Category Archives: Music Therapy

Article: The Role of Music in Adolescent Development

By: Miranda, D. (2013).

From: International Journal of Adolescence and Youth, 18:1, 5-22.

 

This article is a literature review, which highlights how much of adolescent developmental psychology literature and research leaves out the role of music in an adolescent’s life. It concludes by stating that more research into the developmental role of music can present more insights into the psychological, social and cultural needs of the contemporary adolescent.

 

My reflection:

We know that most of the songs we seem close to our hearts are the songs we listen to from our teens to 20s. There is more research and literature about how music can help in reminiscing in elderly patients and clients, helping them make sense of the world around them in their aging years. “Use of familiar repertoire” is a staple music therapy intervention and technique in working with aged care. Most of these “familiar repertoire” are the songs that accompanied them through the tumultuous years of adolescence and young adulthood.

It would make sense, then, to study how the same songs which adolescents are identifying with as they are growing up, are being used (consciously or unconsciously)to help them cope in their psychological and emotional development. With more understanding in this area, teachers, developmental psychologists, counsellors, and therapists might then be able to better understand how to help adolescents cope with the struggles of growing up. These struggles could include: Peer pressure, identity searching and formation, emotional issues, mental health.

Example: I’ve noticed that having the same tastes in music is one of the first things which bond students together into long-lasting friendships. It could be the latest k-pop band, or just the single which became a hit 2 years ago. The moment 2 or more individuals find out they have the same tastes in music, a tentative friendship is formed, which could then be strengthened or dissolved depending on other factors. Music, then, could be used as a bonding agent within the class, especially to aid students who might not be as apt or skillful in social aspects.

During music lessons this week, I asked students what is their “current favorite song”, promising that I would try to incorporate those into our music lessons. My motive, apart from making the lessons relevant to them, is also to improve the social dynamics of the class. Through group musical activities, individuals who might have found it hard to adjust to the social environment would be given an alternative platform to engage with their classmates, and hopefully blend in better into the social fabric of the class. Being well-adjusted is one of the key factors which could prevent later problems from surfacing, such as bullying, truancy or loss of interest in academic studies.

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Am aiming to read and reflect on at least on music therapy article every week and see how I can apply / transfer the content into the music classroom.  Part of self-development and reflective practice, and to not lose touch with the therapeutic side of things!

Bye Di

And so we have reached this moment, the moment we knew was going to come but did not know how it would unfold. It was our last session together, and we had geared ourselves up to say Goodbye.

To my surprise, I felt able to regulate my emotions relatively well, and Di too. Though we were slightly teary at first (at least I was), we did all the usual things during the session. When it came to the last segment of improvisation, I asked her what theme she would like to improvise around this week, and her answer wasn’t totally surprising: “Saying farewell… To you.”

We then talked about the emotions that came with saying goodbye. Di reflected that perhaps it was something that came with age, but she felt that she had become better at saying goodbye in recent years, whereas a few years back she would have been devastated at the thought of parting with people she cared about. I added that it was true, we do gain maturity with age, and that goodbyes need not signify endings, but could even herald new beginnings and navigations which can only be experienced with a physical parting. We exchanged cards which contained heartfelt words we probably felt more comfortable writing than saying, and admired the CD we had put together, containing recordings of our musical explorations.

We agreed that our parting need not be sad and teary. Instead, it could be a celebratory event, a parting filled with happy gratitude that we had the chance to meet, get to know, explore emotions and music together. We can feel gratitude that from this client-therapist relationship, we can now move to friendship, which is not a bad thing at all, from the therapeutic point of view.

And so with these frames in mind, we embarked on our final improvisation on the keyboard together. And it felt like what we had discussed: Celebratory. With Gratitude. Communicative and connected. My only regret was that we didn’t have it recorded, though the presence of recording equipment might very well have hindered the authenticity of the improvisation.

“That’s all right,” Di said, when we spoke about what it pity it was that we didn’t record the improvisation. “We have it inside us.”

