Which one of you is the Music Therapist?

Reconciling Music Therapy and Arts in Medicine Programs

Music therapists have long sought to establish music therapy as a recognized therapeutic practice alongside physical therapy, occupational therapy and speech therapy. We have seen success in accomplishing this through much research and the establishment of clinically proven protocols. Music therapists are generally happy to see other people use music to aid in health and learning because most people already have a sense that music can aid in these processes. So more people providing music in a variety of settings is a good thing in my mind, but this situation has caused some small angst for music therapists over the years. Although music therapy, as an official profession in the United States, is now sixty years old, there are still many people who would see us as the "traveling minstrel" of the hospital or school.

Arts in Medicine programs have the benefit of providing access to the arts for patients who are forced to stay in hospitals for any length of time. They typically involve all art forms, including dance, art, music, poetry, and even gardening. One possible drawback, however, is the potential confusion about the roles of volunteers and trained music therapists in using music in the hospital setting. I honestly had not realized that Arts in Medicine (AIM) programs have been flourishing so well around the country. In a brief survey around the web, I found programs at the Cleveland Clinic, Texas Children's Cancer Center, and the University of New Mexico. We also have a large program at Tallahassee Memorial Hospital through Florida State University and there is another flagship program called the Shands Arts in Medicine program through the University of Florida in Gainesville.

The AIMS (Arts in Medicine Service) program here in Tallahassee does a very good job of differentiating music therapy from the volunteers and students that bring the art and performing art into the hospital. The AIM program for Tallahassee Memorial Hospital (TMH) is designed to, "Improve the aesthetic environment" of the hospital. There is no attempt by members of the AIM program to implement goals and objectives to directly influence health or treatment outcomes. Since TMH has two full-time music therapists and generally two music therapy interns, all direct patient care involving music is handled by the music therapy department. AIMS participants are supervised by Florida State University and receive college credit for their work. They do not use music in one to one contact with patients, but are regularly scheduled to perform concerts in the hospital atrium. In this way, the line between music therapy and AIMS personnel are clearly defined and easy to understand by patients and staff.

The University of Florida employs a completely different model of providing the arts to the hospital setting. The Shands Arts in Music program actually employs full-time "artists in residence" who work at the hospital and supervise the other AIM participants. The "artists in residence" who provide music are not necessarily music therapists, and music therapy is not provided at the hospital. The Shands program is a robust endeavor with more than one hundred volunteers participating throughout the year alongside the "artists in residence." The program at Shands was specifically designed to apply the arts to patient care and not simply improve the aesthetic environment through exposure to the arts. As seen in the picture above, the environment at Shands hospital has been dramatically impacted by the AIM program, but the "artists in residence" are also specifically tasked with developing arts interventions to aid in patient care. I find this idea troublesome since art, dance and music therapists go through much specialized training in psychology, counseling, anatomy, etc. in addition to training in their medium in order to meet the needs of clients.

I think I prefer the AIMS model at TMH because of the well defined boundaries between people doing music therapy and other people doing music to increase the aesthetics of the environment. I admire the University of Florida program for its creativity and dedication to the arts, but it would be nice for them to also recognize the use of music by musicians who have been trained in applying it therapeutically using research-based protocols. I would like to know how other music therapists feel about this situation. I also wonder what it looks like from the outside looking in, from non-music therapists approaching a hospital with one or both programs. Maybe I am over-sensitive to the development of AIM programs or do you think that it might be confusing for a patient to distinguish music therapy from AIMS program members?

Please feel free to share you story of an encounter with music therapy or AIMS when you went to the hospital!

What's In a Name? (Part 2)

Bipartisan Senate bill aims to take 'retarded' out of federal lexicon - TheHill.com

I have already blogged (here) about the changes coming in the new Diagnostic Statistical Manual of Mental Disorders (DSM-V) in May 2013. Congress, always trying to join the "popular" club and somehow redeem themselves, has also jumped on the bandwagon. The American Psychological Association has not endorsed the new bill trying to make it out of committee, but they are also not opposing it. The new bill would change all federal references to "mental retardation" and "mentally retarded individuals," to "intellectual disabilities" and "individual with an intellectual disability." The bill is also known as Rosa's Law, named after Rosa Marcellino of Maryland who has Down Syndrome. Rosa's family successfully lobbied the legislature in Maryland to change the wording at the state level and the crusade was picked up by the national legislature.

I don't see anything wrong with the name changes and just want to keep you up to date on the current proceedings. Society will probably insist on changing the name again in the future as "intellectual disabilities" becomes a "bad" word or phrase. I think that we must continue to strive against ignorant people and people who don't think before they speak. There will always be these people in the world, but it is really their actions and not their words that we should pay attention to.

Hit List! 5 Ways to Successful Drumming with Older Adults.

Drumming activities can be very effective with a variety of populations, including older adults. Many older adults who have been placed in care facilities have symptoms of dementia or may even be diagnosed with Alzheimer's Disease. Although this client population typically presents with lower motor skill coordination and less spontaneous social interaction, this should not discourage you from doing drumming activities! Here are five things to keep in mind when working with older adults in group settings. These ideas will assist you in successfully leading a drumming activity:

1. Use the power of Entrainment! This means that objects in motion or rhythms and beats tend to coalesce or converge when given the opportunity. Imagine a large group of people all start drumming a simple beat at the same time. At first, the sound will just be random drumming without a sense of rhythm or underlying pulse. The beat will eventually emerge and the group will naturally begin playing together on a unified pulse. This phenomenon holds true for any group of people, including some people with disabilities. I have witnessed entrainment many times in groups of older adults. In order to facilitate entrainment, try to provide a steady beat or pulse on a drum with a low sound. Entrainment also takes time. Don't feel bad about allowing what may sound like rambling drumming to continue until entrainment starts to occur.

