knew “William.” Their first exposure to “William” was my presentation of his way of communicating with me. During my last week at the developmental center, I passed “William’s” classroom on my way to a different room. “William” was in the middle of everyone, the center of attention. Smiles were on everyone’s faces as “William” giggled and tapped back and forth with one of the staff. “William’s” world of isolation had been transformed. Music Therapy allowed “William” to not only feel safe with others, but also to reach out to and enjoy playing with his staff and peers. The evidence that day was very visible. Everything that I had intuitively felt, thought, and sensed about Music Therapy and sought after was true. This was my passion, this was my freedom, and most of all, this is what I was meant to do. Antoinette Morrison MT-BC
In this last part of the speech series, I decided to write about using Music Therapy in word retrieval problems, something I am finding myself running across frequently lately. This is for the children who already have some controlled speech. Some of the children can speak in one to three word sentences, but not at all fluently or when upset. Because the emotion is too overwhelming, they cannot retrieve the words they already have. In these cases, the lack of fluency is serious because it takes so long and so much work to get the words they want that in an emergency, there are no words to grab quick enough. The children know the consequences and tantrum instead. In these cases, the element of rhythm comes into play in retraining the brain to run smoother. Other cases I have found are really more of an auditory processing problem. In these cases, upon first glance, the child may appear to look autistic, using repetitive or close to no language and possibly not socializing with others. Some of these children do have sensory difficulties also, but the communication problem does not root itself in autism. It’s root is in an auditory processing difficulty. The children understand generally but not completely. Newer words often come out switched around (example – “chicken” may come out as “kitchen”). These children then, knowing it is not right, just stop attempting. Then, in efforts to be understood, only use the short phrases they do have control over repetitively. I also find these children watch my expression closely, to see if they get it right – if they have been understood. Lastly, these children tend to thrive on the repetitive do-over practice of a language skill. Once it is almost mastered, they then move on themselves. There is a constructive purpose for the repetitiveness. In these cases, visual and repetitive melody seem to be the clues the brain needs to get the motor running more smoothly. Back to word retrieval and rhythm… Using visuals as a prompt is a given here. However, I also employ using rhythm as a key ingredient also. Many of the children with whom I work love Eric Carl’s “Brown Bear” series. I always start with what is easy and fun. As I play and sing the repetitive phrase, I allow the child to fill in the animal, and as this gets easy, fill in the color. (We always begin with Brown Bear, then usually by the child’s request go on to others; Polar Bear, Panda Bear and Baby Bear). This is not a new technique. However, in the process of the repetition, I go from giving the child the time he needs from the initial word retrieval to picking up the tempo slowly. This seems to help with the fluency tremendously. When I think of retraining the brain, I imagine it being like a casino wheel. Instead of starting and stopping, it picks up a slow continuous tempo, giving the wheel (brain) the momentum to continue. Then the child is ready to move on to two-word phrases in the same manner. In fact, if I am just singing and not playing an instrument, I will use my arm in a circular motion and point to the child when it is his or her turn, not stopping the motion. This gives the child a visual rhythm also. In children with auditory processing issues, I tend to rely on melody as my aid. Melody seems to be even a quicker cue to the brain to help retrieve a word. I basically use the same processes as above, but when the child gets stuck, there are sounds and visuals (pictures) that help (the motion or sound of my lips with the beginning of the word), but I get the most immediate response when I simply play the note on which the song is sung to “unstick” the word. This melodic note seems to give the quickest response consistently from child to child with this difficulty. Also, singing tends to be a more age appropriate form of “mother-ease” (The pitched elongated talk that mothers use with their infants). Giving the word a pitch and a rhythm not only gives the brain a little more time to accurately process the sound it is hearing, but also the differentiated pitch accompanying the sound gives the brain an extra cue which helps clarify. These types of Music Therapy sessions are some of my favorite sessions. Children with these difficulties who enjoy working are motivated and automatically know when to move on to something else. They almost always come in knowing what they want to do – picking up from the last session without my assistance. I am truly just a facilitator here. Most of my work is done outside the session, reflecting and determining on what has happened and where things needs to go next. Even then, sometimes the child will unknowingly let me know “not that direction; this one.”
How do you know wen expressive language (speech) is too far off of a goal? I do not believe that when after a child can point, that is when they are motivated to speak. None of the young people I have worked with have ever reacted by gesturing, pointing, or signing first when at the extreme of emotions (fright frustration, happiness). It is always sound that comes out, and sometimes unexpected language. This blog was one that was hard to know quite where to start. Kids with neurological difficulties and developmental delays so often come in anywhere on the language spectrum. Some of the children whom I had never thought would be working in this direction have shown me differently. If the children don’t give up in this area, why should we? If the child shows me any sign of sound at all, there is the possibility. The little boy I spoke of on the last blog (http://backmountainmusictherapy.com/2012/12/part-2-eliciting-speech/) who took three years to learn how to get sound out of a recorder initially demonstrated to me only a throat-clearing type of sound. I’m not even sure when I actually heard his real voice. I have often found that children who usually appear silent can lose themselves in the music and will clearly babble, which several steps up the scale from silence towards speech. Often children are reluctant to imitate or produce what we are asking because they can’t on demand, yet. So they don’t even attempt. Sometimes the children have not yet had the opportunity to let go enough to play with sound unconditionally, like infants do. The following are some signs that I have worked with that have shown me that speech is still possible: any attempt at making vocal sounds sound that just happens vocally crying with sound crying that changes pitch vocal sounds that are similar to vowel sounds accidental sounds that occur in the same range in which the therapist is singing or playing babbling pop-out words vocal glissando’s humming singing or attempts at singing If a child exhibits any of these, I have found that it is possible to move beyond these steps and for the child to gain more control. All the nonverbal children with whom I have worked have gained more control of purposeful sound, but most have gained some purposeful, functional speech. We have to work with whatever a child gives us instead of switching to matching. Matching demonstrates what the child understands and that the child has enough control to carry that out. For a child to be able to have enough control to cognitively contemplate and carry through is part of the picture, but all things need to work together. Most of my clients have gone through periods, from days to weeks to months, where their vocalizing may have disappeared. I have learned not to worry about this. We all gain control of ourselves in different ways. It is also not uncommon to see behavioral difficulties at these times due to the level of understanding being higher than what thy can control to produce. When the vocalization reappears, it has usually progressed while the silent process of organizing, understanding, and gaining control was happening. Quite often, if you watch carefully, other areas are developing during this silence. A mother of a client once said to me that she tried it. She tried going an entire day without speech. She said it was incredibly frustrating. Every human needs to have a voice. Those who can express themselves well are usually seen as having a high degree of intelligence, and are treated as such. Those who do not express so well are seen and treated differently. Imagine having thoughts, opinions, impressions, and not being able to express anything. Imagine having a high degree of intelligence with a body that doesn’t obey and no voice. Imagine having the world treat you like you don’t understand, and not being able to let them know that you do. How incredibly frustrating this must be. Each and every one of us yearns to be connected at some level, and heard. Not everyone has the tools to do so is motivated when given the opportunity and belief that they can. Antoinette Morrison MT-BC
Back to my mantra: watch the child. Let the child direct and the therapist/parent/teacher support. Even if they child is not giving sound, one can support movement or even breathing with sound. Repeated sound, as I had spoken about in the previous blog (http://backmountainmusictherapy.com/2012/12/where-to-start-control-of-oral-movements/), sometimes gives structure to a child’s irrelevant, chaotic, seemingly impulsive behavior. Structure is a pathway to purpose. When we speak of music as being a sensory experience (concerning the autistic population), I think most people’s first thought is “hearing.” I personally find that most of my autistic individuals initially connect with the sound, but learn and make sense from the vibrations of sound. This may initially sound far-fetched. However, we forget that their brains receive and make sense of information differently than our own. We need to stop evaluating from a neuro-typical standpoint. For example, just compare a neuro-typical three-year-old classroom with a four-year-old classroom after Christmas. The three-year-old class, still neurologically more immature than the four-year-old class, is still enjoying musical experiences, mainly from the excitement and the sensory experience including elements of rhythm, dynamics, vibration, and the visuals involved. A four-year-old classroom at this time is generally getting ready to learn academics. Colors, letters, numbers, and words are getting their attention. The four-year-old class is maturing in the minds and bodies for kindergarten. The less mature mind is doing less conscious thinking and more sensing. The flow of a steady rhythm has a pull. If a child feels, sees, and hears something that repetitively reflects what they are doing, they become more aware of their own bodies or actions. When you supply that reflective rhythmic structure, you are facilitating awareness and organization, giving predictability and establishing trust on their terms. However, you are pulling their brains towards a more functional structure. Often with nonverbal children, there are areas of development that precede speech which need organization and structure. This requires patience and persistence. Let’s face it. Waiting three year for a child to learn to blow into a recorder to get sound (http://backmountainmusictherapy.com/2012/12/where-to-start-control-of-oral-movements/) does bring about doubts. However, when the child is eager to continue to work, how can you give up on that? Watch the changes and check the development. Is some other area developing at the moment? Then you are on the right track. Watchful, steady, repetitive, mirroring, topped off with patience and persistence is what elicits speech. Here is a brief example. I once saw a nonverbal three-year-old boy who was labeled with autism. In the early intervention classroom, after circle time the children were to choose their work, sit down, and do it. This little boy liked to clap his hands all the time. If unattended after circle time, he would wander over to the mirror and giggle while watching himself clap. At this time, he did not really interact with the other children. When he came to Music Therapy, we used the clapping in our sessions. I had pictures of his classmates in which he had great interest. We transferred the clapping into tapping out their names. Who knew that this little boy was interested to know his classmates? But there were no means of communicating with him. His tapping and guttural vocalizations eventually turned into one-word sentences. He worked up to two-word sentences. In time, in between speaking and tapping, he would go to my snare drum. Although his fine motor skills were very poor and his arm movements somewhat rigid, he enjoyed hitting the snare drum. He was doing what he enjoyed in a safe, encouraging, predictable environment. Sometimes he would take the sticks and rapidly yet evenly use alternating hands in a perfect brisk rhythm to the music. This always surprised me because nothing else he did with his body was done with such smooth preciseness and control. He didn’t do this for very long, but then he would go back to working on speaking and vocalizing. precise, controlled motor movements alternated with speech. He moved on from early intervention to public school. He recently is returning to private Music Therapy sessions; we shall see where it goes from there. Watchful, steady, repetitive, reflective mirroring topped with patience and persistence is what elicits speech. Antoinette Morrison MT-BC Back Mountain Music Therapy
How does one go about exercising getting a child to exercise those oral muscles? Like everything else, start where the child is. The first response one may say is,”Where he is? He doesn’t do anything. He doesn’t even look at me.” As mentioned in the last blog (http://backmountainmusictherapy.com/2012/11/5-part-series-music-and-speech/), precursors to speech are attentiveness, eye contact, and joint tension. Reflect back to the client whatever he or she gives. I do this musically. For example, if he rocks (with no eye contact), I would play two back-and-forth notes repeatedly (ostinato). As a parent, possibly with little musical ability, sing two tones back and forth, or rhythmically (to his or her rocking) name his action (ex: rock-ing, rock-ing). If the child makes a sound, terrific. He has given you specific tones with which you can sing and work. What is needed next is patience and a willingness to let a child move at his own pace. After all, you may not be aware of how many other areas the simplistic structure may be helping to organize. When you sing the two tones repeatedly, taking a breath with approximately the same distance, you set an predictably achievable structure to join and understand. The therapist or parent must carefully watch what the child gives back. Slightly altering movement and change in posture, expression, or breathing may be a sign. Notate any small change, then remember: this is the material the child gives you with which to work: this is response and success! Sometimes it is not the child who is inattentive or not alert, but may be our own set of expectations that blinds us to the attempts of the child (conscious or not) to join in activity with another. When we support what a child already has, no matter how minute, we also help to inspire confidence, trust, and success. Support any change. Confidence and trust can be more powerful than we realize. I am even humbled to see verbal children, who initially give an appearance of low-cognitive function, blossom and respond instantly, creatively, and intelligently once they have gained some trust and confidence. Before thinking about what developmental steps should be gaining, watch the child. This should also help you to understand what primarily is blocking speech. The child will show you. One example is a little boy who began to mouth things in Music Therapy. As he did this, instead of removing or derailing the self-stim, I chose to work with it in a more appropriate manner. Every time he mouthed something inappropriate, I exchanged in with a recorder (if mouthing is harsh, like biting, I use a harmonica for safety reasons). He demonstrated an inability to blow air into a recorder, suggesting apraxia. I also paired this with “my turn”, demonstrating blowing into the recorder first, and then following with “your turn.” If the boy produced sound, it was accidental, usually from pulling in air. However, repeated accidental success is practice for success. Although it took three years to purposely blow air into a recorder and produce sound, it was reported by his parents that Music Therapy was the only therapy that could get this little boy to work on control of his oral muscles. In the meantime, turn-taking had been established, as had certainty of whom “me” and “you” were. As he quickly began to transfer this skill to a harmonica, he also gained the confidence and enjoyment to try to vocalize and babble purposefully. He enjoyed using his harmonica at home to initiate babble. The repeated musical pattern of “me” and “you”, paired with learning to control those oral muscles, was also part of the process that led to his first controlled words and sounds. Eventually, “oo” and “ee” became “you” and “me.” I would love to give a formula on how to elicit and control speech; however, each child is different, and each disability or neurological difficulty behaves differently. Always follow the child, and attend to the most minute of change. Antoinette Morrison MT-BC
