Category Archives: Music Therapy

Response Art

AL is a lady with advanced dementia. At the time of writing we have had about 4 sessions together. In this particular one, she had come in with her body tightly contorted. Her hands were clasped to her chest, and her knee was almost reaching her stomach. It did not look comfortable.
Having had several sessions with her, I knew that she liked to listen to softer, soothing music, but did not want to sing. She also did not have particular songs she liked, and seemed ok with improvised melodies over structured chords. We started. I used a motif from a well known song and improvised around that, humming, using vowels, extending and playing around with phrases. A minute or two in, I asked if this was ok. She nodded. She showed she was listening by moving her head and lips to the music, though without verbalising any sound. After about 10 minutes, her leg started to lower itself. Her body looked more relaxed. We continued.

And then –

I heard her!

She was beginning to sing the lines from the song we were improvising around. Her words were clear – it was the exact lyrics. I was stunned, and continued playing the accompaniment while she sang the same lines several times.

And just as suddenly as she had started, she stopped. And went back to closing her eyes, listening.

We continued – and I was happy to note that her overall body posture had become more relaxed by the end. She was no longer tensing her muscles and tightly holding her hands to her chest.

That few seconds of her singing, actively engaging in the music, kept rippling in my mind for days after that. I felt that I had to express it in some form, and hence did an art representation of it.

Sometimes I feel that I just live for moments of connection like these.

 

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Her Singing Voice

We were singing the Goodbye Song when we heard it. Her singing voice.

She was going “baaaaaaii~~~!” at every “bye” in the Goodbye Song, while looking straight at me. It took me about 2 rounds of that to realise she was singing.

Before that session, I had only ever heard her vocalise and babble using her baby sounds. It was the first time I heard her use what seemed to be her singing voice – softer, more airy, not in tune but definitely higher than her usual vocal range, as if she was trying to hit a higher note. She seemed to know it was a long note at the end of the phrase, too. As her breath was sustained, the notes would spiral into a descending glissando. In the space in the music after each note, her contribution was mirrored musically, as a validation. To let her know: I can hear you, I can see you, and I am taking your lead in this music we are in together.

Can you imagine what it feels like to hear a child discover her voice for the first time?

It was beautiful.

“Let’s Dance With Our Ribbons”

Fz is a semi-verbal little boy with ASD whom I’ve been seeing in group sessions for 2 years. He loves singing and music-making, attuning to music and songs naturally, frequently singing songs on his own and sometimes using songs to self-soothe. He can be really loud with his voice, as well as unpredictable with his emotional expressions, sometimes bursting into tears over seemingly non-existent or very small triggers. In addition, because of his diagnosis, it is usual to have him engage with objects and instruments more than people.

In sessions, the goals are for him to engage in social interaction through music-making: Responding to non-verbal cues, making eye contact, and to regulate his movements and expressions through co-regulating with the musical environment. Fz has shown capability in all aspects of these goals, but in our most recent session, he surprised us by seeming to go one step further.

We have been ending our sessions with these ribbon streamers – colourful pretty things to encourage expression through larger body movements. Song is a gentle waltz, to stimulate movement, and provide a safe encouraging space for body expression. For the previous 2 sessions, Fz has been playing with his ribbons without displaying much awareness of the environment. Appearing pretty much in his own world. But in this particular session, he had suddenly stood up, walked around the space until he stopped in front of me, and started swaying (Swaying is a very natural reaction to a waltz!) his body in time to the music while sustaining eye contact. I was pleasantly surprised at this sudden initiation from him, and started swaying with him while the music continued. And we stayed that way till the end of the session, about 3 minutes later – which is a really long time for a little boy!

I am thankful I was able to witness his capacity for sustained engagement, and humbled that he chose to share it with me in the music, in our swaying together. I want to remember this, as a reminder that every child is capable of meaningful interaction and connection 🙂

Flow

This quote reminded of the term “flow”, described by psychologist Mihaly Csikszentmihalyi (How do we even pronounce that) as:

“A state in which people are so involved in an activity that nothing else seems to matter; the experience is so enjoyable that people will continue to do it even at great cost, for the sheer sake of doing it.”

