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
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