Why does music make speech so accessible? Why are there so many stories about nonverbal clients (aphasic, apraxic, stroke victims, autistic, etc.) singing when they can’t speak a word? Why is Music Therapy so valuable to those who have difficulty with spoken language? Why is Music Therapy such a value to the autistic community? Although I am not a speech therapist, I see progress in speech more than any other area within the population with which I work. Some of the verbal reactions I witness in Music Therapy would be considered unbelievable by others. This has forced me to research science behind this. First, lets begin with what we all know. Music and art are strong motivational tools that reward our brains and bodies and help us to concentrate. Music, a non-pharmaceutical like physical exercise, does what dopamine does for us. Music makes us feel good and energized. It feeds the brain with self-benefit and drive, therefore leaving a need for music-based engineering to renovate verbal connections. It has been proven that those who make a practice of study in music training have shown plasticity in the brain. Likenesses have also been compared to those who practice, or study, languages or juggling. What can one conclude from this? Well, we know from experience that rhythm flow influences our motor systems. Just watch the unconscious foot-tapping of those in a room with lively music. It is proven that musical rhythm enhances and elicits auditory/motor linguistic mapping. Studies have proven that perceiving music influences, initiates, and coordinates our motor systems and their reaction to the beat. George Balanchine stated, “Dance is music made visible.” The main areas of the brain that neurologists observe when studying language and the brain are Wernecke’s Area and Broca’s Area. Wernecke’s is associated with comprehension and Broca’s with speech production. There is a neural pathway connecting frontal motor planning and speech centers with comprehension and auditory feedback called acurate fasiculus. Other areas, such as the cerebellum and motor cortex, coordinate movement and are directly linked to pods of neurons held accountable for sound production. As one can conclude, music processes and influences many areas of the brain, especially those associated with language and motor functioning. If we think about it, in order to produce individual sounds, oral coordination is necessary. Motor planning for speech is extremely important, and articulation is really only vocal behavior. Typically developing infants develop speech spontaneously without training. They “play” with sounds and babble before they speak their first word. Individuals with autism often use language in the opposite way. Individuals with autism, and some with auditory processing disorders, often use consciously memorized language. After gaining an understanding of a linguistical motif, the motif may be ceaselessly repeated to make a point. An example of this would be echohalic language. Adults learning a second language may also learn this way. This conscious learning takes much more effort and produces minimally comprehensive results. Applying music, a tool with a natural autonomic feel-good response to language increases the right-hemispheric ability of the brain to act as a linguistic converter, rejoining language to the left hemisphere of the brain; in effect, balancing the brain in motion. In other words, musically playing with sound, much like a typically developing infant does, inaugurates function all over the brain with much less stress and effort than learning language alone. The motion of rhythm can act as a motor aid to all those movements that help coordinate speech. Very often, my most severely nonverbal autistic clients will jump and/or handflap preceding speech or sound. Sometimes this appears to be done purposefully, and at other times it appears to be automatic. The foremost prelingual behaviors include awareness (http://backmountainmusictherapy.com/2012/10/5-part-seriesmusic-therapy-from-attentiveness-to-functional-skill-and-optimal-health/, http://backmountainmusictherapy.com/2012/10/autism-the-key-to-self-regulation-and-engagement/), eye contact, joint attention, and behavioral self-regulation. Recent brain studies among typical and autistic children have concluded that when listening to music (pure music, or that without lyrics), both neurotypical and autistic children showed brain activation on both the right and left side of Wernecke’s Area (comprehension) of the brain, and on the right side of Broca’s Area (speech production). However, only the brains of autistic children displayed activity on the left side of Broca’s Area. Typically, in autistic individuals, this part of Broca’s Area displays little brain activity for language alone, but music has the opposite effect. Thus, autistic brain activity displays musical preferences to travel for language. It may be possible, then, for dysfunctional and underdeveloped language areas to be regenerated to work for music. Science alone is only fact, theory, or study. Relationship is what makes the biggest difference in almost any aspect of life. Music does not only affect motor and language responses, but also has a tremendous emotional component. Although it may be difficult to display, read, or understand an autistic individual’s emotions, they are human, like us all, and are emotional beings. Musical-based interventions influencing interaction in a trusting, predictable, therapeutic relationship eases the transition to language and strengthens connections in autistic individuals. The relationship between therapist, music, and client is the most important ingredient and has the strongest impact. After recently reading articles in Cutting-Edge Therapies for Autism by Ken Siri and Tony Lyons, I wanted to write about an area in Music Therapy that I deal with often, and the science behind it.The following books were also consulted: This is Your Brain on Music – Daniel J. Levitin Musicophilia – Oliver Sacks Helping Children with Autism Learn – Bryna Siegel, Ph.D. Antoinette Morrison MT-BC
Functional skill level is ready to begin after, after, after the client has achieved some organization and self-regulation ability. If we haven’t learned yet that trying to stop that “stimming” isn’t going too far, we better go back to the beginning. We have to do something about the need for the “stimming” first. My last blog in this series is a case study summary exemplifying this series; Music Therapy, from a Tentative to Functional Skill. I first started to see “Cameron” in an early intervention center. I remember noticing “Cameron” in the halls before seeing him in Music Therapy. He was a three-year-old, severely autistic boy who daily caught my attention as he came into school. Daily, he silently stared into space while being led to the classroom. Upon entering the classroom unattended, the only motion one may see from this boy was that of covering his ears as other children made noise. Some of “Cameron’s” IEP goals look like this: Demonstrate attending to adult activities, follow simple and multiple step directions Match colors, shapes, letter recognition, and number concepts Demonstrate comprehension of vocabulary Follow instruction to completion Upon request, “Cameron” will use vocabulary in the form of words, signs, and sounds to label Imitate gesture of songs (These are actual goals and how they were written. I did not write these individual goals.) His IEP stated that “reinforcers are needed to promote independent work and task completion during activities. “Cameron” plays next to other children, but does not engage them in play. He is nonverbal and rarely displays emotions. His eye contact is limited and he does have a tendency to stare off during preschool activities. He has a limited response to his name. He has the capability of matching colors, shapes, numbers, letters, and a wide variety of objects; however, this skill is not demonstrated consistently due to his lack on interest and cooperation… Transition between activities and his ability to follow simple one-step verbal directions is extremely difficult. He follows one-step commands with an average of 55% accuracy. Identification of common objects/pictured objects is 50% consistent. His eye contact, response to his name, and turn-taking are emerging, but presently inconsistent.” These statements were made by his classroom teacher, occupational therapist, and speech therapist as he started Music Therapy. “Cameron” started Music Therapy in March of that school year. he came to Music Therapy very interested and easy to engage. After the initial assessment, the therapist wrote two long-term goals for “Cameron.” “Cameron” will play five short phrases with the music therapist, following verbal and/or musical cues “Cameron” will imitate a five-beat word phrase, three times These goals were written intending to increase attending, increase following verbal direction, increase imitation skills, and increase awareness of multi-syllabic words. Music was something “Cameron” enjoyed, and engaged in jointly without prompting of every kind. He demonstrated great eye contact and rarely stared off. When he did stare, he was easily re-engaged. By the third session, “Cameron” was following verbal directions. Therapist and client played “stop and go” games using words. Not only was “Cameron” following the directions, but he was also perceiving what would happen next. He demonstrated this by bringing the reed horn (the instrument of his choice) to his lips as I inhaled to say “go.” “Cameron” willingly played co-responsively with the therapist, smiling and demonstrating great eye contact. The “stop and go” game was repeated over and over. By the fourth session, a routine had been established, and “Cameron” was eager to engage in this game. Shortly after, “Cameron” began to say “sss” with the therapist as she said “stop.” This was something “Cameron” was doing on his own without request from the therapist. ‘Cameron’s” co-responsive playing had evolved into turn-taking “peekabo” games put to music. ‘Cameron” was actively involved in the music making game, consistently showing interest and making eye contact. By May, ‘Cameron” knew the routine and was comfortable with the therapist. He began to test the boundaries (pushing the video camera, opening the door, etc.), yet his interest in eye contact continued. He began to vocalize often, and Mom also reported hearing this at home also. The therapist thought she heard him say, “good”, a couple of times. After the boundary testing ceased (approximately two sessions), More musical game playing continued. Using a telephone song, “Cameron” continued to respond by picking up the receiver and putting it back down according to the words of the song. “Cameron” also looked to the therapist for what was to come next. Throughout the month of May, eye contact, co-responsive interaction, and verbal direction following increased. By the end of the month, “Cameron” demonstrated interest in the ABC’s. Not only was he identifying the letters, but was also demonstrating interest in the sounds that the letters made. the therapist had “Cameron” pick a letter out of a bag, and then sang, “the B on the bus goes ba, ba, ba.” As she did this, “Cameron” watched her lips, and bounced the letter to the beat. “Cameron” was instructed to put the letter down on the ground. The process was repeated with a new letter. Throughout this process, “Cameron’s” eager attention was sustained as he followed the direction, eager to get to the next letter. ‘Cameron” sang the B sound with the therapist. When finished, he helped put the letters away as the therapist sang about each letter that he picked up. Routine and responsibility had been established. Hand-over-hand assistance was used only in the initial demonstration of the direction to put the letter down on the drum. All of “Cameron’s:” actions throughout the session were co-responsive and continuous. By the end of the month, “Cameron” was improvising, eagerly following verbal direction and interpreting changes. His vocalizing increased and changed from “ba ba” sounds to jargon with diction that sounded more like words. “Cameron” ended the session by playing the “Goodbye” song with the therapist. The therapist played the beginning of the phrase, and “Cameron” intuitively ended the phrase on his horn. As summer approached, “Cameron” had done so well on all of his goals, a new goal was written. The Music Therapist had conferred with his Speech Therapist, and more consistency was established. “Cameron’s” long-term goal was to follow eight commands without prompting in a thirty minute session. “Cameron” was already following commands at this time, but now the therapist was looking for more consistency in his responses. By the end of the summer, “Cameron” was testing boundaries again, but continued to respond to verbal direction. At the end of the summer, “Cameron” verbalized letters T-Z, and H. He was also imitating some letter sounds and said,” Goodbye.” The therapist continued to see “Cameron” on and off at the early intervention center as funding permitted until it was time for “Cameron” to enter kindergarten in a public school. At that time, “Cameron” began to see the therapist privately on a regular weekly basis. He continued with her until he moved at the end of first grade. Strides were still being made. “Cameron” began to speak in one-word sentences. The therapist began work on phrases by singing to a book or requested answer-games. She eventually would leave out one word for ‘Cameron” to put in until he was asking or speaking in phrases. This quickly carried over into daily life. At the beginning of first grade, he was demonstrating behavioral issues often, in Music Therapy and in school. After conferring with his TSS worker, the Music Therapist concluded that as “Cameron” left kindergarten, there was less and less sensory time, which he sill needed. “Cameron” had made major strides in his development, but was still an autistic boy with sensory needs. ‘Cameron” was working hard at school and in Music Therapy. He spent some time in an autistic classroom and some time in a typical classroom. ‘Cameron” had demonstrated reading skills in Music Therapy while still in early intervention, but did not always demonstrate what the teacher would ask of him (in the area of reading). Sometimes ” Cameron” did this because of distraction (other classmates’ behavior), and sometimes he did this because what he was being asked was something he had learned long ago. If not stimulated, it was still easy for “Cameron” to stare off into space and lose his attention. The Music Therapist decided to let Music Therapy be used as “Cameron’s ” sensory time. As she did this, “Cameron” demonstrated playful creativity while often leading the session, laughing and trying to trip up the therapist with his stops and starts. He really began to turn the tables on her as he started counting in Spanish in song and gradually picked up the speed. The Music Therapist is not strong in Spanish and often had difficulty keeping up. “Cameron” himself is not from a Spanish-speaking family, he was just very bright. As he was playing these games in Music Therapy, he also began to develop friendships in school, seeking out certain typical peers to play with in the regular education classroom. The TSS worker, who was with “Cameron” at school, also reported “Cameron” becoming more and more aware of his surroundings. She reported that when the children in the regular ed classroom sat in a circle on the floor, if “Cameron” sat a little inside the circle, he would notice himself and scoot back. In mid-summer after first grade, “Cameron’s” parents were transferred in their jobs, and “Cameron” had to move. “Cameron” continued to have areas in which he needed extra help (like all of us do), but was attending, learning, talking mostly in phrases and sentences, answering “yes” and “no”, making friends, and occasionally playfully testing limits like seven-year-old boys do. The developmental learning that took place did not cease when stress occurred. Stressful situations were not as common as they once were, and all that was gained in Music Therapy was transferred into every day life. I hope this series on “Music Therapy- From Attentiveness to a Functional Skill” clarified what Music Therapy is and what it does. I would love to hear responses to these articles and am wondering if those of you that are not familiar with Music Therapy have gained a different view after this series. The next series will be about gaining speech through Music Therapy- how and why. Antoinette Morrison MT-BC
I have written about self-regulation several times and have given a couple of visual examples on video. This week in my series on Music Therapy I hope to connect some of the dots. I have often talked in my newsletters about the humanistic approach in which I believe wholeheartedly. Although Music Therapy is “evidence-based”, I tend to avoid that term so that people can understand the humanistic qualities of Music Therapy instead of perceiving it as a rigid scientific formula. Music Therapy is evidence-based and individualized, as is any other therapy that is obtaining optimal results. I personally have witnessed, and have had parents of clients relay to me, experiences of other “evidence-based” practices having little positive effect. My belief about this is not that the practice itself is invalid; however, if the simplest humanistic qualities are forgotten when approaching our clients, results will inevitably be poor and possibly stressful. Practices that achieve maximum positive response are not “magic”, although when it feels that way, one can be certain it is most productive. Explanations can be scientific and humanistic. I believe witnessing results are much more profoundly revealing and truthful than reading results of a formula repeated hundreds of times. How do we accomplish self-regulation in Music Therapy? First, the child must be able to attend. This may or may not take some time. Following, discriminating, and identifying all become part of organizing. Here self-regulating may overlap some, but then one can move onto comparing, conceptualizing, and recalling sensory stimuli. As the therapist, up to this point, has followed the client and given his or her world structure and meaning (Part 3: Music the Organizing Tool, http://backmountainmusictherapy.com/2012/11/part-3-music-the-organizing-tool/), the therapist has essentially used music as a powerful non-verbal way of communication. A pathway to gently enter the client’s world gives the client the safety, security, and meaning that the client needs for entering ours. The shrouded life on uncertainty can be lifted. Music now holds the child’s attention and gives the child the capacity to concentrate. The child can then begin to work. In previous weeks, my client “Eddie” had slipped into some form of discomfort, becoming unregulated, behaviorally difficult to handle, and generally unhappy. By the continuous use of his “Click-Clack Song,” “Eddie” adapted to his recent nuances. At this point, nothing was demanded of “Eddie,” only reflected and structured. “Eddie” slowly decreased the need for such “atypical” behavior. He did not need to take his socks off or squeeze Playdough to feel alive and safe. As these sensory needs were met and accompanied by the same predictable tune, “Eddie” was allowed to feel safe and secure and begin to become aware of and enjoy moments of happiness (http://backmountainmusictherapy.com/2012/07/disconnect-to-self-regulation-all-systems-go-ready-for-take-off/). “Eddie” began to work again, dancing to the music, jointly taking turns, playing the recorder, responding to “ready, 1, 2, 3, play.” “Eddie” began to move beyond the point at which he left before deregulation. “Eddie” began to vocalize when he had a need, sequentially opening his mouth with babble (instead of a closed-mouth cry of frustration) when he desired something, or even just out of happiness. Music is now not only a predictable stabilizing experience, but one that taps into the client’s emotions. Through the emotions, the urge to communicate and share arises most strongly. Vocalizing or singing to the music is now the most direct expression of himself, his emotional life, and mental life, and is apparent in its physical, vocal, integrated, and intimate expressive act. Vocalizing to the music is a joint activity between the therapist and the client. In learning to control and predict the timing of sound, “Eddie” will improve his ability over time to integrate sequences of sound. Most recently, “Eddie” sings an “ee” sound at the appropriate time as the therapist plays two measures of the “Click-Clack Song” to “Eddie’s” brother’s spinning, then two measures of singing “squeeze”. “Eddie” instinctively sings in tandem with the therapist for the two measures of “squeeze.” “Eddie” is moving from babble to controlled, imitated sound. Situations may still arise that take “Eddie” to those uncomfortable sensory seeking states. Typically, he may even demonstrate his frustration in recognizing the detailed messages of sound and their meaning, but not yet being able to deliver it back in the way he wants. He does not have enough control over sounds to do this yet. However, as long as “Eddie” makes these developmental gains, even as his behavior may temporarily fall back to situational issues (like all of us), he has developed enough stability and regulation to pick up and continue development after temporary sensory needs are met. When a client reaches this point of self-regulation, the therapist can then begin to more purposefully set a structured session instead of always following. All of us, when under severe stress, need to have some stress relief before we are able to follow directions or give it our all.