2. Reminiscing. This is an important tool for working with older adults because it helps to improve their quality of life. Remembering and talking about favorite places and things promotes positive emotional responses and improves interactions with staff and family. Groups of older adults will probably have varying ability to remember things about their life, but props, pictures and songs can be helpful in encouraging participation. I like to use word rhythm drumming about favorite places, hometowns, foods, etc. Word rhythm drumming is simply breaking down words into their syllables and playing the syllable parts with the same emphasis and cadence you use while speaking the word. Different words can be used with different types of drums, shakers or bell sounds to create unique and fun drum activities.

3. Themes. Theme-based activities compliment the use of reminiscing. The easiest way to employ themes is to talk about current events and holidays. Many of these events have songs that are already well established, so the chances are greater that many of the clients will know the songs. Christmas, the Fourth of July and Baseball are all good examples of events to build themes around. Other themes can be found through investigating songs and events from the clients' early adult years. The ages of 18-30 have been found to be the most significant for developing taste and preferences for music. This age span is also sufficiently young enough that clients with Alzheimer's will be more likely to remember things from that time. Songs like, Alexander's Ragtime Band, My Bonnie Lies Over the Ocean, BINGO, and Deep in the Heart of Texas have been big hits with some of my groups! All of these songs have natural places to add in instrument and drum playing.

4. Dancing, moving, sharing. One of the most important ways to increase success with older adults is to get them moving! Kinesthetic involvement with the music is a key to unlocking old memories. Moving to music also increases entrainment and meets goals and objectives set by medical staff to practice motor skills. Exercise routines, stretching, and relaxing can all be facilitated with drums and instruments. Try using an ocean drum to facilitate moving a parachute up and down. Another great idea is to end the group with very soft rhythmic drumming facilitated with ambient sounds of the ocean drum or rainstick and soft music while doing deep breathing and relaxation to simple imagery. Ocean drums, paddle drums and gathering drums are great instruments to encourage sharing. Older adults in facilities tend to keep to themselves and can benefit from strategic settings that promote social interaction.

5. Look for Rhythm Allies. This is term coined by Arthur Hull, Christine Stevens and the other founders of drum circle facilitation. Rhythm Allies are your special helpers that you have instructed before the activity to help maintain the beat, work with specific clients or play special instruments at appropriate times. Rhythm allies are usually staff or family members, but I have also received help from capable clients when possible. Rhythm allies are more important with groups of clients who have more severe dementia or physical disabilities.

In addition to the previous considerations, I suggest a 30 minute music session as an optimal time to maintain focus of attention. It is also important to be aware of clients prone to agitation or who have pain that prevents certain movements.

Good luck and please let me know how it goes!

Primer on Music Therapy from the Library of Congress

Concetta M. Tomaino is a music therapist and executive director for the Institute for Music and Neurologic Function. The Library of Congress has been doing a great series of presentations on Music and the Brain. Ms. Tomaino spoke on March 12, 2010 with a presentation titled: The Positive Effects of Music Therapy on Health. She then did a podcast discussing how music therapy has changed over the last ten to fifteen years and provided a wonderful modern primer on what music therapy is and where it is being used.

Dr. Jayne Standley from Florida State University did a presentation on May 14, 2010 titled: Wellness and Growth: Acoustic Medicine and Music Therapy. This presentation is not yet available through the Library, but I am confident it will be a must read in the future. I will try and link to it when I can. In the meantime, here is the podcast from Concetta Tomaino. It is only 17 minutes long, so well worth your time and manageable to fit into hectic schedules!

Library of Congress Podcast: Music and the Brain

The World Gone Crazy!

Here is the headline from FOXNews.com - Autistic Boy Accused of Terroristic Threats

The story describes a middle-school boy who drew a picture of two stick figures. One of the stick figures is the student holding a gun and pointing it at the other stick figure who is labeled as the teacher. The mother of this 14 year-old boy claims that he has autism and a documented I.Q. of around 75. If this is true, then he most certainly should be in the special education system and have an Individual Education Plan. The school is refusing to confirm anything about his case, so at this point we only have the information from the mother. If her statements are true, then I have no idea what this school system is doing!? The school district has this boy scheduled for a "tribunal" and charged with terrorism! Apparently the drawing goes against the districts "zero tolerance" policy. What are people thinking!!??

So, we are to believe that charging a 14 year-old with terrorism charges is going to help the situation or somehow prevent others from drawing pictures!? Obviously the student was upset with his teacher about something and if he has autism, then probably lacks the ability to appropriately express his feeling. He also might be simply drawing something that he saw on TV! Who knows! That is the whole problem with Autism Spectrum Disorder, of course. We often do not understand why the stereotypical behaviors, verbalizations or acting out are occurring.

It would be nice if school administrators with their misguided, although well-intentioned, rules (i.e., zero tolerance) would step aside and allow the trained therapists and diagnosticians handle cases like this. Now that there is all this publicity it will probably make the situation worse and this student's education and learning will end up taking a back seat on the priority list.

I hope you will share your thoughts about this. I am obviously a little outraged, but maybe there are other circumstances we do not yet know about. It should make us all, however, try to think critically about the rules and standards in our public schools. District superintendents get paid hundreds of thousands of dollars per year in salary. I question their value when they lack the courage to take a look at individual cases instead of deferring to blanket rules and standards.

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