Tuesday, March 30, 2010

What's the Protocol? An Example for Therapeutic Drumming

Protocol: The plan for carrying out a scientific study or a patient's treatment regimen.

Protocols are often established in the medical setting for standard treatments of common diagnosis. I often use protocols to outline a series of music therapy activities or a treatment plan for a music therapy session with a client. Although there are common traits and behaviors associated with certain disabilities or medical conditions, there are certainly differences between any two clients with the same conditions. A protocol used in a music therapy session is just a set of guidelines similar to a session plan, but it can and must be adapted almost every time to meet the needs of the client. Protocols are often developed for use in research about the effects of music on changing behavior or outcomes. A protocol for research, however, must be adhered to in order to maintain the validity of the results.

One example of a research protocol using music was a study conducted by Dr. Barry Bittman using active music-making in the form of hand drumming. This research study used a protocol of music activities that included singing, drumming and group discussion that became the basis for Remo's HealthRhythms program. The protocol developed for this program enabled the researchers to use the same set of activities multiple times over a number of days and weeks. They took some measurements from the participants before and after the program and compared the differences. The adherence to the music protocol allowed the researchers to conclude with some confidence that there was a significant effect in improving the immune system caused in some way by the participation in the HealthRhythms program.

Research is often different than clinical practice because therapists alter the treatment to meet the needs of the client. I do think, however, that clients can benefit from having a plan that is familiar and that can be used in some ways when the therapist is not present. With this idea in mind, I developed a protocol for cardiac patients who want to change their lifestyle by managing stress and developing more leisure skills.

My protocol for this type of workshop/training program contains the following steps:

1. Ice Breaker activity: Call and echo on hand drums. I use Remo tubanos, paddle drums, frame drums or buffalo drums. The basic premise is to introduce simple drumming on hand drums by the therapist playing a two beat rhythm and the group playing it back. There are many types of ice breaker activities, but for people who have probably never touched a hand drum, simple can still be fun and even a little challenging. An ice breaker activity also allows for the therapist to assess the musical skill level of the group. If they are able, then more advanced drumming such as playing on word syllables (e.g., names) may be introduced. Sometimes I have also used a fun "shaker pass" activity to encourage group interaction. There are dozens of chants that can work for this (e.g., Take and shake and shake and pass!), but the basic idea is to take an egg shaker from the person next to you, shake it, and then pass it to the other person next to you around in a circle. Everyone starts with an egg and the therapist gradually speeds up the tempo until everyone drops their eggs or one person ends up with most of them. This is a fun activity and usually gets people laughing and eager to try new things.

2. Presentation of Key Ideas: I have included three parts to this stage of my protocol for workshops. I quickly teach some basic hand drumming technique so that the participants are comfortable playing the instruments. This includes the idea of the "hot" drum so that players bounce their hands off the drum head instead of playing like they are trying to swat a fly. I also teach about the low, medium and high tones that you can play. The next step is to prime them for learning by explaining the way drumming can facilitate focus through the principle of entrainment. After this, I briefly talk about some of the current research regarding drumming and wellness.

3. The Beat of the Heart: The "iso-principle" is important for participants to understand. Entrainment will work best if a person tries to match their current level of activity/emotion/mental state with a drumming beat and then gradually move in a desired direction. I like to practice some rhythmic drumming in this stage that helps the participants connect with their breathing, heart beat, and even walking bodily rhythms. Don't be afraid to use some recorded music at this stage as an aid to the experience! Christine Stevens has some good drumming tracks just for this purpose. (Note: You can find her products on the "store" tab at the top of the page or just by searching for Christine Stevens in the Google search box at the upper right.)

4. Create a Healing Transfer: I teach that music builds a relationship with relaxation. Music becomes a conditioned stimulus that can activate relaxation responses. Music also helps to maintain a relaxed condition by increasing focus and eliminating distractions. This stage of the protocol is important because the therapist can start to connect drumming to the goals and desires of each client. The drumming becomes personal so that as each person drums they are drumming positive self-statements.

5. Guided Drumming with Imagery to Enhance Relaxation: Now the stage is set for an experience in drumming and relaxation. Participants are encouraged to have a frame drum on their lap or Tubano accessible in front of them. If you have assistants, then you can use them as "rhythm allies" to play ambient instruments (i.e., ocean drum, thunder tube, rainstick) at appropriate times to compliment the imagery. I sometimes begin the relaxation experience with deep breathing and stretching accompanied by soft recorded music.
Kevin Kern is a great artist to try out. (Note: Sample relaxation scripts and guidelines will be discussed in a separate post.)

6. Sharing the Experience: The relaxation session usually leads to some discussion and sharing of thoughts and feelings. This is an important step in convincing participants of the power of the music and drumming so that they will try it at home. Go over the education materials they will be taking home with them, so that they understand how to recreate their positive experience.

I hope you will experiment with your own set of activities and see what works for you and your clients! If you are able to set up a protocol of activities that you can repeat over several sessions, try taking some measurments before and after and compare the results. And as always, please feel free to share your experiences and thoughts about the subject!

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