And these are the 8 characteristics of flow:

  1. Complete concentration on the task
  2. Clarity of goals and reward in mind and immediate feedback
  3. Transformation of time (speeding up/slowing down of time)
  4. The experience is intrinsically rewarding
  5. Effortlessness and ease
  6. There is a balance between challenge and skills
  7. Actions and awareness are merged, losing self-conscious rumination
  8. There is a feeling of control over the task

Source

 

This prompted me to reflect and examine the frequency with which I currently experience this state of flow in my job (because that’s important to me!).

Yes, when I conduct sessions, I can see how being “in the zone”, having my skills and the challenge at hand being equally matched, seeing the natural and connected engagement with the children, creates the circumstances for flow to take place, which contributes to my perception of meaning and joy.

I suppose it is when we are unable to experience this state of flow in what we do, that the tasks and job may become more tedious and arduous. How do you feel flow in a session with the little boy who is screaming his head off, or with the one who is scratching his peers and everyone is just trying to stop him but making things worse, or with the little girl who is crying because she wants her favourite snack and the teacher is refusing to give in to her?

I think that’s when being able to be in the moment and taking the stance of an observer can really help a lot. Thinking “Wow, this is a difficult situation” instead of “I AM in a difficult situation” can really make a lot of difference in how we react and/or respond to the challenges. It certainly takes practice, and I’m still working on it 🙂

A Little Thing

It’s a usual music therapy practice to greet each person in the group individually at the start of the session, and to say goodbye to each individual. It is a way to invite each individual into the group setting, and at the end, to thank them for their contribution to the group.

Well yesterday, I forgot to say bye to each individual kid after a session.

After the group goodbye song, the boys were transited to go toileting, then to go for their outdoor activity.

But one of the little boys decided otherwise – he apparently pulled his teacher back to the classroom, where I was still packing and clearing the area after their session.

I had turned around and there he stood, looking at me, somewhat bashfully.

Unaware of his agenda, I asked “A, what is it?” Not that he could verbalise a reply, but I knew he was capable of communicating through gestures and vocalisations.

When a few more moments had passed without him initiating anything, I looked at the teacher standing at the entrance of the classroom.

“Do you know what he wants?” I asked.

“He wants to say bye.”

BOOM.

It hit me then. Of course. I had forgotten to give each kid their individual goodbye after the session, perhaps unconsciously assuming that the goodbye song was good enough and that it wouldn’t make a difference to them anyway… Apparently it does!

Squatting to his eye level, I said “Bye bye A!” and held out my palm for a high-5. He returned the high-5 immediately, smiled and turned to walk back to his teacher.

Heart melts.

The little things do matter. A lot.

July 2018

So. It has been an eventful month, to say the least.

When I applied for this Friday off from work (about a week ago), I was feeling emotionally drained, fatigued and slightly jaded (even if I did not always show it). It made sense to take some time off, to regather my thoughts and feelings, and to perhaps reconfigure the WHY of what I’m doing.

It all started from 3 Sundays ago, when I received a call from a colleague tearfully telling me that one of our kids was in intensive care and not expected to make it through the next day. The social worker had asked if I would be able to have one more music therapy session with him?

Yes, I said. Of course. We made plans to go down first thing next morning.

I don’t think I had much time to prepare myself for it. I texted a trusted peer and shared my worries about doing the session. My worries about not being able to separate my personal emotions from my role as the therapist in the room. She reassured me that it was ok to show our emotions and that I could try taking deep breadths if it got too much to handle. I wrote about my emotions in my journal. Had some alone time in the morning before work, to ground and steady myself. That was about all the preparation I could do, I think.

The session itself started on an emotional high. Little D, not even 3 years of age, was in a comatose state, kidneys failed, his face swollen and puffed up, with machines and tubes all around him (But then this wasn’t something new, even when he was coming to school he was already surrounded by tubes and machines). It became quite apparent that the music was more for mum than for D. She started crying the moment the strings of the guitar filled the room.

Same chords. Just repeat. Hold the space, I told myself. C – G – F – G – C. Repeat. Mum took a call. Came back. Continued crying.

“We are here… Here with D…” A song to establish our being there. Our presence. Our being together. Humming. A space for comfort. And also because I didn’t trust myself to sing words continuously without breaking down or cracking with emotion.

“Is there anything you’d like to say to him?” I chocked out to mum, after some time of just playing instrumentally. A floodgate of emotions opened as mum verbalised what she seemed to have been keeping in. “You can go and do all the things you couldn’t do here…”, “Mummy has already tried her best, sorry…”, “If you want to go you can go, it’s really ok”… It felt like she needed that space, and perhaps even the presence of people who allowed her to say those things.

