I have the pleasure of working with consumers* in an in-patient acute psychiatric setting. One of the interventions I do is a "music expression" psychosocial rehabilitation group. I usually have approximately 8-20 patients at a time depending on the hospital census and doctor referrals. The group of male patients is always changing, so I never have the same set of people twice. Even though the group is different each week, however, there are certain things that remain constant. One of these factors is safety. The safety of patients and staff is always a concern and something I have to consider for each activity. The group participants are all considered acutely mentally ill while residing in the unit where I go to do the music expression group. It can be challenging to engage these consumers in music-making since they are at all different levels of functioning because of their illness, physical condition or effects of medication.
Drumming activities are often a very good way to engage the clients in my group. I have done both organized rhythms with them as well as more loosely structured facilitated drum circle activities. The consumers seem to like the drumming and usually stay engaged with this active type of music-making. I want to offer you some of the things I have learned in doing drumming activities with this population:
1. Take caution! Some instruments like the REMO tunable tubanos have tuning bolts and other potentially semi-sharp or exposed parts that could be dangerous in the hands of an agitated patient. In addition, I usually will not take tambourines or a Gankogui into an instrument activity with the acute psychiatric patients.
2. Emotions. Expressing and managing emotions are very difficult for many people with mental illness. Exploring emotions and appropriate ways to express feelings is a good topic for music therapy sessions. This can be done through song-writing, improvisational instrument ensembles and especially drumming. After you have taught the clients that they can make unique sounds by playing drums in different ways, it is a great activity to have them express feelings exclusively through playing on drums or rhythm instruments. I like to do a guessing game where I assign emotions to different people and try to have them play a drum in a way that the group can determine the emotion.
3. KISS! The old adage, "Keep It Simple Stupid", applies to rhythms. Many of the patients are on high doses of medication that cause drowsiness, decrease focus of attention, and sometimes motor skill impairment. The easiest way I have found to overcome these obstacles is to use words and syllables as the basis for rhythms. Drumming your name is probably the most common example. You can actually have a pretty rockin' rhythm just by getting everyone to play rhythms that match how they say their names!
4. Wave! Like you do in a stadium, that is! Even if you cannot get a drum circle filled with acute psychiatric patients to sound good playing together, you can often get them to successfully do a drum wave. You can use one drum hit or a short drum roll and pass it around the circle faster and faster until you get a wave going. A facilitator pointing to people is usually helpful, especially in order to get the wave going faster.
5. Be our guest! One of the most empowering moments in music therapy is when a client gets to facilitate a drum circle. You can make this successful by clearly modeling ways in which a facilitator can guide the circle in dynamics, timbres, groupings and starts and stops. Therapists know that patients in any facility have had much of their control over the environment taken away. When you turn the drum circle over to "guest" facilitators, you provide an opportunity for self-expression, choice-making and practice in non-verbal communication. That is a lot of therapy happening in one moment!
I am sure there are many more things we should add to the list. I hope you will share your own tips and ideas with us! Happy Drumming!
* (consumers = patients, in official psychiatric hospital lingo)