And she went on to say the line which would surprise me most: “I feel a lot more confident expressing myself through the keyboard now.”

I was surprised because:
– Increasing sense of empowerment and resources for expression had always been the main goals of her sessions.
– I have never told her that these were the goals planned for her, or that we had goals to begin with.
– Di has NEVER described herself as being confident in anything.

The fact that she said that on her own accord, the fact that she has been able to recognize the change that has taken place on a personal level – it is truly a testimony to the power of music to facilitate non-verbal communication, the mystery and magic of improvisation, and the wonders that can emerge when 2 people connect.

To have been able to experience this journey and transformation, learn, and gain a precious friendship, I am immensely thankful.

Not “JUST”.

At a workshop for allied health students a week or two ago, I witnessed an exchange which stuck with me.

It started when one of the physiotherapy students asked our facilitator: “Are — (I forgot which profession she mentioned) doctors? Or medical personnel of some sort?”

Our facilitator replied no, the mentioned profession were not considered doctors or medical personnel.

“Oh ok.” The student replied. “They’re just allied health then.”

At that, the facilitator pricked back: “Not JUST. They’re allied health!” And because she had a twinkle in her eye, a little ripple of laughter ran around the circle.

The exchange stuck with me, more than any of the content spoken (family-centered philosophies and practice), and more than any of the role plays enacted (though I must say we were given some pretty tricky situations to respond to).

The exchange stuck with me because it occurred how important it is to take ourselves seriously before anyone else can. I know it’s common sense, all linked to the “love yourself before others can love you” train of thought, but the response from that student, the way she used the word “just”, stirred something in me. And I realize I could have been guilty of labeling myself or my profession as a “just” as well. After all, we don’t study for 5-6 years like the medical students do. We don’t sit for rigorous exams and tests. We don’t earn $60 000 or more a year. We don’t have to work shifts or hours as long. We don’t have to make decisions that concern life and death. We’re “just” allied health.

But if we were to think like that, who else would there be to advocate for the professions? To stress the importance of psycho-social experiences in early intervention and it’s impact on the type of adult one grows up to be? To come up with individualized  interventions for possible cognitive development in special needs? To understand how environmental and relational factors interact with each other to form an individual’s worldview and respond accordingly? To look at what a disabled individual can do instead of simply what they are limited by? To help a family through grief when their loved one is dying?

Medicine and science could probably solve a lot of problems, and yes, robots may take over the world someday, but for now I firmly believe: Without the holistic care of the person, existence can be more burdensome than meaningful. And that’s why it’s not “just” allied health. It’s ALLIED health.

Teacher Supervision

When I first heard this word: “Supervision”, my heart was struck with fear and worry. And is it any surprise, coming from a system and culture where this word is linked to images of someone standing by the side while you do your work, watching you with a critical eye to make sure you’re doing your work “right”, making sure you’re meeting all the necessary criteria and prerequisites to be deemed as passed and qualified? Supervision, even with the best of intentions, have unfortunately become a word of relatively negative connotations in our work culture.

Despite my initial trepidation, I soon realized, to my relief and delight, that Supervision in music therapy (or Allied Health, for that matter), does not have direct correlations to my perceived impressions of being Supervised. It’s in fact the opposite –  a whole culture of being non-judgemental, accepting that the typical human being is failable, that everyone has emotional baggage, that everyone has times when they need to talk to someone about their emotions and not only about how good they are in their skills and job.

In such an emotionally-charged job, Supervision is seen as necessary and some places, like mental health wards, make supervision mandatory for the clinicians there.

I was thinking about all these, and wondered: Why isn’t Supervision made mandatory for Teachers?

Not supervision in the lesson-observation, work review sense, of course, but in the above-mentioned sense. Supervision for teachers in the sense of each teacher having someone they can go to to sort out whatever comes up in their work. It may not even necessarily be senior teachers, just like music therapists don’t always go to senior music therapists for supervision. As long as it’s someone who understands the nature of their work and the nature of the client population they work with. For teachers, it may be someone who works with students of similar socio-economic status, or perhaps someone in another school who teachers the same subject.