Keep playing, keep playing. Don’t stop the music. Hold the space. She needs to let this out. Even though my tears were salty, my nose was dripping grossly, even though my shoulders and fingers were tensed and tired from the continuous plucking.

When she seemed to have finished all she wanted to say… or at least reached a suitable pause… I let the song take over again. To gather. To validate. To comfort.

“Mummy loves you… Loves D…”. “Thank you mummy… for taking care of me.”

A voice for D, perhaps, who has never uttered a word in his life.

Hesitantly, I ask. “Are there… any songs he liked in particular?”

“Not really…” A pause. “Maybe… Can you sing You are my Sunshine?”

And we did.

You are my sunshine
My only sunshine
You make me happy
when skies are grey
You’ll never know dear
How much I love you
Please don’t take my sunshine away

“D, I’m sorry I did not dare sing this song to you because I was afraid I would cry. You will always be my sunshine ok…”

Needless to say we were all emotional wrecks by this time. Yet, it felt like the right moment to wrap up the session.

“Can we sing a goodbye song?” – This, I had not expected.

“You mean the one we always sing in class?”

“Yes that’s fine”

It’s time to say goodbye
Goodbye to D, goodbye
Thank you for your music
And now we say goodbye

 

After we left, we heard that mum had brought D home. And D passed on at home the next morning.

How do I even begin to describe what the journey was like after that experience?

I moved through the world feeling numb, drained and fatigued for the next week or so.

I could not sleep, and woke up early.

I continued sessions but could feel that my heart was nowhere there with the kids in front of me.

I don’t know if it was grief, or emotional exhaustion. Or maybe a combination of both. I didn’t understand how everyone around me, my colleagues – could continue as normal when inside I felt so hollow and empty. I felt isolated – no one else could understand what that space felt like, what it felt like to be holding the space with music and connecting in those moments through song and music. I tell people “It was an emotional session” but that did so little justice to the experience that it became a chore to even try to explain.

Doubts also crossed my mind. Was I being unprofessional by investing too much of my emotions? I should not have allowed myself to get so deep emotionally? Is it a sign of my incompetence as a therapist that I’m unable to handle the emotions when it gets this tough? How do people working in palliative settings do it? Does this mean I’m not suitable to work in palliative settings?

But.

It’s getting better. Even though there were times when I thought it would not.

And I am glad I can honestly say: I’m very thankful for the privilege. For the experience. It has deepened my practice so much. To have been there, with the music, as the music therapist. When I started working in this job, I never imagined that I would get to do a session like that. And now I can look back and see how it has helped me grow, helped me know myself better, helped me truly appreciate what music can do.

The feelings may be difficult, but they can teach us so so much.

And the journey continues.

“That Was Hard.” – a Lesson in Self Compassion

“That was so hard! You did amazing for what you were given to deal with!”

These words meant a lot to me for 2 main reasons.

  1. It’s not our cultural norm for someone to acknowledge how hard the things we have to do sometimes may be. I mean this in a widespread sense, not job-specific sense. But when your job is sometimes seen as nothing more than “having fun” and “making music with kids”, it can be even harder for people to understand why you feel like you have a hard time. So, having someone who understands when we have a difficult session, and acknowledge that it was hard, can be enough to move me to tears.
  2. I learnt that acknowledging and accepting when something is hard does not necessarily include admitting that I’m incompetent, which is one of my greatest fears. I learnt that acknowledging and accepting when something is objectively and naturally hard actually opens my mind to think about what can be done to overcome the difficulty of the problem, without getting too personal about it. Without thinking that if this doesn’t work = I’m a complete failure. Simply acknowledging the mountain-like nature of the tasks we have to do (Eg: Engage 6 kids at once on the same task, each of which have a different developmental delay diagnosis and/or have ASD and a cognitive age estimate of below 12months..) can go a long way in accepting that sometimes we don’t get the kind of completion and success we want, but can still learn and grow from the experience.

After that line was said to me, I felt so touched that the challenging nature of the situation was acknowledged, and I felt myself become more open than ever to take in suggestions for change and improvement. And some of the suggestions given were really good.

Of course I would have accepted the suggestions given anyway. But if not for this line, I don’t think I’d feel as confident about moving on, and might have even internalised some negative messages about myself. Not exactly the most healthy thing.

So today, I am thankful for this lesson in Self-Compassion. May all be well and happy!