The last two weeks I have talked about music therapy and attentiveness to our clients. Today I want to expand and talk about the results of these combined subjects, mainly the organization they help our clients to develop. As we promote music therapy as a nonthreatening medium, we often talk about how the qualities of music help to: captivate and maintain attention stimulate many parts of the brain provide immediate nonverbal feedback easily adapt and reflect an individual’s abilities tap the emotions in memory structure time in a way we understand support and encourage movement provide safety and meaning in an enjoyably repetitive context set up safety through structure effectively aid memory orientate success When we really attend to a client, noticing the most minute change or the most sublime form of participation, we can help our clients organize themselves tremendously. As we combine this reflective attending, the client begins to be able to build a rapport with the therapist through the emphatic dignity this encompasses. In combination with using the most basic formative element of music – rhythm- we not only provide more predictable safety for an individual who lives in an unpredictable world, but we also ultimately set up a sequential task in rhythm that occurs over time. Simultaneously, as this predictable sequencing is occurring, music provides our clients with a variety of sensory experiences, including vestibular, tactile, and kinesthetic. Many of my autistic clients, and some clients with emotional disturbances, relate to the world in more of a sensory way. As the client is drawn by a sensory experience that is not only predictable, but also reflective of his or her own experiences, the client learns to control and predict timing of sounds that will improve the child’s ability to integrate sequences of sound. As the client is drawn to something so predictable and familiar, then begins to move in response (even if the movement is as subtle as breathing), his or her movement to the music also aids in the integration of tactile, kinesthetic, and auditory perception, and the differentiation of what is “self”, and what is not. I always have mirrors in my music therapy room. Parents have often told me as they observe their child look and play into the mirror that they do not even notice the mirrors at home. Here is one example – http://backmountainmusictherapy.com/wp-admin/post.php?post=865&action=edit. As my nonverbal autistic client “Frank” entered the room, I was determined not to lead this boy at this time. We had been in a stage of wandering and I decided I needed to watch and reflect. “Frank” was quite aware and wants more, but at this point was frustrated with his inability to organize himself enough in order to respond in the way I was expecting. The response I was asking for was based on his understanding, which was farther ahead than his organizational ability which would allow him to respond in a way that he determined. I followed “Frank” musically the first couple times as he spun around in the spinning chair, not only was his vestibular sensory need met, but he was also given a predictable repetitive sequence of tones and words. “Frank” then began to relax and gently respond (although not yet frequently) vocally in a gentle song-like manner. “Frank” began to feel happy and laugh. This was a first for me to hear. I continued to follow his lead. I sang about the Q he purposely pulled from my chart, and he smiled again. By the third session of this, as “Frank” spun, he began to tap the drum at the end of each phrase, maintaining eye contact with me. I continued singing “round and round” as he spun. “Frank” then held up his arms and began to rotate each forearm around the other. No pop-out words or miracles that day. Yet a step-by-step integration began to evolve. “Frank” was gently vocalizing to the music in a relaxed, undemanding manner. He was playing sequentially with me on the drum while moving in a way his body was propelled to do. He was demonstrating to me that he understood the words I sang while he watched me and began to rotate his arms as he spun his body in the chair. Music is a wonderful, associative, organizing tool. In combination with dignified reflective attending on the part of the therapist, music helps a disorganized body or brain regain enough control to make sense of the world. Our actions and thoughts have the most impact and give us all a great sense of satisfaction when they are carried out in a way that we can control. When we can organize ourselves wholly – mind, body, and spirit at once – we can accomplish what we want, giving us satisfaction and a sense of self.
The picture at the beginning of this newsletter is one of my grandfather and myself as a child. This is one of my favorite pictures because it captures the quality my grandfather had that is missing in society at large today. My grandparents lived across the street from me on a farm. I voluntarily spent a lot of time there. My grandfather was probably the kindest, most everyday person that I have ever known. By that I mean he did not do anything that would ever go down in history, but in his day-to-day interactions, he paid attention. He always put others’ needs first in a way that just seemed very natural and unnoticed. He was always helping, but again it was just his sublime way of life; nothing ever hugely noticeable. I never heard the man complain and he never put anyone down. I use this picture because I always loved to tell my grandfather news, whether it was the new doll I got for Christmas at age three or the things I was learning in college about music therapy. It never mattered because the look in the picture, the look of, “That is amazing!”, was always the message conveyed in his eyes and his complete attentiveness to the person speaking. When my aunt compiled a history of my grandparents after they passed, my though tupon seeing this photo was that every child should have someone that looks at them like this when they have a message to deliver. Not all children are verbal, or can even make eye contact, but every child is human and needs this too. This attentiveness to a child needs to take priority over any babbling goals, pointing goals, social goals, or self-help goals. This kind of attention must come first. Children, above all, as Maya Angelou put it, “will remember how you made them feel.” When I get to a place with my clients where I feel lost and I don’t know what’s going on, I don’t know where to move, or in which direction to go, I go back to this: watching the child. I watch the child and reflect their human dignity back to them, via the music. Whatever gifts or strengths they bring to the session are valued. Sometimes the miracles happen as soon as the music reflects. For example, those who previously did not give eye contact suddenly meet my gaze, if only for a moment. On the other hand, sometimes processing needs to happen first. You just have to persist, keep reflecting, and watch for the subtlest of change. Upon first glance, it may seem like the child hasn’t moved or grown much. However, when you start to use the elements of music – rhythm, dynamics, tone, etc. – and match them to the child’s displayed behaviors, one must alter the elements slightly as the minute displayed behaviors begin to alter. This is the beginning of attentiveness. Transformation has begun. It may not be dramatic transformation, like a caterpillar to a butterfly. It may be a less obvious growth, like grass growing. One never really witnesses the change, as it happens on a very subtle continuum. Sometimes it seems, as professionals, we tend to be human. When we don’t understand how to reach these kids that react so differently to the world, we unknowingly tend to treat them as if they are not sentient. We need to remember this. I truly believe that when you look at the way we feel inside, these kids are exactly the same as the professionals that work with them: emotional beings. Last year, I ran into Maya Angelou’s above quote three completely separate times in a two-week period. I figured I was supposed to pay attention to this for some reason. Those of us who are able to respond to the world in a typical manner must take responsibility for our actions and thoughts in this regard when working with those who do not respond typically. Musically, we can relay this message to the children who do not respond in this manner by being reflective in the use of the elements of music, for example, by matching rocking movement with an ostinato rhythm. Not only conveying to our clients that what they bring is good enough and valued, but also giving their strengths structure through the predictable rhythms and tones that lead somewhere. As their vigorous nervous rocking slows to a calming motherly rocking, the dissonant, loud music reflects this in its transformation to a relaxing lullaby-like quality. The basic ostinato structure stays the same reflectively, yet mellows and transforms, allowing our client to finally direct his or her own growth. As my grandfather aged, and it was apparent that dementia was hovering over him, the grange to which he and my grandmother belonged celebrated him while we were still able to recognize his appreciation. I was away at college, but I wrote a letter to be read at his celebration, ringing true Angelou’s quote. I recalled living in the bitter cold of every upstate New York winter to “help” my grandfather with the chores. After chores, Saturday was the day to clean the gutters in the dairy barn, and then take the wagon filled with fertilizer to the fields. If I was home, I didn’t miss a chance to ride on the tractor with him. I am certain that it was not the activity itself (above all, I hate being cold) that I enjoyed. It was the company I kept, and how I felt being in that company. My grandfather’s attentiveness had captured my own.
PART 1: MUSIC THERAPY This week’s blog is the first part of a 5 part series, Music Therapy from attentiveness to functional skills and optimal health. I had been supervising a Music Therapy student this week and posed a question to her. A little behavioral problem arose with an age group that she had been working with. I was very familiar with this population and knew why the behavior occurred, but many times especially with clients that we are not familiar with yet, we do not know why things are happening. So I posed the question to her “what musical elements could you have employed to re direct the situation”? People around where I live are not yet very familiar with Music Therapy. The conclusions that people tend to draw are “well if speech therapists work on speech and physical therapists work on strengthening our bodies, then Music Therapists… must teach music?” Each of the above disciplines works to repair or improve something very specific. All therapists in all disciplines however are confronted with why and how. Music Therapists are trained with a tool, Music. The elements that put organized Music together are rhythm, tempo, dynamics, timbre, pitch, texture, and meter; these are our tools. Our tools don’t always tell us why or how but with observant planning can take us from point A to point B. To get back to my student – she gave me the answer I was looking for, there were two obvious elements that she could have used and she described how. I went on to tell her that depending on where you work, you may have a quick turnover of clients or have to switch populations for one reason or another. However, no matter how well acquainted you are or not, when you focus solely on the individual or group, when things start falling apart, follow the client and use the elements to facilitate. When you are fully focused on your client and meet what they are presenting you with, the pathway that you will take will be outstanding. My best work has evolved out of watching my clients. I have been very surprised musically at what I have done and the results. Music is the universal language, maybe not always able to convey specific ideas however, vitally able to convey our deepest emotions. It can motivate, relax, energize, comfort and express. After careful watchful assessment, siting needs and strengths, no matter the difficulty, Music Therapists make use of the elements to illicit, redirect, accompany, reflect or meet a client where he or she is. The music carefully composes a pathway utilizing strengths to aid needs. The Music Therapist will adopt or alter the musical elements to help a client towards health or growth. Since music is the universal language, it speaks to individuals of varying cultures, religions, backgrounds, abilities or disabilities. Our tool, music, is processed over both sides of the brain. With recent research findings on the plasticity of the brain, music is probably the most malleable tool to utilize or aid those not only with neurological disabilities but physical and emotional as well. The elements of music can also act as a unifying agent, bringing a group together, focused yet meeting individual needs. Music, in and of itself, can provide therapeutic effects, however when people are trained in applying the elements of music, and basing their use upon what they are presented with in their clients each time they work, the results can be astounding. I have witnessed speech out of non-verbal clients, children who appeared unable to bear weight or balance their bodies, sit erectly as the music begins, individuals who gave no eye contact, look directly at the music therapist first. If speech Therapists work at gains in speech, physical therapists work on strengthening bodies, music therapists utilize their tool and what a client already posses to gently meet or facilitate the clients greatest need. As with anything else, when all team members are working together with a focus, any situation, group or individual receives it’s maximum benefit. Music Therapy, a therapy without negative side effects, in one that promotes a clients already existing strengths to achieve optimal results. As was mentioned in the beginning, this is the first part of a five part series, tracking Music Therapy from it’s ability to elicit attentiveness, organize, aid in clients gaining self regulation abilities to functional skills and optimal health.Music Therapy is not about teaching musical skill, although that may be a by-product, it is about a gentle process of adapting music in order to elicit gains in health and wholeness.
This week, I continued my thoughts from last week; to Support What is Given and Give Structure. Previously, I had trouble with my client “Frank”, staying engaged and wanting to leave the room. In my anxiety about this, I continually kept presenting new material to “Frank.” Last week’s blog (http://backmountainmusictherapy.com/2012/09/support-what-is-given/) presented a video clip of Frank staying and briefly engaging with the music. I know that “Frank” likes to rock or swing, but lately, he seemed to need to move on. The vestibular input had seemed to calm the existing anxiety, however, now seemed to move “Frank” to lethargy. Keeping in mind the comments “Frank’s” mother told me about recent needs of “Frank” to keep things in a certain place and in a certain order, and the recent stress in the home caused by the many people visiting the home. This prompted two thoughts. “Frank” either a) needed sameness to feel safe and needed predictability, and/or b) he needed some control over things. Right before “Frank” came for his next session, I decided to put a rolling chair in the room. I wasn’t sure why the chair, but was firmly resolved that “Frank” needed to lead . I needed to not only observe more closely what Franks control looked like, but also how it was employed. “Frank” spotted the chair and sat in it right away. He mostly rocked or shuffled back and forth in the chair at first. I sang and played subtly to the rocking, allowing the music to reflect the subtle rocking. He gently played my chimes now and then, and grabbed my cabasa and sounded it with his movement. Subtle vocalizing followed. Then combinations of the vestibular rocking and spinning, playing and vocalizing emerged. As one response was reflected back in the subtle manner it was displayed, another response emerged. A look of peaceful happiness covered “Frank’s” face as he closed his eyes and listened also. Lastly, as he slowly spun, he opened his eyes and sustained eye contact with me for the remainder of the session. As he stopped moving, so did the music. His brief vocalizations began to match the tonality I played and sang in. Not only were there no attempts made to leave the room, but also yet at a sensory level response, “Frank” stayed jointly engaged with the music and myself. As we peacefully ended our session, I had to lead Frank out of the session this time. I thought the session had ended well, staying jointly engaged and leaving the room peacefully regulated and content. I thought the session had ended well as I closed the door to begin his brother’s session. A new, completely different session with not so subtle dissonant chords, high pitched, accented music. My assumptions were wrong however, “Franks” session had apparently not ended. “Frank” let himself in and began to engage to his brother’s vastly different music, this time seeking my eye contact. As I continued to play his brothers music, both the boys actions and sensory responses were integrated into the music simultaneously. Although the boys attended each to me, and to the music, at this point they seemed unaware of one another. However “Frank” not only engaged, but remained and stayed engaged with this foreign music for the entirety of his brother’s session. Follow to regulate, follow to support, and follow to engage.
