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!

Thursday, March 18, 2010

Who Sang That Song On the Radio!?

How many times have you thought of the words to a song, but can't remember the title or singer? This happens to me all the time! I often hear songs on the radio and don't have a clue who is singing them! I found this website by accident and have been loving it ever since. If you can remember just one keyword or phrase from a song you want to know about, then you can find the title, singer and complete lyrics with one click of the mouse.

This site is a great resource for music therapists because we are often looking for songs that talk about a certain theme or subject. If you are going to do a song activity about being a friend, for example, then just type in the word, "friend," and see what comes up. My search turned up twelve songs that at least mention the word "friend." The best part about the search is that it also links to you-tube videos that play the song you are looking at!

This is a great find! Easy to use and pop-up free too!

Tuesday, March 9, 2010

Let's Talk! Facilitating Therapeutic Discussions.

Here are some ideas to help you facilitate discussion after a music intervention. Most of these suggestions will be applicable to both individual as well as group settings. I put the following considerations to paper as I thought about how to encourage and guide discussion in a group setting after a drumming intervention. My intention is to provide music therapists or music therapy students with some concrete guidelines for leading a discussion.

1. What should you say and how should you say it?

Reflecting: This is when you say, "It sounds like you might be feeling..." Reflecting is a good way to prompt someone to go into more detail, but it keeps you from unintentionally leading the client's thoughts and words.

Restating: This could be a phrase like, “I heard you say that…” Restating is very important for several reasons. First, it demonstrates that you are listening. Second, it clears up any misunderstanding you might have of the subject. Restating something back to a client also has the effect of allowing them to hear back what they are saying. There is something very powerful in hearing your own words repeated back to you in a different voice. It is amazing how something can sound perfectly logical when
you say it, but seems like "crazy talk" when you hear somebody else say it!

2. Allow the client to develop the solutions and strategies.

It is always more powerful for a person to think that they have come up with an answer on their own. They are much more likely to follow their own advice and people feel good about themselves when they think that they solved their own problem.

The therapist can help this process by asking leading questions:

For example, if the client starts talking about an interpersonal situation they are having with a spouse or family member, the therapist might ask, "What can you do to help yourself prepare to talk to this person?"

3. Stay away from asking "why" questions and don't give too much advice. The best thing to do while counseling is to have other people in a group come up with suggestions or help develop strategies that might lead to a solution.

4. Focus on the client(s) and not other people that come up in the discussion. Help the client or group think about their "circle" of influence and what they can actually control. Help them to realize that they can sometimes influence other people, but should maintain and cultivate their own healthy "circle" at all times.

These ideas will work in a hospital room during one on one music therapy with a patient or during a cancer support group after a drum circle intervention. The important thing is that the therapist assists the client or group in transferring the ideas that came up during a music intervention into applying the ideas in life or a given situation. Ideas like "teamwork" and "focus" are some examples of words or ideas that might occur in a music activity. A good facilitator will be able to help the client think of how those words can apply to their current situation in real life.

The guidelines I have outlined will help the therapist maintain appropriate therapeutic boundaries as well as maintain the flow of discussion. I know from my own experience that there have been many times when a client has said something that I did not expect! If I had not been in the practice of restating or reflecting, then I am sure I would have lost my composure and provided some awkward silence!

Good luck!

Monday, March 1, 2010

Arrogance or Courage? Doctors Draw a Line in the Sand Over Vaccines

New research from the University of Michigan reveals that about 25% of parents in the United States believe that there is some connection between vaccines and autism. This high percentage has disturbed doctors because it may threaten the efficacy of the vaccination program if enough parents do not vaccinate their young children. The research also revealed, however, that even though many parents feel that there is some danger in giving their child the vaccines, they still feel that vaccines are the best way to avoid illness.

I am disappointed that this news article, like most recent reports, simply recounts that there is no evidence that the MMR vaccine causes autism. While this is a true statement, the reporters never explore the fact that almost all of the studies regarding the MMR vaccine and possible links to autism have flaws in methodology or were perpetrated by special interest groups with specific policy agendas. The media also never seems to initiate the discussion about vaccines being a trigger for an autoimmune response that leads to behaviors and symptoms in children who are eventually diagnosed with autism spectrum disorder. Much of the latest research regards problems in the gut and intestines that are connected with the brain.

In my experience, I have not been impressed by the majority of pediatricians' efforts to keep up with the results of the latest research. I have found that most doctors rely on bulletins and statements sent out by their professional associations, the AMA or the Department of Health about the safety of vaccines. There seem to be very few doctors who actually take a look at the research themselves. This news report from Fox news said that some doctors are creating a "manifesto" to their patients insisting that they have their children vaccinated or else find another doctor. It is usually time consuming and very inconvenient to change doctors, but I would change from these doctors as fast as I could! Personally, I find their attitude toward parents to be offensive. Many parents have studied the issue of vaccines and autism much more than most doctors and they certainly have the best interest of their own children in mind!

I am afraid that we will continue to have this confusing state of information about autism and vaccines as long as the public is only able to digest news in sound bites and thirty second interviews. The variables to consider regarding autism and vaccines are complex and the literature suspect. Parents and doctors alike should devote considerable time to understanding the issue without "grandstanding" or holding steadfastly to one opinion or another.

The Fox news article can be read here:

1 in 4 U.S. Parents Buys Unproven Vaccine-Autism Link - Neurology | Alzheimer's Disease | Stroke - FOXNews.com

What's in a Name? Making Sense Out of the Proposed Changes for Mental Retardation and Autism in the DSM-5

The newest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) will be published two years from now. The American Psychiatric Association (APA) has asked for public comment on the proposed changes to labels and diagnostic categories for mental retardation and autism. The APA is proposing that the term "mental retardation" be changed to "intellectual disability." They are also advocating that the diagnostic use of Asperger's and pervasive developmental disability (not otherwise specified) be discontinued and labeled as "autism spectrum disorders."

It seems that about every ten years society goes through a vocabulary change as words become stigmatized and associated with unwanted connotations. This was the case decades ago, for example, with the association of the word, "mongoloid" and people with Down Syndrome. The term was not originally meant to be used with people with Down Syndrome, but became associated with the Syndrome and offensive to many people in its use.

I think that the term "mental retardation" varies in its use from state to state, but was still an official code for disability on an individual education plan in the school districts I was working at last year. I think it is interesting that people continually become sensitive to labels and want to change them. Changing the labels, however, does nothing to change the disabilities. We have the same clients, students, friends and family members no matter what we use to describe their disabilities. I think that the recommendation to use "person-first" terminology when discussing people with disabilities was a great step in the right direction. (e.g., "Jane" who has mental retardation versus "Jane" is mentally retarded, autistic, etc.) Changing from "mental retardation" to "intellectual disabilities," however, seems to be semantic window dressing. The APA is apparently changing the label in order to conform with the terminology from the Department of Education. It almost seems like we keep giving in to political correctness instead of getting the public to recognize people for their individuality and humanity instead of their label. We are all labeled in multiple ways every day, but do we let the labels define us?

I will gladly go along with the APA in trying to avoid disparaging thoughts or talk about people with disabilities, but I do have to wonder when society will be able to get past the immaturity of assigning negative connotations to words. Hopefully, we can focus on the people and not the labels in the future.

The change from using the labels for Asperger's or PDD seems to be much more practical in nature. The APA is trying to make it easier for schools and doctors to get help for children by including Asperger's and PDD in the autism group for funding and services. They are also recognizing that it is difficult to assign labels on a spectrum disorder. Every child with autism has different attributes of the disorder which makes it impossible to accurately assign a single label.

The APA news release can be found here.

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