Music Therapy, Bottom Up Method, Feeding the Senses

One of the many areas of need worked on during Music Therapy sessions at Back Mountain Music Therapy are sensory processing issues. These issues are often found in people diagnosed with Autism Spectrum disorder, Smith-Magennis Syndrome, Rubinstein-Tayebi Syndrome, Cornelia De Lange Syndrome, Auditory Processing disorder and a host of other developmental syndromes. 

Sensory processing disorders affect many basic systems such as visual, auditory, tactile, smell, taste, vestibular, proprioception.  One common symptom of these disorders is the inability to regulate incoming stimuli, to the point which an induvial is totally overwhelmed.

The symptoms vary from person to person, and sometimes from situation to situation within the same individual. Sometimes we can see clients trying to protect themselves from the overwhelming sensory input when they cover their ears or shade their eyes.  In these cases, the individual is attempting block out the area which is experiencing the sensory overload. 

This week in the Music Therapy room, one of the clients, “Benny” displayed what most would think of as “unusual behavior” during the session. But, if you keep in mind his sensory issues, it can make sense. This client was forcefully beating the drum during a significant portion of the session, then sat on the trampoline and rubbed the mesh underneath him. At Back Mountain Music Therapy, we incorporate whatever the client is doing and use this behavior, however small or seemingly inconsequential, to create the musical interaction. After all, behavior is communication. The reason that we work this way is; we may not understand why the client is doing what they are doing, but it serves something for that client.  We allow the client the sensations that they need and desire so that they can eventually feel regulated and move forward. 

Let’s look at this from a perspective we can all relate to. Imagine that you are at work trying to get your work done and you are really thirsty. Until you go and get a drink of water what is your focus on: the work or the water? Once you quench your thirst, you are able to move forward on your work with a renewed sense of focus on your work tasks at hand. 

During Music Therapy sessions, allowing the client to get the sensory input that they require is quite similar to the example about the water. Once the client has had the ability to get the sensory input that they require, they can move forward.  However, in order to move forward and not get “stuck” in this sensation, we need to have a reciprocal relationship. We structure the music around the behavior, giving it a musical direction so that the behavior is not stagnant. Including these behaviors, often through the movement in musical structures such as harmonic progression, to engage the client. We utilize silence and vary the elements of that simple tune structure so that we have the client’s attention to both satisfy the need and utilize it to help them to regulate and move forward.  

In the example about the client forcefully beating the drum, this particular client was diagnosed with autism spectrum disorder (ASD). A common symptom of this disorder which Benny routinely exhibits, is difficulty engaging in interactions with others.  During the session, when we matched and followed “Benny’s” forceful beating in both volume and rhythm, he responded to by turning toward the Music Therapist and smiled. This client realized that we were relaying to him, entering his world, and interacting with him in a way that reflected what he wanted and needed at that moment. Benny responded with demonstrating shared attention. As he continued to play, he looked to the Music Therapist anticipating the interaction again. 

Towards the end of the session, the client was seeking out this relationship of musical play with the therapist. He was clearly involved and was laughing and smiling. This client was able to get the sensory input and his needs were heard, honored and responded to. This, in turn, helped build the positive, trusting, therapeutic relationship that will aid in developing the client’s ability to connect with others. This client went from exhibiting solitary, “stuck” behavior to engaged, meaningful interactions with another. He was able to join in the interaction with the therapist and maintain that interaction knowing that he was being heard. 

This is one example of the many different sensory displays that we can see in the Music Therapy room at Back Mountain Music Therapy. Each client has unique needs we need to support these so that they can regulate, relate and engage with others. This ultimately helps them accept and integrate these sensory needs as they occur. 

Benny came into the first session that he had at BMMT and was all over the room in the session. He could only attend for seconds at a time and he needed lots of prompting to get him to join into interactions with the Music Therapist. Now Benny has been attending Music Therapy for a few months. Within the time that he has been in Music Therapy we worked with the sensory needs and Benny has become more regulated and can stay in a joint interaction for a few minutes at a time. He is still highly energetic, but he can focus and now he notices the therapist and seeks the interaction. His sensory needs were met so now he can focus on the other things in the room rather than having his focus on the strong sensory need.

Madison Indyk, Music Therapy Intern

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