I have written on “The Importance of Giving Processing It’s Own Time” http://backmountainmusictherapy.com/2012/09/the-importance-of-giving-processing-its-own-time/ , but this week one particular example displayed a reason I had not yet considered. I have 2 severely autistic clients that are brothers. The younger “Eddie” appears to have slightly more difficulty with sensory issues. When he gets frustrated, it is very visible and unpleasant. He lets out his discomfort in a frustrated cry for help displayed in lashing out (if pushed) or non-compliant, tantruming behavior. His older brother “Frank” is just the opposite. He does not appear to have as many sensory issues, but I believe is quite aware and intuitive of what people want, are like and what different situations are like. Both boys are currently non-verbal;. “Frank” often knows and realizes he can not get his point, his thoughts, his wishes across. Anxiety seems to be a large issue for this subdued child. When “Frank” can’t get his point across, he shuts down and gives up. You can see the sadness on his face. In Music Therapy, he tends to head for the door. I assume this is because he knows a) he gets a response to change the situation, and b) it gets him out of the discomfort of not knowing what to do next. I have made the mistake of coming in, feeling or thinking I need to keep presenting him with new things to get him to be more responsive. What I am actually learning is that yes, he does feel this anxiety of not knowing what to do – but that is ok in the Music Therapy environment. In school, professionals teach and observe or test to see if a new skill has been learned. I believe he understands this expectation, but would like to avoid the anxiety of not being able to respond. This repeated expectation of no response creates more anxiety . In Music Therapy he heads for the door. At his last 2 sessions, I did not allow the door to be an option, we worked through it. I realized my assumptions were correct because not leaving the room did not seem to be an issue. Instead, he sat back, rocked in the glider to the music and began to play with the instruments and his voice. (The videro is taken after the door option is closed, this is what happens next: No expectation, in the moment, creative play. If there is ever a hope for language, first “frank” must be comfortable using and playing with his voice. This is where the aim should be. My experience and belief tell me that when non-verbal children believe that they will not be heard, they stop using their voice. The expectation then becomes the reality. (who then is the ones having trouble reading facial expression?) The outcome of the play then is two-fold a) it decreases that self-choking anxiety, creating space for curiosity and learning, and b) it gives “Frank” opportunity to just relax, and play out of that curiosity. It unlocks that self-choking anxiety and creates room for spontaneity, creativity, relaxation and play. In my eagerness to be a good therapist, presenting new things each time, I have created that anxiety, plugged that “Ready for Take off” curiosity http://backmountainmusictherapy.com/2012/07/disconnect-to-self-regulation-all-systems-go-ready-for-take-off. I do not know how things are processed in “Franks” brain; only “Frank” experiences what he can work, how, and what he can not. I need to help him relax by eliminating that heavy expectation bar, let him show me what he’s got and support that. If I can support that musically, give it some structure in repeated experience, he can play with it, experience some predictability and control on his own and that is where the path that we take lies.
I had waited on this blog, unsure what to write. I had had a huge success this week. Last year, when I wrote “Don’t give Up On Speech!” (http://backmountainmusictherapy.com/2011/10/dont-give-up-on-speech/), although all the non-verbal children I had worked with had progressed from no speech to beginnings of speech, to labeling and even complete sentences, I had one exception. This week as I sang “you, you, you” and my one exception sang “oo” back to me, then sang me, me, me and had “eee” reflected back consistently, I felt relief and excitement! As this little boy next got onto the therapy ball to bounce to the music, his first sound was “ba.” This was a great day! Later in the week, I had worked with a little girl who has a rare chromosomal syndrome which leaves her with severe developmental delays. Although 5 years old, she appears more like a very lean 12-18 month old. As we made music, she just seemed to flourish with unexpected growth! This little girl, who came in haveing difficulty sitting by herself, was bouncing up and down, standing, and holding onto my piano. The little girl quickly grasped objects with one hand or the other and dropped them, then took my shaker with both hands at mid-line for about 1.5 – 2 minutes and played with it. The little girl who could barely wiggle my lightest drum beater, was intentionally hitting the drum head over and over on this day. This morning I worked with 2 groups of typical children. They were enticed and attentive. This experience of standing up, moving around, singing, playing, and listening was very different than the classroom experience they had been having. Why were all these things working so extremely well today? Would I have to explain myself to the typical children’s teacher? The answer to both these questions was “teaching with or meeting the senses.” I’m not sure why sensory therapies are questioned so often. Young children, including typical ones, learn best when utilizing multiple senses. It is a very rare occasion that, when working with individual children in therapy, that I don’t follow the individual initially when they first enter the Music Therapy room. Children come to Music Therapy from many different circumstances: after a bus or car ride, after a long day at school, before the school day even begins, tired, stressed, or anxious. I sometimes know what their day has been like. They first must-be regulated and “Ready For Take-Off” (http://backmountainmusictherapy.com/2012/07/disconnect-to-self-regulation-all-systems-go-ready-for-take-off/). Some days, all I hope to accomplish is to sooth the stress and get to this state of being. The little boy who sang back “oo” and “ee” to me has spent several sessions bouncing to the beat on a therapy ball and trampoline, and raising his feet as I tap them with a lollipop drum singing “feet” or “toes.” I can’t say how many times he left and I wondered if I was actually doing anything helpful. I always have to look back and give processing its own time (http://backmountainmusictherapy.com/2012/09/the-importance-of-giving-processing-its-own-time/). It took one year, from throwing himself on the therapy ball, never putting out his hands to keep himself safe, to intentionally maneuvering safely on a therapy ball in ways I’m sure I could not do safely. It may have taken this boy more time than others to say “oo” and “ee”, but all the things he has accomplished on the way- the receptive language skills, the vestibular and proprioceptive development, and the increase in social skills- are equally important and precursors to these sounds. Watching the children, letting them show me what senses needed to be stimulated, calmed, or fed – then reflectively writing and thinking, “Where should we take this?” This has never led me astray. Watching the child, and using deep listening skills to meet, feed, or nourish the senses have never disappointed me, nor the child! Feeding the senses is the key to treasures yet to develop.
This week I read two articles that made an impact on me. One was about “Deep Listening,” and the other was “Autism and the Expected-Unexpected Social Thinking Vocabulary” (http://www.autismsupportnetwork.com/news/autism-and-expected-unexpected-social-thinking-vocabulary-2782942). Earlier this week, I also had a conversation with my son, a high school senior who is taking an AP Psychology coarse. He was telling me about a discussion they had in class concerning whether any knowledge at all was innate or all learned. He began to tell me about a behavioral experiment in which the facilitator taught a baby to fear rats, a fear which the baby had not had before the experiment started. Sarcastically, I told him that the final answer to all behavior problems; behaviorism. Now don’t get me wrong, I use behavioral techniques all the time. Behaviorism is extremely useful and necessary when implemented correctly. Behavioral techniques can be a terrific partner to other types of therapy. However, it seems to me that the prevailing thought among most is that kids need to be taught to listen and follow through. If they are not, then consequences must be implemented. What I think we often times forget, or miss completely, is that we are teaching loads unintentionally. Kids, including those that are autistic, behavioral, or have special needs are picking up much more quickly on the things on which we aren’t even thinking. I think all kids are always listening deeply. We are actually throwing the ball at the wrong target. Kids are naturally always learning and listening to the things we don’t even realize we are doing or teaching. They see the irritated look in our eyes and the hands on the hips, they hear the frustrated sigh and tone of voice when they are not getting it, or when something else in our day gets in the way. I know if I’m working musically with a group of kids and a group of adults, although I may have to ask the kids to look at me a couple times, or hear incessant chatter at times during a practice, the kids always naturally follow me. This is constantly demonstrated when unplanned, unrehearsed, unexpected things happen in a performance. The kids will look at me like “What’s going on”, but they will automatically follow the music. Adults, on the other hand, tend to stop or stumble until they find firm ground. In the article “Autism and the Expected – Unexpected Social Thinking Vocabulary” (http://www.autismsupportnetwork.com/news/autism-and-expected-unexpected-social-thinking-vocabulary-2782942) found at the “Autism Support Network”, describes expected and unexpected behavior. This behavior is based on how one is left feeling – not exactly what is said. Most all kids pick up on our irritation, need for control, what pleases us, and what makes us uncomfortable, all without us adults ever having to utter a single sound. I believe that children with even the most severe processing difficulties pick up on these things also; they sense our general intentions, our feelings towards them, and our expectations towards them. Why are we always trying to teach kids to listen better? They are. They are often times listening better than ourselves. Maybe our work would be more effective if we tried to teach and listen to the student we see in the mirror. Sometimes, this is where the deepest listening needs to happen. Maybe the best way to lead students and teach is to “teach” very little, listen a lot, and then facilitate. All children know innately, “All behavior is communication.”
I have often heard teachers or therapists’s ask the question, “what motivates her?” or “I can’t find anything that motivates him.” Well stop looking, it is found. It is usually being demonstrated when the child is left to his own devices. The answer is 1) watch, 2) listen, 3) mirror, and 4) watch again. Watch and see what the child does. Is it rocking, flicking fingers, is it clapping hands repeatedly? Whatever it is, mirror it, mirror to a simple tune which can be repeated – then watch and see what happens. Is the child looking, smiling? Although the behavior may be unusual from what a nuero-typical child does, the child is receiving something motivating from doing it. As we all know, spectrum children have many sensory issues, an observed behavior is probably satisfying something. It is not necessary, at this point, that we understand what the behavior is satisfying, all we really need to know is what motivates, or satisfy’s this child. Remember, 1) watch, 2) listen, 3) mirror, and 4) watch again. See the result you get from mirroring back that behavior. In previous blogs, I have written about “Eddie” (also containing a video clip. http://backmountainmusictherapy.com/2012/07/disconnect-to-self-regulation-all-systems-go-ready-for-take-off/) and his “Click Clack” song Eddie carries a matchbox car which he holds by the wheels and flicks back and forth repeatedly. We have developed a “Click Clack” song to accompany his stim.As the music ant the stim are matched, the therapist can vary the tempo and the energy of the tune and “Eddie” will follow the music, staying connected in a co-responsive activity with the therapist. As “Eddie” plays, he gives eye contact to the therapist, engages in turn taking activity and follows 1 step verbal direction. This week “Eddie” needed to be carried in tot the Music Therapy room. Recently, in Music Therapy, “Eddie” has been sitting in the corner, pushing his hands along the carpet. As he waits for his session in the waiting area, he pushes on play dough. Last week, I happened to have left play dough sitting on the piano. As “Eddie” was carried in last week, he immediately spotted the play dough, grabbed it and started to squeeze it. I used his old, familiar Click Clack tune and started to sing about the “squeeze” of the play dough that he was engaging in. Although the TSS remained, “Eddie” connected with me through his vigorous play dough pushing with frequent eye contact. This week, upon being carried once again into the Music Therapy room, “Eddie was given the play dough. I left the piano and used only my voice as I squeezed the play dough in both of “Eddie’s” hands, then his feet. “Eddie” then pushed on pillows with his feet, allowing me to hold the pillow. “Eddie went from displaying anxious, frantic behavior to spending most of the session smiling at me maintaining sustained eye contact., shaking his head “yes” to my assistance and continuing to gesture for my continued assistance. “Eddie’ left the session calm and happy, not displaying the anxious, frantic behavior that he entered the room with at the start of the session. “Eddies” sensory need had been met. Did he learn or develop anything this day? I don’t think so, but he did leave the room displaying calm, attentive behavior. “Eddie” displayed trust in the therapist by smiling, giving very consistent, sustained eye contact, answering “yes” with a head shake to assistance offered, and reaching for what was needed, employing the therapist’s help. “Eddie” was able to trust the therapist, the therapy routine and the environment. As in Maslow’s theories, physiological needs must be met first, and then trust must be established before other higher learning is to occur. Watch, listen, mirror and the watch again.
This week, as my own kids have headed back to school, I thought it might be the appropriate time to talk a little about those “aimlessly wandering” times in Therapy. The time when it seems like you, as the therapist, and the client are a standstill. As I had mentioned before, I do believe those times are quite necessary to the Therapy. Although we cannot see any outward or forward movement, we need to try to remember something usually is happening. It will help us feel better about our work and more directed if we can begin to identify what is really happening. First, I think anything in life needs room to swing to exist well: right to left, up to down, yes to no, black to white. We as humans are not created to be any one way all the time. In fact, I believe that is how development occurs. Sometimes we even need to take a few steps back in order to get a running start up a hill. On that note, when I assisted in cross country, one life lesson that was repeated over and over and over again was “pace yourself – don’t start out to fast”. Many junior high and high school students consistently had a hard time with this, however true it was. The kids that save their strength for the end had better outcomes. The kids that started out at top speed lost their momentum early. Sometimes we have clients that as soon as the Music Therapy door closes they show us a completely different person. Then there are those who take time to show us their improvement. It is a huge disappointment when those “New Person” kids go for a session, or several or several months not showing us what we expect to see. To understand this I had to equate it to my own journey. When my kids started school, I dreaded the school year beginning. The school day began late and the kids arrived home at dinner time. My kids were mentally done and crabby. I was the prison guard making sure homework was done – trying very hard to focus a very young immature 5 year old boy. We changed schools and it was wonderful. The day began and ended earlier which was much more conducive to my children’s learning. I was much more informed and soon began working at the same school. I enjoyed every holiday, was well informed and known, was part of a wonderful group of adults, and was responsible for 20 some other little preschoolers to focus on while mine were away. Since we lived pretty far in the country, errands, groceries, and everything else was done with the kids. As my oldest transitioned to high school, my job transitioned to new place – still with little ones. Now my kids needed me to cart them from activity to activity after school, and then I began to know the people with which they spent leisure time. As my oldest was making the transition to college, I found I was doing very little Music Therapy at my new school and a lot of other things I did not wish to be doing. I transitioned into private practice. Although I was learning a lot of new things (business basics, computer basics, social media, becoming reconnected, and many other things), it was the first time in 20 years I did not have a group of kids around me all day – it was quiet. One would think quiet time would help focus. It always used to help me, but not now. For the first time ever the very structured and organized Antoinette was having difficulty planning her day, knowing what needed to be done and remembering things. Although I was beginning to pick back up on my dream, and had the time to do what I needed to, the quiet, 9:00 to 1:00 hours were very hard to structure. I felt that unfocused wandering feeling because for 20 years what I was used to and familiar with functioning at was missing. I was growing, my kids were growing, and we were all headed in healthy places, but I was uncomfortable. This quiet working alone was very very foreign now. I had to relearn how to function this way and enjoy the difference. Learning how to utilize social media and my computer felt like learning Chinese at times. This blogging business was baffling – what do I write about, how do I know if I am doing it right? Is anyone going to read this? Is it really going to help my business or am I wasting enormous amounts of time going nowhere. This computer does not give me eye contact! It took awhile to give me feedback. As my kids started in with half days, my oldest went back to college, I found I was very busy every minute. I was relieved that some of my sessions had not begun so I could catch up on some business work. I actually have learned to let my week and my thoughts become more reflective by writing them into my blog. It took me a year to look forward to the larger chunks of quiet time to be able to use my creativity. I needed to be able to process the changes until they not only became familiar but comfortable. Sometimes the re-learning is initially much more challenging than the existing compensating behaviors and skills our clients have developed. These skills or behaviors have become easy because they have been repeated over and over. Our clients have adjusted, and readjustment can be initially uncomfortable even if it is more healthy.
