Music Moves

Late last night (Feb 19th) I returned from what is quickly becoming one of my busiest weeks of travel every month to Minot and Bismarck, ND, where Music Therapy is quickly on the rise (contact Emily Wangen at Music Therapy in Motion for more info there!)  Yesterday alone I completed 7 new assessments.  I always find myself feeling revitalized after assessments, not just because I’ve had the opportunity to meet and add new clients to my caseload, but because they help me check in with why I do what I do and what I’m always striving to achieve.  Many loved ones and professionals come into an assessment thinking, “we don’t use music much at home or in school, we just wanted to see what it could do,” and all of them come away amazed with just what the possibilities of Music Therapy are – some of them see their patient/loved one do things during our assessments they’ve never seen them do or thought them capable of before.

Let me first start describing my process by saying that every assessment is different.  Not only because every individual client is different, but because every therapist is different.  My assessment format began out of my experiences and assessment formats with the Clayton County Public Schools in Georgia, where I interned, and is constantly adjusting as I acquire experience with new populations and ideas throughout  my years in practice.

I always start with an interview portion.  I ask for all the basic facts of a client’s age and diagnosis.  Checking in to see if there are any seizure disorders, hearing loss, or other things that might affect their ability to interact with me and the music I use is always a must for me.  I want to know before I start interacting with the client what things I should avoid using or doing.  After getting the basics, I start getting into the specifics of how the family, client, or other professionals use music in the home or other environments, and how the client responds to it – physically, cognitively, emotionally, and socially.  If the client is able to participate in this interview portion, I might ask them what kind of music they like, or “when you hear music, what do you like to do?”  How well they understand and respond to the question can tell me just as much (if not more) about an individual’s level of functioning as their actual answer itself.

After the interview section, which usually lasts about 15 minutes, we interact musically for 30-45 minutes.  I follow a typical session format (which I’ll be happy to share in future posts!) and I add little elements and questions here and there to see what the individuals’ capabilities are physically, cognitively, emotionally, socially, etc.  For instance, I always start with some sort of Hello Song and end with a Goodbye.  During a typical session I might just sing Hello and Goodbye myself as bookends to the session, not requiring any specific input from the client (though remember every client is different and I may change it up from time to time!), but during an assessment, I always ask the client to get involved in the bookends somehow, perhaps to try learning each song with me to see if they can approximate or match pitch, or I might ask them to strum the guitar with me to see how developed their hand-eye coordination is, or if they’re able to strum with a relaxed, open hand.  With every activity we do I’m looking for clues as to how their body moves in general, how their thought process works when I give directions (and what kind of directions they best respond to – complex, simple, written, verbal, etc.), and how they connect emotionally and socially with me during the session.  I watch (and sometimes push) for signs of frustration to see where the limits of an indivual’s abilities are, so that I can see just what our possibilities are for goals and other areas we might address during future sessions.  When I feel that I’ve seen every ability and delay that I can in all of the areas on my form (physical – which includes sensory – cognitive, social, and emotional) then we end the musical interaction portion of things and move on to the post-assessment interview.

So, just as each session I lead has bookends of Hello and Goodbye, every Music Therapy Assessment has the bookend of an interview – before the session I ask what’s being done and seen already, after the session I ask what’s being seen now and what can be done for the future. I want for family members, other professionals, and anyone else in the room to tell me what they’ve noticed so that I can so I can ensure that we’re all seeing the same basic things and gauge how enthusiastic they are about the prospect of moving forward with therapy.  Then I can validate what they’re seeing with the additional insight my training gives me.  For instance, if a parent says, “they really seemed to be enjoying the music with you,” I can point to eye contact, vocal expressions, and other specific things I noted during my interaction with their child to say “I agree, they were very engaged in what was happening, I think music will serve as a great motivator for X, Y, and Z,” and from there we can segue into talking about goals and the future of treatment.

At that point I pull out my data collection form (which, like my assessment form, is always undergoing new incarnations and transformations!).  The current form consists of three large boxes at the top labeled “A” “B” and “C,” for writing the primary goals or “Target Behaviors” we want to address (i.e., “The client will do this” or “improve this”).  Underneath the Primary Goals, there is room for more specific objectives, like when or how often the client will do this and specific dates or benchmarks for completion of the goal.  Below that is a little table with blanks for each of my activities to be written in as  I complete them and to the right of each, miniature boxes labeled “A” “B” and “C” to coincide with the goals above.  I use those mini boxes to check or tally if and how often a client complies with the goals each letter represents for each activity.  I can then keep a grand total of how many activities or what percentage of the session the client was in accordance with their goals and write additional notes in the space below the table if necessary.  Thus, with all the information gathered from the pre-assessment interview and musical interaction, a plan can be set in place for when we (the client and I) will meet and how we will track and document each their goals, and the therapeutic process can begin.

Now, what can you as the reader take from this?  As I said early in this post, I find myself revitalized by assessments, not just because of the possibilities they provide for the new client and myself, but for the reminder of how what I do impacts lives.  It’s all in the little things – the slightest interaction or request can reflect so much, and cause a ripple effect that reaches further than I or that possible new client could ever see.  Take note of your day-to-day interactions with music, how they influence and sustain you, and take joy in knowing that every little note, every little interaction, counts, and has the potential to do even more for you the more energy and focus you devote to it.  So devote, I charge you – devote and enjoy!