There is informal Supervision, of course. Teachers talk to each other all the time. Along the aisles of the staff room, along the corridors. Over lunch. Mentor-mentee sessions – these probably come closest to Supervision. But even then (at least in my experience), the mentor-mentee talks were always filled with issues like classroom management issues, pedagogy, effective delivery, etc. There was little focus on the individual perspectives of the teacher and how that individuality could affect day to day interaction and working.

The best supervision I’ve had so far was when working in Mental Health. The client group was undoubtedly the most challenging I had encountered up till that point, and having good supervision was so essential to my well – being, development and growth.

In the confidential, closed door, one-to-one sessions, I was able to bring up emotions I felt when working with certain people, ask questions about MT interventions and techniques, discuss academic readings and discourses with the much more experienced and ever non-judgemental supervisor. That experience really made me view Supervision in a different light, and now I find myself wondering if the burn-out rate among teachers would be less if we could have a culture like this. A culture of supervision where it is ok to talk about our problems and inadequacies, instead of trying to hide them and hope that you can overcome them in time to produce a good lesson for observation, to push for that school carnival, to pull off that speech day concert.

Over a meeting with Lecturer K the other day, she asked me how I was going with the course, giving me very encouraging feedback and advice. One of them was: make sure you get yourself a good supervisor and continue to develop yourself professionally when you start working as a MT.

The culture of supervision is so strong in this field that anyone who lets it be known that they don’t have a supervisor to go to is frowned upon and thought of as less-than-professional. It implies that they are not making efforts to reflect, talk about the difficulties faced, and possibly not keeping up to date with the latest developments in the field. That’s how important Supervision is viewed.

Maybe it’s time someone introduces this concept to Education Ministries and get something started. Teachers, like therapists, also give a lot of themselves – mentally, emotionally and physically. And any work with vulnerable individuals is bound to expose vulnerable aspects of ourselves too. Why should teachers be denied the platform to work through these vulnerabilities, take charge of their own professional and personal growth, empower themselves to be the best person they can be, and ultimately present the best aspects of themselves and their abilities to the ones that matter the most- their students ?

The Trap of Definitions

While on placement about 2 weeks ago, a question arose which bugged me surprisingly deeply.

It came after a session with an 8-year old boy, who, being an 8 year old boy, didn’t want to engage in songs or musical activities, but was only interested in enacting imaginary stories about zombies and the apocalypse, and showing us his mindcraft structures.

It was good. Everything was good. There was quality interaction which I observed between the supervisor MT and the little guy, and she very cleverly subtly used music to support his imaginary stories and enactments, which really boosted the whole feel of things.

I couldn’t even put my finger on the bubbling question bugging me. It was not until we stepped into the office my question formed the words: “For sessions like M’s, do you ever wonder if what you’re doing is music therapy, and what is music therapy then?”

I was very grateful for the supervisor who validated my question, yet very genuinely admitted that it was a question she herself constantly struggles with, and that it may be something we just have to accept as part of the profession.

“What we were doing was a lot of imaginary play, which a play therapist or child life therapist would have been able to do a better job at. Yet on the other hand we have child life therapists who use music and sing songs with the children they work with. It can be hard to draw a clear line.”

Reflecting on her reply, it can be easy to see why inter-disciplinary or trans-disciplinary models in allied health departments are becoming so prominent these days. Rather than continue to insist that each profession stick to “what they do best”, looking at how we can support each other in overlapping areas could result in more holistic care for the patients and clients.

So in M’s case, instead of insisting that he “do music” with the music therapist, allowing him to continue with his imaginary play would have been helpful in establishing the patient-therapist relationship. M knows that he can trust the MT to allow him to express himself in his own unique way (zombies and the apocolypse). Should M continue therapy into adolescence – who knows? Those stories might turn into a script for a short film, or into a song to be recorded. I think the session might not have been strictly music therapy, but it was definitely therapeutic, and beneficial. And isn’t that what everyone is aiming for at the end of the day?