This week I thought I would keep the writings short and give a little visual commentary. I think when it comes to the communicative abilities of music, as Victor Wooten said, “In some instances, music works better than the spoken word because it doesn’t need to be understood to be effective.” This last week I had the wonderful experience of playing for an anniversary mass. The church was filled with people, all of whom sang, even those who only knew a few others present. I have never, ever played with so many voices in my life. To ice the cake, I also played the mass with a violinist whose playing just must have ignited everyone’s heart to sing. Never having played together before, we tossed melody and harmonies back and forth moment by moment. Having spoken later, after the mass, I had found out we shared many of the same thoughts about the communicative abilities of music. To play and experience music with so many people at once – from the well trained violin performer to the mass of people in the pews, impromptu, was exhilarating! The next day, I met TJ, a brand new client. TJ, being a bit shy at first, came in and did not do much or say much for quite some time. But when we got the music started, even though there was just one other person in the small room, who simply enjoys music with his whole being – the experience was much the same. We all connected through the music, united in our differences. I guess the ability that counts most is the ability to let go, listen, and play or sing, not just with your head, but your whole self! (A little addendum about the video, a big thanks to my son’s long time friend Joseph. Having computer problems, despite my husbands and sons’ warnings “Don’t do it Joseph, once you start, she will skype you at college to find out how to skype,” Joseph still assisted me with the video and fixed my trumpet. (another promising young engineering student) Thanks a bunch Joseph!
Last week, I wrote about listening in order to figure out the information that either we have not been given concerning the children we work with or finding the clues that we need to progress (http://backmountainmusictherapy.com/2012/08/what-to-do-with-missing-pieces/). Someone asked me if I thought that was a skill one could develop, or if it came from years of experience in working. Like anything else, some people are much more perceptive than others. and yes, years of practicing anything makes you better. I do, however, think that there are several direct steps one can take to develop this skill. In the world of multi-tasking, deadlines, result orientation, and evidence based research, we are all looking for the results, progress, and tracking the numbers. In the pressure to do this, we may be missing key evidence or clues we did not even consider that make a big difference. How do we find these clues? They are quite often right before us. But how do we see them? STEP 1: TAKE A BREATH – Having a clear mind helps. Even in my private practice, I have to slow down my life and make sure I give prep time for my mind. If I go from one thing to the next, I actually end up taking twice as much time in the long run to do a good job. I give myself time to look over the notes from the previous session and remember what happened last. This takes ten minutes, tops. In facilities where it is beyond your control, you see clients back to back – a shorter, more focused session is still more productive than “time put in.” Take a breath before entering the room, clear your mind for your client. Fight the urge to take on more than you can. The most productive person is not always the one with the most clients, it’s the one with the best results. Parents, when you are with your children, sometimes just watch. Do this especially when you are feeling the most frustrated. Step back from the frustration and just watch. STEP 2: TAKE NOTES – If you absolutely have to, shorten your session to write down a quick reflective note. This is also part of your focused work; it is time dedicated to your client. It will save you time in the long run. Like anything else, starting this process takes the longest. Parents, when you see things that you feel are significant, but really don’t know why, make a note someplace. Keep that notebook in a safe place. Write it down, and over time you may have what you need in order to give helpful insights to others working with your child. This gives evidence, not opinions. STEP 3: MAKE A VIDEO OR AUDIO OF YOUR SESSION (Get written permission first) – I do not view all my videos, seeing as there truly is not enough time. When I cannot figure things out, get stuck in a rut, or when those unforeseen things happen right after a session when note taking is not possible, a video is a great tool. Often times, I noticed things on my video as an observer that I did not pick up on in my sessions. It is a wonderful “nudge” tool when I feel lost and wondering with a client. It is also a great tool to have on hand when asked for progress over time. There is nothing like a visual to testify to results. STEP 4: KEEP HELPFUL RESOURCES CLOSE BY – This could mean professionals, friends, books to consult, or helpful websites. I have two resource books right at my desk. When unsure of what is going on, I get out my books, and they almost always help give me direction. Often, clues I noticed and felt were significant (and did not know why at the time but wrote down anyway) are put together here. The resources help me to put the clues and pieces together and make sense of them. Parents, keep supportive friends and insightful professionals close to your side. Consult them often. Let them help support you. STEP 5: GIVE YOUR MIND QUIET TIME – Make sure you give yourself uncluttered quiet time when doing paperwork. DO NOT MULTITASK. Paperwork time is often time when epiphany happens. Clues are strung together and begin to form a map. As much as I dread the hours of my end of the month paperwork, it does become refreshing as things start to make sense. When I begin the new month, having added up the clues, percentages, numbers, and consulted my resources, I feel like I know where I am at and what I need to do, but most importantly, where my client is. When I walk in that way (even if my assumptions are wrong), the sessions seem to direct themselves effortlessly. STEP 6: SURROUND YOURSELF WITH POSITIVE LIKE-MINDED PEOPLE AND CONSULT THEM OFTEN – People who support your thoughts help keep your mind open to what is really happening and where it is going. Those who do not support you close your mind as you tell yourself “no, can’t be.” This eventually leads to frustration for you and your client or child. STEP 7: LET YOUR CLIENT/CHILD DO THE WORK – Watch, watch, watch, and listen, listen, listen. The most “uncommunicative” client is constantly telling you what works and what doesn’t by his or her behavior. Remember the quote from one of my earliest blogs, “All Behavior is Communication.” http://backmountainmusictherapy.com/2011/11/treatment-of-autism/ STEP 8: TAKE A BREAK – Take a break to go back and take a look at those “unproductive” sessions. Looking back by reflecting or watching a video may show you things you never noticed in the session. I will go into a session often with expectations. When those expectations do not happen, my mind becomes closed to reality, to what direction my client is taking. It is the client’s direction – not mine. STEP 9: When you feel things are significant, but don’t know why, write it down. It may make sense later, hindsight is 20/20. STEP 10: FOLLOW “GRANDMA’S RULE” – Do what you need to do, then do what you want to do. Procrastination clutters the mind. Parents, on the other hand, it is good for you to just step back and have some fun with your child. Professionals do not spend most of your time with your child; you do. STEP 11: GIVE YOURSELF A BREAK – No one takes a direct path upward without a break, a little slide back, a meltdown, or everyday life just butting in. Remember, your clients are individual people too. Some can move faster than others, some take more time than others, and bad days happen to us all. Be patient with your client (child), be patient with yourself. Quiet times in therapy are as necessary to the therapy as sleep is to daily life.
This week, some of my work was cancelled so that I could work at a week-long camp I agreed to work at one year ago. The children at this camp were not children I knew much about personally, and did not have an opportunity to get to know individually. After writing last weeks blog about Mastering a Skill; Measurement of Progress and Actual Development (http://backmountainmusictherapy.com/2012/08/mastering-a-skill-measurement-of-progress-and-actual-development/), I realized something. I had talked about home conditions of which a teacher or therapist may not be informed. What does one do without background information? One must do the best they can AND pay attention to those “little” signs that catch our attention briefly, or things that don’t quite add up, but we cannot pin-point. Sometimes there are so many priorities to take care of, we notice something but quickly move on because we have to, and then forget. I once read an explanation about intuitive feelings that made sense to me. The article mentioned (I do not remember where I saw this, I only remember the information) that “intuition” is not as mystical as some people think, but instead is many little things on which our sub-conscious mind is picking up. However you explain it, these things can be very important. I first thought about this when an adult friend of mine was going through therapy. She had endured years of sexual abuse at the hands of her own father. During her course of therapy, I happened to witness a very violent physical reaction she had in dealing with the issues that were being brought forth. Up until her point of going to therapy, she had only told one person of this trauma. I remember thinking as I watched, “Didn’t anybody ever notice anything wrong?” A true story. My oldest son came home from second grade one day and proclaimed to me that his friend “Christian” had failed a test and never studied. At the time, I probably was able to put a face with the name, but did not know anything much about this little boy. I found it strange that Nicholas even said this, since it was not something that ever seemed to concern Nick at this time. I told my son, “Nicholas, you don’t know that, you don’t know what happens at home,” listing a couple scenarios. We had left that school at the end of the year, but remained living near by. A few years later, we joined a group and quickly learned that “Christian” and his family belonged there also. Nick and “Christian” are now 19, and have never again attended the same school, however the boys continued to get together throughout the years despite their busy schedules. They have remained friends all these years. Years later, I found out the at the end of that same school year, “Christian”‘s mother had him tested elsewhere and found out he was dyslexic. “Christian”‘s mother confided to me that he did not want to go to school and would wake up during the night crying . He did not want to get into trouble any more. Nick and “Christian” have remained friends regardless of this conversation I had with Nick years ago. However, what a great teachable moment this ended up to be. We don’t always have all the information, but sometimes we dismiss things that may make a big difference in a child’s learning progress. We might not be able to correctly label these things, but they may be worth paying attention to. Time will most likely give us some insight later.
Earlier this week, I had read an article by another Music Therapist, Kimberly Sena Moore, on being stuck in a rut in therapy ( http://www.musictherapymaven.com/stuck-in-a-rut-11-ways-to-get-your-music-therapy-mojo-back/ ). Her timing was perfect with this article. This had not been a glorious therapy week. I had also read several articles on sensory integration therapies being valid practice or not. In combination with the ongoing Olympics, I thought this would be a good time to talk about mastery of a skill, measurement of progress, and actual development. Our Olympic athletes certainly are an example of that: hours and hours, years and years of hard work, and look at the amazing results. Some, like Michael Phelps, master and achieve multiple times. Some winners, such as the gymnasts, win by a score given on predetermined standards of gymnastic events, but yet still by subjective scores given by human beings, or the judges. Others prevail by proving themselves better, stronger, or faster than their opponents throughout a number of contests. In education, mastering a skill now means it is easy for the student to reproduce over and over what you are asking of them, simply put. The skill is past the stages of emergence or developing; it is now mastered. Therefore in school, the child should be currently learning beyond that mastered skill in the best of all possibilities. This seems to make perfect sense. What about the winner of a spelling bee, who has outlasted all his / her opponents in their own school and others? In order to achieve this, he or she must learn countless words, suffixes, prefixes, and both basic and complex rules of the language. But what did we forget? What about the child who is innately smart, never studies spelling because he / she goes home at the end of the school day and makes dinner for him / herself and three other siblings because their alcoholic, single mother is often times not able and incapacitated? After dinner, this child takes care of mom and does anything to keep her from flying into a drunken rage. Did this child have someone studying with her daily or encouraging her all the way? Did she even know if there would be study time available when this she came home? It had nothing to do with safety or security or food. When she got to the microphone, she was presented with a word which most kids her age could not spell and probably secretly thought, “Whew. Glad I didn’t get that one”. As she was about to take her turn, her mother came stumbling. All the child wanted was to hide, and as a result misspelled the word. Spelling the word suddenly sank to the bottom of important things to do. How about the child who never does homework, and is failing the class because of this? This child not only passes each and every test, but soars through them. The evening prior to the PSAT test, he is up all night huddled with siblings as his mother is taken to the hospital and her boyfriend is taken to jail for beating her up. He fails everything miserably. Had he not really mastered some of those skills, is his learning capacity not beyond those scores? They are, but not on this day. A common complaint I hear from parents in IEP’S is, “but my child can do this, he knows this, that, and the other thing.” However he does not, and will not perform. The child who spells, identifies words, and can read, but is non-verbal, continues to try to pick “A” out of a set of 3 letters. The person holding the letters is a teacher who believes the child can’t and thinks that he is most likely retarded. She has allowed him to continue to attempt to match the blue, red, yellow and green blocks day after day after day. He cannot do that at school. There are way too many distractions, such as bright lights, itchy clothing, and screaming children. Letter “A” is not a priority. It is not important. Making sense of where he is in space and getting a hold on his environment in order to feel safe is his goal. Instead of pointing to the “A”, he flaps his hands. At least now he is pretty sure he does exist. We have to have a system of measurement to set in place, but many times there is more to the picture than just that. Without keen observation and thought, we will assess the child wrongly. We will miss the individual and the opportunities they present for learning. Not only do we do the child a great disservice, but we bore and frustrate and tire ourselves trying to find a spark. Even in therapy, we have to look at where the progress is happening. I myself often expect to see the same excitement and exuberance I had seen in the last couple of sessions. When it is not there, I feel like I have failed. However, when I go to write my notes, I often realize: No, I did not get what I was expecting or hoping for. I did get something else that was significant development instead. It just did not come in the way I expected. This week I worked with a 5 year old who does not walk, can not always hold herself up sitting, and has very infantile fine motor skills. Every week she comes in exuberantly playing the chimes with me, keeping her arms lifted, all the while building strength and endurance in her arms, back, and torso. This week, however, I did not see this. I kept trying different things. Towards the very end of the session, I gave her a light drumstick with a rubber head. She usually swings this and throws it down, unable to control it well enough to strike anything. This week she played with it, swinging and then holding it with both hands at mid-line for several seconds (two handed grip – skill not seen yet, nor seen at mid-line). She would switch hands. She would swing for several seconds and repeat the process before throwing it down. I continued to offer her the stick, and even though her chimes and a drum were right there for easy access she did not make any attempt at utilizing them. Her short term goal this month is to shake an object for 3 seconds, 3 times. Although she is given this opportunity at the beginning and end of each session, not much time is spent doing this. Today, as she swung, she hit a lollipop drum head accidentally. She then continued to hit the drum head repeatedly, intentionally. We had spent 50 minutes trying to regain the exuberance on the chime playing, but failed. However, progress was made, as she had gained some control over those little arms and hands today. This easily could have been overlooked, as the entire 50 minutes was spent looking for something else – progress elsewhere. Momentum and opportunity could have been lost, leaving us both frustrated. I could have left, looking in all the wrong places for the development, leaving me feeling frustrated and discouraged. I could have passed this on to her by simply not recognizing the progress this individual had made. Each client, each person ticks differently. Studies and research are extremely helpful in expanding our skill area and insight. Research and studies do not always, however, ,constitute “the answer”. Each person is an individual, receptively and developmentally. Studies and research help us, but they don’t reveal all the answers. We have to look at the individual – look at them closely.
Today, in two seperate sessions, three examples of my blogs happened all at once, using “stims” in learning (http://backmountainmusictherapy.com/2012/03/autistic-children-watching-for-developmental-learning-cues/): Frankie finding his voice (http://backmountainmusictherapy.com/2012/06/frankie-finds-his-voice-where-words-fail-music-speaks/), using a different rule book (http://backmountainmusictherapy.com/2012/04/the-yellow-brick-road-of-development-different-route-different-rules/), and recognizing significant development (http://backmountainmusictherapy.com/2012/04/recognizing-development-and-its-significance-in-each-individual/). It did not come in a beautifully wrapped package, but it was very significant. Today I had a session with “Frankie”. “Frankie”, a couple months ago, found his voice. He found it by taking turns playing the recorder with me. He found he was able to become vocal after using the recorder. Next, I gave him a toy microphone. He blew into it and quickly became discouraged, expecting his voice to come out. He then quit attempting to retrieve his voice. Today however, Frankie figured it out for himself. Frankie figured out how to work with his own body to get the desired result. Today, as we played “your turn – my turn” with the recorder, Frankie again would softly vocalize. I observed this a few times, then after sang “ah-h” into the microphone. As I sang “your turn”, handing Frankie the microphone, he again blew into it. This time I told him “good job” and continued the music and the routine without pause. Frankie did not get discouraged this time. We did this repetitively enough times that he realized if he made fists and contracted his torso muscles, sound came out. As he realized this and produced sound intentionally, he looked at me and smiled each time. He smiled a smile of pride and accomplishment. Today, Frankie could get the desired result himself. Something from his biology was finally under his control. Later, another non-verbal child, “Eddie”, came in for his session (Eddie was seen in last week’s blog – Ready for Take Off). Eddie’s mother had told me before his session that she was happy to report that now Eddie was attempting to communicate through pointing and gesturing. Also, he was beginning to produce “pop out words”. Today Eddie, a non-verbal child, who until recently only attempted to communicate through tantrums, watched outside the room as his mother took a sibling to use the bathroom. Apparently a little sibling rivalry or possibly turn taking evolved. Eddie kept gesturing to me by putting his hand on the doorknob to go. As I tried to ignore this, in order to continue the session, he began taking my hand and putting it on the doorknob. When I continued to ignore, he finally held himself as if he had to go to the bathroom (at age 7, toilet training has not yet been accomplished). After quizzically asking Eddie, “Do you have to use the bathroom?” he looked at me. Again, he looked at me with a bug eyed sustained exacerbated look as if to say, “Finally, lady. What took you so long?” Eddie had used cognition to calculate and was not dependent on sensory feedback alone. He was able to watch, understand, and control his decision appropriately. Eddie was able to absorb extraneous information, control his understanding, and react. Was Eddie playing much music today? No, not much today. Remembering the last session however, (http://backmountainmusictherapy.com/2012/07/disconnect-to-self-regulation-all-systems-go-ready-for-take-off/), of getting ready for take off, this was significant. I enjoy happy, highly visible productive sessions, but the consistent expectation of seeing results each time is unrealistic. What happened this day was a result of consistent turn taking playing music together. Frankie and Eddie had begun to function independently, and isn’t that the point? You may be wondering what the picture of the bird has to do with this blog. It is an actual bird who has made a nest in a Rhododendron bush right outside my Music Therapy room. Upon going to take this picture, another bird landed and fed this one worms. It turns out this bird in the nest is either a mother getting ready to birth, or a baby bird not yet independent. This bird stays in the nest and is being fed so that development can occur (all the while listening to the children’s music). Autistic or not, children are not merely robots that we continually program to point to the right answer, drilled till they win the spelling bee or get to the top of the class. Children need consequences and rewards to learn from, and they need tools to use. They have to be fed what they need. The more intrinsic the reward is, the more life changing the outcome. Independent development does not occur because of receiving an award, a certain grade, or executing a certain behavior so many times. Development and independence occur along a path over time, bit by bit.
Sometimes children get to stages in therapy where there is no outward movement forward. However, these times are extremely important. These are times of inward movement, or processing. A therapist or teacher needs to watch the finer details in order to recognize this when it is happening. Signs to watch for include posture, facial expression, smaller, less obvious movements in time with the music, and glances. Is there a difference between the “far away” disconnected glance and a thoughtful one? This next video is an excellent example. First of all, this boy’s very calm demeanor is not his typical character portrayal. When “Eddie” came to me, he was self abusive, head banging and biting himself. Usually there is a good amount of back and forth interaction between the two of us in his sessions (turn taking with the recorder and eye contact). However this day, “Eddie” was a little more inwardly focused, which I felt was important for him, and I wanted to help support and facilitate with the music. If you watch carefully, he is still connected to the music. At the beginning of the video, the most obvious sign is his finger tapping. I’m not sure this is visible in the video, but certain chord sounds evoked an eye squint and slight smile also. Every non-verbal, autistic child is non-verbal for different reasons. By watching a child’s outward behavior, his “stims”, one may find clues into how he/she learns, receives information, where his underlying processing problems contribute, or his/her compensatory means. “Eddie’s” “Click Clack ” song was developed just by these observations. His matchbox truck, which you see, and his behavior of rocking it or “clicking” it back and forth is the behavior mirrored and matched. As I have matched the music to this behavior, I have also simultaneously alerted his attention, engaged “Eddie”, and supported his inner workings, and he has accepted my invitation into a joint activity (music playing), using this “Click, Clack” song as my invitation piece. Today, “Eddie” has something else going on which I did not want to disrupt. Listening involves the whole brain, and one can see visually “Eddie’s” physical experience (although it is more subtle than outward actions or behavior). Listening involves areas of the brain such as the brain stem, cortex, reticular formation, and cerebellum. Listening accesses arousal level, sensory integration, emotions and as stated previously, posture. When a person hears a sound that grabs their attention, the person pulls that sound to the forefront and attends to it. Sounds that can alert an autistic child’s attention often support and reflect a child’s biology. These are the moments when the child gives a conforming, direct response. The child will use his/her body to demonstrate this. Listening has now become an active, sensory motor response. All systems are now working together, regulating, attending, and actively responding to arousal systems, emotional systems, and muscular systems. All systems go, ready for take off! (watch video below to observe example or click on link)
This year my two sons were in their freshman year of college and junior year in high school, respectively. Two boys, who chances are, may one day be household heads. You could say the dominating terms in our household at this time were (are) “college” and “job market”. I was havng a conversation with one of the boys about a friend who was planning to go to college at which, before getting a job, the friend planned to get his doctorate. The bachelor degree the friend was getting is useless on it’s own in the job market. I had suggested maybe the friend could get a slightly different four year degree and continue with his plans for education so that this bachelor degree would allow him to get a job. My son agreed with me but reminded me this friend isn’t in the same tax bracket as us and was not going to even consider that. As we were talking, my other son, who is in college and fortunately has found the degree of his dreams, replied to this conversation with “Why would anyone want to get a four year degree in something they couldn’t get a job in?” As a Music Therapist in an area where some people want to know if I made “Music Therapy” up (the more I get out there, the less this question is asked) I replied sarcastically with, “Gee Nick, I don’t know.” But Nick, here are the reasons I continue to find and search for Music Therapy jobs; Dear Nicholas, The reward in working in Music Therapy is moment to moment. However, here are some of the carry overs of Music Therapy that have been reported to me by parents: 1) The non-verbal client that calls his mother “Mommy” the first time. 2) The client that hates loud noises and crowds who goes to the circus and giggles and laughs all the way through the show, even when they shot the cannon at the end. 3)The non-verbal client who can’t sleep and is able to say to his mother, “I hurt”. 4) The non-verbal client waiting to go in the pool who says, “I’m ready”. 5) When the school asks Mom, Why Music Therapy? She wells with tears and says “He looks at her and communicates.” 6) The 28 year old, non-verbal man in an institution, whom others have worked with for years says (in front of my supervisor) “No, I don’t want to do that,” as clear as bell. 7) The frail little boy who goes to get blood tests done and takes his “Brown Bear” book to sing and relax. 8) The boy who only moans, groans and wanders, develops and becomes one of the most gentle, loved, funny, participatory students in the classroom. 9) The withdrawn, non-verbal, autistic boy who enters public school and learns to play and joke with others. 10) The four year old little girl with Rett Syndrome who had lost her voice, but on occasion can now find it and use it appropriately 11) The four year old who did not interact with peers. In his last Music Therapy session, days before he died, gestured to another boy to come make music with him. 12) As I watched the five year old, non-verbal, autistic boy giggle and laugh as his Dad tickled him, I asked, “Did you see this at home before Music Therapy?” The reply was no. That is why, Nick. I have a tool that aids in changing lives. And maybe for a very selfish reason, I do it because it just makes me happy, and so I have to. For me. Mom
This week I had observed something after one of my sessions that I have witnessed many times before. As I talked with a parent about her child, we talked about some of the things others may consider self-stimulatory behaviors. However, this mom was watching and trying to figure out what exactly was going on. She was not discouraged, nor spoken to as if she was from another planet. We were talking and she told me, “We’re noticing that N (the child) is really making good eye contact now and is trying to communicate with us.” Was this all Music Therapy? No, not all of it. The little boy’s behaviors were being taken seriously, reflected back to him musically and instead of being judged in Music Therapy. That was half of what was happening. The other half is that years of a sensitive, loving mother, who has been conditioned by “educated people” to stop listening to her children, is being undone. If we work miracles in the classroom, then walk out and blame parents for all the work we have to do, then we might as well throw in the towel and forget about what we just did in the classroom. Or if we accuse a special needs parent of having unrealistic expectations or say it’s impossible when the parent tells us the child can do something and we have not seen it yet. Well, we are then breaking up already existing communication. We are essentially saying to parents, “You don’t know what you are talking about. What degree certifies what you know?” Parents hear discouraging things like that often enough. Their ability to listen and see their children gets clouded with self-doubt. We have now cut off the food supply to communication and made our job much harder than it needs to be. I remember one of my first jobs out of college. I worked with pre-school children who were labeled as developmentally delayed – not because of any neurological or cognitive impairments, but due to environment. They were all children from homes of substance abuse. Their homes were filled with unpredictability, chaos and often lacked in necessity, education and were sometimes fueled with violence. Most of these parents were not much older than my 19 year old son. Some were single parents, grandparents raising kids, or had one parent in jail. One little boy belonged to a mom who had bore three other boys and had relinquished custody to the grandmother. All four boys had serious difficulties and behaviors. This little boy had a different father than the other three. The previous father had passed away and this mother remarried. It was rumored that the mother was schizophrenic. She never talked, was obsessed with cleanliness and never showed the boy any affection. The mom never smiled (that any of the staff had ever witnessed) or reached out in any way. Although the little boy displayed many behavior problems, over time I noticed that he had a wonderful sense of humor. I relayed that to his mother one day when I saw her. I saw her smile for the first time and actually look at him while doing so. This moment stayed with me. I myself was not yet a parent. This had been such a simple thing -I hadn’t even done it purposefully – but what a change it had made. Later that year, the boy had described to me in Music Therapy the abuse he had undergone at the hands of his father. The abuse was reported and nothing happened with the father, except that he was told what his son had said. All the staff at the school thought we may not see the boy again, but he continued to come. Later, for the first time ever (of all children’s attendance at our school) the mother reached out and called the school for help. We as teachers, therapists, or doctors see these children briefly. We do not stay up at night with them on their sleepless nights or run to doctors, specialist therapy, and school appointments as if they comprise a full time job. We do not bare the full consequences for what we as professionals accomplish with their children or not. We do not always know what else lies at home, other sick family members, financial burdens, or other clouding situations parents may face. Sometimes it is just as important that the parent gets strokes and support for the job they are doing . They may not be doing everything correctly, and they may not have the tools to work with that others have, but they may be using all the resources they have. Before we attempt to instruct, or worse, berate them for what they do not have, we need to praise them for what they are doing. We need to listen to the parents’ thoughts on their child. We may have the degrees and certifications, but the parents hold something more valuable: they hold their child’s heart.
I have a small group of kids that I have been working with musically for several years. They all have diverse needs, strengths and diagnosis. As I met with them this week and listened to them talk, I picked up on some things that they said. As I looked back over the years together, the quote by Maya Angelou came to mind; “People will forget what you said, people will forget what you did, but people will never forget how you made them feel.” I took a look at how these kids have grown over the years, how they have learned what their strengths are, and how to use them for good. In learning how to use their strengths, they themselves have diminished their own negative behaviors that get in the way of positive, social relationships. This week, one child in particular made me realize that she has put a large amount of trust in me and our group because of how she felt there. She was able to see her own strengths and goodness by the constant reflection of her strengths and goodness, instead of what she usually receives from peers and authority alike; criticism, putdown, and punishment. When a challenging kid is constantly met with “no”, punishment, or constant limitations, the scale becomes unbalanced. The child then sees themselves as bad, or unworthy, or in the need to constantly protect themselves in some negative manner such as attitude. This turns into a negative cycle downward; bad behaviors leads to limits, to rebellion, to punishment, and to attitude, leading to more limitations. As therapists, teachers and parents, we need to realize that change takes time (the more damage, usually the more time) but if a situation does not improve, we as adults and authority are responsible for the catalyst, not the child. We need to stop blaming the child and find and bring out the goodness, the abilities, the strengths, and reflect them often to balance out the scale. There are times we really need to search. Even if a child is just breathing at the moment and not causing a problem, we need to be quick to reflect that back to them. The more often this is done, the more often the child hears, sees, and feels that they have ability, strength, and goodness. The more the child starts to feel this, the more they begin to act that way. All of us know these things, but challenging children (or those children close to us) can catch us up easily in this cycle sometimes. I remember my most clarifying moment with this kind of situation was with my own son, who was about five at the time. I was a stay-at-home mom with three children under five. We lived way out in the country, where there was little opportunity for adult conversation. My baby at the time was very sick with a serious heart condition, and therefore things were a bit tense in the household. My oldest son was the family thermometer (as I use to call him). He reflected behaviorally how the family was doing. In other word, if things were already tense, he added onto it (as it felt at the time). I was feeling the stress. He certainly needed limits, but nothing was getting any better. I sat down in a rocker for a moment because I could tell if I reacted to how I was feeling, it was not going to help. I was reacting to him, he was reacting to me. I don’t remember what the behavior or action was that he did, I just remember what followed. I told him very calmly and politely what he needed to do, some cleaning up for me. When he was done, he could play. This redirected him to what he could do, limited the behavior and gave him something positive and productive to do. It also gave him a “time out” or a breather from the situation, and myself too. He absolutely did not like the activity, but because he knew there was an end, his esteem had not been berated and his activity level, which was already on the rise, was not being ignited more with more negative juice. He went right to it. Not only did he go to work diligently (which was absolutely not typical for him with this kind of an activity) but he started to happily hum. He stopped for a moment, came and gave me a hug and said “I love you Mommy,” and then went back to work. This was not a con game – that was his little bothers deal – which we will leave for another blog. Someone had kindly taken what he was having trouble getting hold of, and taken charge of the situation. Children feel safer and behave better when they know someone other than themselves is in charge (so don’t let them fool you). His behavior was limited and redirected into something positive and under control. No negativity was added onto the situation. Since things had also then calmed for me, I was able to really look at the situation and realize how the negative was really outweighing the positive. From that moment on, I made a much greater effort to find, notice, and reflect the good, acceptable behaviors. I then started to see change. The child in my music group used to be the most challenging child. As her behaviors worsened with the negativity that was surrounding her, I was very quick to recognize this (which usually happens when it’s not your own child). I made every effort to find the positive. She recently acknowledged that to me that she, this week and for the past year, has gained control in such a way to catch her own behaviors and make a very conscious effort to change those behaviors and simultaneously help me in the group with others. As an addendum, those of you who read my blog regularly, may find this ironic that this week I am recommending a more “behavioral” approach. This is truly needed, I never said it was not. However, sometimes we need less obvious tools or a completely different set of tools to ignite change. However, the end must be kept in mind and, once again, I think Maya Angelou stated it very clearly, “I’ve learned that people will forget what you said, people will forget what you did, but people will ever forget how you made them feel.”
I personally have difficulty using behavioral therapies as the “proven” therapies to use for a child who does not have a behavioral problem but rather has a neurological one. I recently saw a video put out by Dr. John Carpente of Molloy College on DIR Floortime and “Play”. Check out this DIR/Floortime Research…thanks Carol Ann LoPinto Blank for sharing this…http://www.cbc.ca/video/#/News/TV_Shows/The_National/1233408557/ID=2220343281. “… it is a response given(by an autistic child) because they want to, not because they have been conditioned to.” It seems to me that the “symptoms” of autism have been placed under the “behavioral” catagory. So instead of treating the difficulty, helping to repave or connect new nueral pathways that may not have developed properly, education and insurance have chosen to fund treating the symptoms, or overlook the problem entirely and re-condition the child to behave as if he had developed typically. In my opinion, any “behavioral” therapy, as the defining therapy, implies the wrong answer by it’s very name. Implementing this adjunctly, yes, could be a great asset to assisting the child in the everyday world.Conditioning the responses, however again in my opinion, is not aiding in helping neural difficulties in Autism that make typical functioning difficult. When I work with autistic clients, I always ask the parent “What is it you want most for your child out of therapy? The unanimous answer they give, apparently not only to me, but also those involved with IEP’s is communication. I ask the parents because I believe the parents most often, know the greatest need (which usually validates what I see.). It is not difficult to establish some sort of communication given the right elements: time, attentiveness and openness. However, not every individual we encounter on the street is given these opportunities when meeting these youngsters. So it is essential, especially in emerging situations, that one is able to communicate to others, not necessarily given those elements. I mention this because it is not only the modality of music, but also it’s relational values, relational applications, and relational communicativeness that nurture health and neural repair. Music Therapy is different for each individual because it is relational, not a specific set of behaviors or formulas. Here is another way to view therapies we choose to fund. Do we want “custom fit” or “one size fits all?” Custom fit being not only fitting but meeting most our needs. One size fits all is just that, it fits all, but is it flattering what strengths one already posses? Is it meeting any needs or is it just a reasonable fit? One reasonable application, for a specific need, tested over and over, repeated identically over and over on varying individuals with specifically varying needs is bound to get a result with several individuals . However, one brand, cut custom fit, will get tremendous results for the individual it is cut for and far less results with others of varying sizes – giving far less in numbers. Lets look at this from another angle; if you were in a snowstorm without proper attire, would you lean towards a custom fit down coat with built in form fitting hood, or would you pick the one size fits all plastic, see through rain cape made for wet weather? You are guaranteed it is going to fit your very cold body and will repel water. Personally, our family has never bought custom fit items, not even the two men in our family that are 6’7″. No cars, clothes, appliances – we can’t afford that. The one size fits all plan works for us. However, when it comes to healthcare, we can’t afford one size fits all; custom fit is all that works. For instance, my oldest son had allergic asthma as a child. He came down with some kind of severe respiratory infection every 3 weeks by the time he started kindergarten. Protocol for administering antibiotics at the time was a) fever over 101, b) green color, and c) symptoms for a specified number of days (the one size fits all plan). Time demonstrated to us that if we waited for all those signs, after antibiotics there was no infection but the boy was so worn down and weak that as soon as he got back to school he picked up the next round of whatever was going around and we did the whole process over. Missing anywhere from 4 days to two weeks of school st a time was typical. He needed the custom fit plan. The other two children, who rarely got sick, could use the one size fits all plan, it worked for them. Another comparison is the “No child left behind” plan. How did that work out for the non-typical learners?
I had a very exciting session with a non-verbal client this week. He demonstrated to me that he was consciously beginning to learn how to use his voice when he wanted. After last week’s blog about signs of speech, I thought a depiction of this would be appropriate. Frankie is an eight year old non-verbal autistic child. I had worked with Frankie for about two months when he was five. In that time, we were able to demonstrate that Frankie understood what was said to him and could respond appropriately on his own without speech. We used his stims of turning the lights on and off and opening and closing the door. We took these actions, put them to a tune with words, gave the stim a direction and made a game of this. As we were playing the game, he opened the door and saw his mother sitting outside. He put his fingers to his lips, (motioning shh) pointed to the piano, and then closed the door. His neurologist, whom I had never met nor corresponded with, saw Frankie towards the end of our therapy together and was able to confirm that Frankie understood and could respond. Frankie moved onto a new school and three years later our paths crossed once more. We began Music Therapy sessions again. Currently, Frankie has demonstrated that he is easily able to control his breath by blowing and sounding a recorder upon hearing the words “your turn.” As we were playing our “your turn, my turn” tune with the recorder, when it was once again my turn, I sang “ahh” on three notes . I then handed Frankie the toy microphone and said “your turn” . Frankie did understand what I meant but was unsure on how to go about this. He put his mouth to the microphone – but nothing came out. He tried what he could already do; he blew (in the same manner he blows into a recorder). I continued the music without pause and went back to my turn. I repeated the same process, except this time as I sang “ahh,” I put his hand on my throat to feel the sound. As I handed him the microphone, still unsure how to do this, sound accidentally came out. I did not alter, pause, or lengthen the music. I kept it going, back and forth, your turn, my turn. Each time he tried to get his voice out, he accidentally achieved this goal, but was still uncertain as to how he did. Keeping the music going did not give him time for any anxiety when this did not immediately happen as he attempted. Each time Frankie took his turn, the voice came out sooner and lasted longer. Each time Frankie smiled at his accomplishment. The concentrated look on Frankie’s face led me to believe that this was a very conscious act, however, allowing the music to continue keeping the flow continuous and left little time for frustration or disappointment when the voice did not immediately come. After we ended the session, as I took Frankie to his mother and told her what had happened, Frankie stood there smiling proudly. Immediately after I was finished speaking, Frankie proudly used his voice with a long string of babble. It is my belief that Frankie had something purposeful he was telling us but just has not gained enough control to clarify. The look of pride on his face was all we needed that day.
I recently worked with a couple of non-verbal autistic boys who were having wonderful sessions. The very next day I ran across an article online by Margaret A Fish, MS,CCC-SLP. The article was entitled Development In Children With Severe Childhood Apraxia Of Speech – www.pediastaff.com. Later that day, a mother of a Downs Syndrome son (who had speech but had lost it) asked the question many parents ask, “Is it too late, will he ever speak again?” I knew it was possible by a couple of things she told me. I thought I would share some things I hear that let me know not only is speech possible in children with neurological impairment, but lets me know where the child is developmentally with speech. * One of the things the mother told me was, when her son is alone , one on one, and comfortable, he can sing words. If a child can sing words, he or she is already speaking in melody. Speech ability already exists and the person is not far from speaking. * If purposeful humming is demonstrated, that means the child has enough control to not only comprehend what they hear, but also are able to replicate it vocally. * Children that have occasional “pop out words,” once again, understand and apparently do have some speech. They need to learn how to get control of that speech. * Children that babble are on their way to sound formation and are open to making sound and are motivated. They are “playing” with sound. (for more on learning and play :http://backmountainmusictherapy.com/2012/05/the-balance-between-structure-and-play-and-its-long-lasting-results/ ) ( http://backmountainmusictherapy.com/2011/11/music-therapy-and-autism-from-developmental-psychologistdr-stanley-greensan-co-authors-perspective/) * Children who react with sound to an unpleasant or pleasant situation should have that ability encouraged and nurtured. That is an opening to increase sound, to begin to use sound for expression. * Even silent children with neurological difficulties may still speak, probably not on the same time line as their peers though. In these cases, speech goals should look like pre-verbal goals. There are many different reasons for the lack of speech, however, if your child is beyond the age of 2 and still not speaking, take care to talk to them and respond to them verbally, always, as if they do (http://backmountainmusictherapy.com/2012/04/recognizing-development-and-its-significance-in-each-individual/). Others response to the child may help or hinder the process.If your child is not talking, many others will assume your child does not understand also, so it is very important that you keep that expectation alive. Communication begins way before word formation. Sing a lot to your child. This is more predictable and understandable to the brain than just words. Music has more structure. Respond to sound as if it has meaning. Children may not be demonstrating understanding, but if they are understanding and just yet can not let you know, imagine how demeaning it must feel when people treat you otherwise. The two boys whom I mentioned earlier are beginning to make sound and are demonstrating “pop out words”. They are also beginning to find ways to joke and let me know they like something. One of the boys, whom I haven’t seen much or regularly, due to health and doctors appointments, has always been good at letting the world know he was unhappy through limitless screaming, self abuse and pushing away. Today, as we ended the session, I played “Good bye” on his feet with my hand drum. He played it back afterward with his feet. We finished the song and I thought we were done. He took my hand with the drum in it, and tapped it two times (I’m assuming “Good bye”) and smiled ar me as he did so.
This week as I was working with a group of emotionally disturbed adolescents, I was amazed to watch this group of boys, who seemingly easily set each other off, eagerly choose instruments and begin to work together. None of these boys have any musical training, but as they chose their instruments I began a very loosely structured “rainstorm”. The boys quickly listened to one another, allowed a leader to emerge, established a beat and structure. They listened to one boy who used a repetitive ostinato on the keyboard, gave it a visual label,”That sounds like monkeys” and they all tried to compliment the label he created. Soon after another label emerged from another boy. The same pattern followed. Our time was coming to a close and the boys wanted to continue, so one said to the other, “Next time we’ll both use this keyboard N, ok?” The two boys who never really interacted, and were really at two different places developmentally, were voluntarily working as partners. How did this happen? As my week continued, I watched a few other situations and came to this conclusion: we all need structure and play. We all need a space to be accepted for whom we are and our abilities. I think so often a benchmark is placed on our abilities. Everything must be done inside the box and there is only one pathway that is measureable and acceptable. The problem is, outside that box, exists so many wonderful things. Roads that are less travelled can lead to the place we are striving for anyway. Play happens outside the box. Play has structure. There is no perfect play, just performance perfection. Academics need standards and benchmarks. When we approach a group, of kids or adults, we need to decide on the priority for the group (or individual). Is it academic or growth (social, emotional) related? If the latter is the priority, we need to be a good parent in the approach; set the boundaries, with some direction but more support. Quality of production is not important at this point. What is inside will come out. Giving structural support allows the individual (autistic, special needs, emotionally disturbed, etc.) to own and gain control by their very own motivation. The importance of the playfulness is the freedom it gives, whether we are adult or child. Directions give us responsibility, and many clients, adults or children are either just not ready for that yet, need a break from it, or need a balance. How many people are ready or willing to let you know how to do it better? Bigger, better, more – the theme words for our time. But how many people are willing to accompany you while you attempt, fail, succeed, climb, fumble, search? Not quite as many. Which would you generally prefer? I think we forget the term is to “play” music. We say play, but often what is really meant is perform, learn, study or memorize. Children that can play for an afternoon, not needing adult intervention, have excellent communication and social skills. Someone comes up with an idea, the next one adds to it or uses it as spring board for the play to take a different direction. Critical thinking skills are not taught, they are developed. An improvised play is spontaneously produced. No one person is the owner, the boss, entitled. What is developed is natural, long lasting, and healthy. Children with autism repetitively stim, not play. When someone can support and structure that stim, it can become playful and functional. One last example; when my own kids were young, I decided they needed to learn piano lessons at an early age. I approached it as learning with a right and wrong way of doing things – the way I said. When they tried to do it their way, I was forever correcting them. I decided just to give them basics; scales, arpeggio’s and basic one, four, and five chords. The rest of the time, I played and sang with them. We enjoyed that. The boys both found their own instruments and now improvise and write their own music better than myself at much earlier ages. My daughter does not think of herself as a singer. She has a beautifully clear voice, and although rarely, voluntarily “performs,’ if asked, does it without squirming or nervousness. I remember being on the phone, several times when she was little and people saying “Who is that? Who is singing? Is that Monica?” She sang when she played, she sang to put herself to sleep. I was so used to that, I didn’t even really notice. Last week, I was a chaperon on an overnight trip with her. She, and some of her friends won individual awards on a fairly intense science presentation they made and were at the next level presenting again. I was rooming with her teacher (in college dorm rooms) with the girls on either side of our room. The night before their presentation, as I was falling asleep, her teacher (also a long time friend of mine) kept saying, “Who is that singing?” The next morning as we were standing in line for breakfast checking with the girls on how they slept. Finally I asked, “Mrs S kept saying someone was singing. Who was that?” Several of the girls chimed in at once: “Monica.” This was her last burst of letting loose and having fun before the seriousness of the morning.
This week a private, non-verbal client walked out of my Music Therapy room and told his mother, “Ready”. The TSS worker of another non-verbal autistic client told me the most words her client speaks come out (pop out words) during his Occupational Therapy sessions. When do you feel most alert? When are you most motivated to get things done? Other than food, what are most social events structured with? What do all these scenarios share in common? Three simple things, movement, motivate with emotion and structure with music. Do you not feel most alert after a good exercise routine? What gives most people energy to get things done, extreme emotion such as happiness or anger. What do most good parties supply? Music. The boy that walked out of my room came to Music Therapy very happy and anticipating good things. (The evidence of this was the observable smile on his face versus his somewhat anxious look). He climbed onto my small exercise trampoline, and as I put musical structure and words to his movement, he was motivated to do more. His already happy mood gained momentum and energy. The repeated structure of the music, that matched his energy and movements, joined all these facets together to help lay a foundation for speech. The little boy that goes to Occupational Therapy loves his therapist and spends time swinging and moving and is motivated by her insightful exuberance as she interacts with him. (In Music Therapy we work on the structure part to give him more consistent control over the pop out words). As I see it, the three key ingredients to pre-verbal situations, or speech, is movement, emotional motivation, and musical structure. I have never yet witnessed a child sitting calmly that has suddenly produced sound or pop out words. If a child is not ambulatory and I see the feet start to kick my piano, or the hands start to excitedly wave, I know something wonderful is brewing. All three things are at work. The child is being stimulated through their emotions and/or motivated by the music. Children have a faster heart rate than adults for a reason- they need to move! The calmer, more subdued children need that even more. Children sitting is more helpful to the adults (those of us with slower heart rates). Some children do need more focus than others. In these situations, half the work has been done already. Their need to move is granted and provided structure through the music. This matching, structuring, and mirroring their already physically stimulated bodies elicits not only their attentiveness and alertness, but also heightens the emotions. What is inside will come out at some time. It needs structure in order to obtain control, and we need structure. We need a beginning, an ending, and something predictable in-between. The little boy who had pop out words in Occupational Therapy comes to Music Therapy humming and vocally following the contour of my music and singing. He comes to Music and wants to move although he is a very clumsy child. How many senses or areas of the brain is this repetitive structure, motion feeding, nurturing, and healing? When a typical child goes to practice instrumental lessons or to hit a baseball, the coaches, teachers, and parents are proud. We see the persistence at what we have instructed them to do. Why is it that we insist on teaching children, who are developing neurologically different, the same as their nuero-typical peers? Why not take their cues and provide the structure and limits for them instead? This week that same little boy (from Occupational Therapy) came to Music Therapy. As he ran back and forth, as he has for weeks, I sang “Go, go, go and stop” to his tune. Smiling, he watched me and hummed the same tune. Soon he picked up a drumstick, played a bit, and then put the drumstick in his mouth. I traded the drumstick for his recorder. I took turns, back and forth with him playing on mine. As he now had seated himself, and was getting tired of the recorder, I got out a basket of plastic fruit. Each time he pulled one out, I sang the name of the fruit to a simple repetitive tune. I would sing the fruit name once, twice, then tap the speech rhythm on a drum. I would request that he do the same. Before the end of the session he had said “Banana” appropriately, three times. To end this blog, I want to leave an illustration of movement, motivation and music. This is the boy that said “ready”. It is a sample of the beginning of that session that day. Take note of his expression and the sounds this usually quiet boy makes.
I have written numerous times about using “stim” behaviors in autistic children as learning tools. However this blog is referring to having a Music Therapy Practice in an area where Music Therapy appears to be a new concept. I recently attended an IEP meeting where it was suggested that if the parents were interested in music for their child, maybe they should look for a Suzuki or Kindermusic class. Currently in North East Pa, many qualified teachers with seemingly secure jobs are loosing them due to funding cuts. Schools are closing and being combined. Anyone dealing with special needs can talk about the loss of funding and/or services extensively. After a couple of days of diversion, I came to realize that although you may not have as easy access to working with other specialties being in private practice, and being responsible for your own workings of a business, but there are some things about private practice that are a wonderful trade off. The one benefit I want to talk about is the one that makes my actual work stress free . The luxury of being able to decide what is the most important goals to work on for a client, what is their greatest need, makes my work very clear for me. Now let it be said that I enjoy input from other specialties. I love what their expertise has to offer. I thrive on insights different and deeper than my own. It is still accessible to get this in private therapy also, it just takes a bit more effort. I also enjoy the luxury of being able to decide and write for Music Therapy goals that I feel are a priority for an individual such as writing babbling goals for a non-verbal child instead of identifying colors. If I feel what may be considered a musical goal by others , such as stringing two pitches together (in reality a pre-verbal goal), I am free to write it that way . I am free to work on what I see as priority’s for the child and what the parents see as priority’s for that child (usually the same thing anyway). I think there are many other conscientious professionals and specialties that have to slighty alter their wording to fit a standard, but yet try to work on the priority for the child. I also see the need to have an educational standard as a measurement, or as a checks and balances system. However, no matter how academically sound a system may be, it is still a system, and we work with individuals. Systems are set up, for good reasons, to include the majority. This leaves the minority to seek the next best category available. I have rarely found my autistic clients to fit into any majority category There are wonderful systems and excellent specialty professions, however if something that is not on the list of resources is getting excellent results, that is the something I want to do. If I respectfully disagree with the system, I am a little freer to do that. No hoops to jump through.
The “Yellow Brick Road” was a familiar phrase that was a treat to watch for my brother and I growing up. Essentially, Dorthy needed to and wanted to go home. She ended up in an unfamiliar, unpredictable place and apparently ,the “Yellow Brick Road” wouldn’t get her directly home, but it would get her to someone that could tell her the way. Along the way, she meets companions, not people, but typical personalities in a-typical bodies who accompany her. In the end, Dorthy’s trip home is just a dream, and as we know, although dreams originate within us, they take an unpreditable, a-typical route of their own. I like this comparison to the development of an autistic child. We know there is a broad spectrum, but essentially, just like all children, they grow up and their hopeful destination is the same, as typical children – as much independence as possible. However their pathway there is different, and unique. Their bodies grow bigger, and they each have their own personality. Their individual pathways that accompany their development can be, like a dream, unpredictable with a life of it’s own. Sometimes our view of what is “appropriate” for a child needs to be adjusted. This week a common concern was posed to me by a child’s worker was. A tss worker, who’s original training was with nuero-typical children came to me perplexed. Her four year old, non-verbal client was beginning to bite. After seeing “Ralph” in Music Therapy and watching him happily mouth everything, I asked a few questions. What I had concluded was progress. But would this be considered progress in the classroom? The aid’s concern were that this little boy had given up a pacifier in September, it was now April and he was mouthing everything. He was biting, we concluded, when frustrated. He would not sit for circle time as he passively did previously in the school year. Ralph wanted to be moving and was becoming very vocal. What was his behavior communicating? I explained to her that, although for a typical four year old, this was not acceptable classroom behavior, for Ralph this was good news. It appeared that Ralph was gaining awareness, including awareness of some kind of sensations in his mouth. He was not selective, nor angry with his biting, he was being reactive. When he was being pushed to do something he did not want, biting was not a thought out behavior, it was a sensory based, immediate reaction for a boy who could not express it. The need to constantly have things in his mouth was a new sensory type of awareness. This awareness not to blankly sit was an energy to keep moving. I compared it to the energy you get from exercising. The kind of energy that makes you alert, happy and want to keep going. This movement was sending constant messages to his brain, keeping him alert and aware. Unfortunately, for now, it does make classroom behavior a little more challenging, but not impossible. His team gave him a rubber tube to chew thus feeding the mouthing sensation and keeping him aware. In Music Therapy, I played music to support Ralph’s activity. Ralph frequently vocally imitates short strings of pitches being sung, or the contour of what is being sung. This is exciting news, because instead of the random recent babbling he had been doing, his vocalizations were beginning to take on some structure. I think sometimes we have to be careful when applying behavioral techniques to what we’ve known has worked with typical children. We really need to know and see the autistic individual. What was his behavior like before, what is it like now, what purpose does it serve.? Certainly for a typical four year old biting and sudden non-compliant behavior should cause concern. What is that behavior communicating? But possibly in the autistic child, the same behavior may be serving a very helpful purpose, his/her “Yellow brick road” to development. We would not be terribly concerned with an infant who is going through a stage of temporary biting while cutting teeth. Certainly there is an accentuated awareness and sensation in the mouth at this time. Although, sensorily, this is where Ralph appears to be, that does not mean that is where he is cognitively. Most of use who work with autistic individuals agree, usually people on the spectrum know much more than they can accurately demonstrate. Once again, their Yellow Brick Road, different routes, different rules. It is a matter of perspective. I don’t think the proverbial “Box” included autistic individuals. It is truly necessary to look outside, beyond the “box”. We need to take a different path, apply different rules of learning. At the end of the yellow brick road, was not home for Dorthy. But in the end it was all a dream. Life for our autistic community may exist like a dream, unpredictable , but it is not a dream, it is their home.
Process versus product. Generally when I give an introductory talk about Music Therapy, I begin by making the comparisons between Music for Leisure, Music Education, and Music Therapy. Music for Leisure is a passive type of music which I am going to leave alone today. Music Education and Music Therapy are active processes and very different from one another. Music Education is mainly concerned with the product. How does the product (music) look, sound, and is it done correctly? Music Therapy is not concerned about a product, but rather a person and the process that they are going through, where is the person headed, what are they going through and/or what are they now becoming? I think in our society today, this concept is difficult for some people to comprehend. People understand the definition but have trouble applying it. Misinformed comments such as “We’ll just let the kids bang on drums and call it Music Therapy,” are made by people who just do not know what Music Therapy is. Music Therapy is the process of using music and/or its elements to assist health, growth or development. I think in today’s society that being focused on the process is so foreign to some people (or for foreign to their concepts about music) that they have difficulty grasping this. This idea of not being focused on the product, the “correctness” of the music takes some getting use to. Society does not function this way today. To be the best, to do better, to rate higher than our peers to be successful is contrary to being better than I was yesterday or to be the best me I can be. One must always ask why: why is this important, what is most important in this situation. What does the person involved in the music need, what might they be hoping to gain? Is it perfection of an instrument, their voice? That belongs in a music lesson. Is it growth, connection, security, or development? That is for Music Therapy. In school, it matters whether you hold a note for 8 beats or not. It matters in a lesson whether you are holding a guitar correctly or not. It matters in school whether you hit all the right notes or not. School is a place where your skills need to be judged as worthy enough or not. In Music Therapy it matters a great deal if some sound comes out of a silent child or not. It matters when the teenager who normally will not participate in a group comes in and picks up a guitar and thoughtfully plucks random strings. It matters when a child who stays isolated bangs on a drum to his heart’s content as he enjoys engaging with another human being.It is going to be very difficult to get enough research to convince a society who measures success in dollar amounts, in awards, and in the degree of power which an individual attains . An adjustment of perspective may need to be attained before a priority is given to the importance of the individual’s well-being. Then the process will be important and easy to comprehend. . . “People will forget what you said, people will forget what you did, but people will never forget how you made them feel” -Maya Angelou.
This weekly blog is about change, development, and growth and recognizing them. Not only recognizing them, but attending to their significance in each individual. Sometimes when working with special needs children, most specifically in this case children on the spectrum, there comes a point in which growth appears to have come to a stand still, and work with the child seems to feel like blind wandering, leaving the dedicated professional to wonder if he/she know what he/she is doing. The bothered therapist will have to search, and think: What do I do now? What should I be doing? This week while working with Derick, a non-verbal, autistic seven year old boy whom I have worked with for approximately three years, I had to ask a couple questions: Where was this going? Was it going anywhere? At the end of this week’s session, was I hearing or seeing what I thought I would? Had there been real work, was this making progress? Three years and was this non-verbal boy developing, growing? One of my earlier blogs was entitled “Why give up on speech?” I still feel very strongly about this, but Derick continually challenges this belief. Although I have worked with Derick for three years, “pop-out words” have been very few and far between. Progress at times makes me wonder. When the session was done, I had to look back and research. Looking back after the session. two things stuck out in my mind. 1) When Derick was seen individually this week was when I questioned progress, when his autistic symptoms were all I could see. Yet when I saw him in a small group with another little boy – Charles, who is three years younger with similar symptoms – I saw something else I had never noticed. Sometimes Charles is somewhat intimidated by Derick because Derick is bigger. Although because I realize this intimidation factor, I tend to be slightly more attentive to Charles in this group. As I was maintaining that attentiveness, I noticed Derick being very perceptive and not just with listening to my directions (which, because I have seen Derick for a while, I forget that that in itself, is very significant for Derick). As I was giving structure to the session, Derick watched me and waited to see what came next or what to do next. It appeared to me as if he was filling the role of the older child, being more responsive and considerate of Charles. I had never noticed this about Derick before. Then came the individual session. Derick had pulled out two books we had put to song: “Brown Bear” by Eric Carle, and “Ten Wriggly, Wiggly, Caterpillars” by Debbie Tarbett. Derick taps out the name of the animals on a drum as I finish singing “Brown Bear, Brown Bear, what do you seeeee….”. Then we sang the counting book where he points to each caterpillar as I count. Later, he threw down his plastic mirror as I sang: “It (G) is (D), then he sings “me” (C) over and over. (Derick had learned to make the “eee” sound from repetitious play with “eee” such as in “Brown Bear”. I repeatedly held “see” as he first matched pitch, then vowel sound.) Lastly he laid on my piano bench as I sang about his feeet, his kneees, and his hands while tapping those body parts with my lollipop drum as I sang. We had done this and done this over and over again, were we wasting time? I looked at my developmental book (“Music Therapy, and Early Childhood: A Developmental Approach”, by Elizabeth Schwartz) and in the stage of developing independence, all these things were listed. The following skills were listed along with the need for repetition in this developmental stage: – Extending the child’s world through vocalization. (Derick had played with babbling and was now filling in the appropriate word sound- “me”.) – Attempting at gesturing and spoken language. (Derick was showing me what he wanted.) – The need and craving for repeated sounds and movement. (Steps towards word formation). Two of the most important points at this stage of development were: A) “At this level children absorb more than they produce”. B) “Allow the need for time for child to move on their own to music” I had forgotten six months ago, I did not hear specific vowel sounds such as “-ee” and when I did hear them, it was at random times – not at the end of the same phrase (“it is me”). Also, Derick goes and gets the mirror himself. Wanting to hear those same two books over and over was not random: Derick chose those books from a pile, and instead of flipping pages, as he would have six months ago, he waited patiently for the singing to finish. Derick now enjoys listening to me count/sing repeatedly as he counts caterpillars with his fingers consecutively. His vocalizing isn’t the “ERKSH” sound he had first come to me with. Now Derick’s sounds had definition. I wanted to see more. I had lost track of progress, that this independence was developing. He had to move on his own time, not mine. I flipped the pages to the next stage of “Control” to see what might be next. Another phrase “Gaining Control takes WORK and PRACTICE, and there are many times when “success” is difficult.” While Derick was singing “meee” and getting out the mirror, he was now repeatedly demonstrating the skills of listening, processing, and responding. This was carrying over to the small group session. Derick was listening to the direction and responding and then looking to me for what came next. He was “absorbing the external information”, the chord progression and words (it is me). He was not only controlling his understanding, but also controlling his reaction to it (singing “me” and getting the mirror as he happily looked at himself). Derick was also recently learning how to control his breath and mouth by making a sound on the recorder. This was yet another skill area described in the book; “blow and sustain sound on a simple wind instrument”. At earlier sessions, he was practicing and becoming more successful as I played the recorder after singing “my turn”, then following suit after I sang “your turn”. Derick was physically learning how to control his mouth to get it to do what he wanted. What I also had forgotten, over time, was that I was now waiting for Derick to show me, by gesturing or by leading, what he wanted to do in Music Therapy. Previously, I had given structure to his responses, sounds, and movement. Now Derick was choosing what we did. I have become much better at watching and being able to see a child as he/she processes things instead of demonstrating new skills. One has to watch subtle things like a change in posture or the child’s facial expressions. However, at times I struggle with allowing a child to move on their own. Usually with a bit of reflection and a check on what is happening developmentally, I regain my vision and know exactly where the child is. Our society today has difficulty waiting. Our society wants to see us produce, produce, produce. One has to be able to look and see if there is forward movement. Is there growth? Where is the growth and what are the changes? What direction are we headed? If I can answer these questions confidently, then I know I am not aimlessly wandering. Sometimes I need to look specifically at the child and see what he’s doing: what has his path been? How has the Music Therapy facilitated this? Competency will be demonstrated in the carefully prescribed goals, objectives, and methodologies set forth in the paperwork. Then at the end of the day I need to give the credit to the child and see that this child, this individual, did grow and is growing. He may not always grow on my timeline though. When I can say that this child got from point A to point B. and demonstrated (through my paperwork) how the music has facilitated this growth, then I will be satisfied. Growth for the child and competent therapy have been procured.