Also, I know that the questions I’m grappling with here also come from the need to prove the worth in what I do, to alleviate the fear that others will see no value in what I do. I also need to embrace ambiguity, an ongoing lesson-in-progress.

The journey is the destination.

The Girl Who Gave Me Her Heart

At the start of the session, the little girl was lying on her bed, admitting to feeling a little lethargic and tired, having just taken her medication.

“That’s alright”, my supervisor said. “We can just sing together.”

And that was what we did for awhile. The singing seemed to perk her up, and soon she was sieving through the instruments to decide which she wanted to play.

By the end of the session, she had gone through playing on the drums, shakers, narrating stories, and engaging in mischievous play. For those moments she was not just the girl with cancer, but also the girl with the cheeky smile and playful and sociable personality.

At the end of the session, just as we were getting ready to go, she dug under her sheets and held out something in her palm to us.

“For you”, she said to us with a smile, revealing the two little hearts.

I place this heart on my table, where I can see it everyday. Each time, it reminds me of a few things: The transformative power of music, the reassurance that this is the right path for me, the reminder it’s the little things that can mean the most.

It has always been the little things.

Thoughts from Pediatric Oncology

So, this term’s placement has been at the local hospital, in the pediatric oncology ward.

I stepped in on my first day about a month ago (which only means I’ve been in 5 times), not knowing what to expect, hearing stories about children being traumatized and reacting badly to treatment and hospital environments, and wondering what the approach to music therapy would be in this setting.

I’ve learnt that music is so important and relevant in the lives of especially young children. We tend to underestimate how much of our learning during the developmental stages takes place through play, listening and repeating back, singing songs, rhythmic patterns, coordinated movement, imitation, initiation… All of which eventually leads to meaningful communication. For a child in hospital during this stage, being unable to experience life as a “normal” child could have severe adverse effects on their development and psychological growth. One of the main goals of MT in this setting is to provide an environment where the child can still engage in the elements necessary for development, so that they are not as deprived and affected (physically, emotionally, psychologically) by their stay in hospital, some of which can last for the better part of a year.

I’ve been blessed with 2 amazing supervisors this time. Both are unique in their own right, yet are equally experienced and evidence-based, supportive and inclusive. I have never felt inhibited asking them questions, or felt put down in their presence, which is really important for my personal growth. Every week I have a set of readings to complete, reflect on, and discuss with them in relation to the ongoing work in the ward. It’s the sort of reflective practice I love. Being able to read, have the time to process and then bring it to the table for discussion and hear their opinions on it as well – has been immensely rewarding.

On a more personal level, as someone who has never particularly liked kids, especially when they start screaming in public, climbing over seats in public transport, or start pulling your hair while their parents smile on awkwardly… I think I’ve surprised myself by the level of engagement achieved. I suppose it’s easier to feel compassion for kids when they’ve been diagnosed with Leukemia or other forms of life-limiting conditions. But from this experience of working with kids in the hospital, I think I’m also now able to see “normal” kids with more understanding, especially when they’re having melt-down or tantrums etc. From the psychological and developmental and behavioral analysis point of view, I can better understand why they’d act the way they do – they’re responding to their emotional and psychological needs which they themselves might not be able to express or even comprehend properly. Music, as a symbolic form of communication and expression, is hence really useful as a tool and platform to reach kids.

While I’m not a convert to the extent that I’d say “I can’t wait to have a kid of my own!”, this placement has definitely affirmed my capability and openness to working (just working) with children, and I feel thankful to have the role of the music therapist to make it so much more engaging and enjoyable, for the child, family, staff and therapist.

On my recent week there, the supervisor suddenly said: “I think you’ll be ready to go into sessions on your own now.” I felt affirmed, yet…

Going in with my supervisor as the co-therapist and going in on my own as the main therapist is another uncharted territory which understandably evokes feelings of apprehension. But I’m going to embrace it, and do the best I can:)

3 Weeks

After that beautiful weekend in Byron, came Monday. And the onslaught experience known as Placement.

This 3-week placement was really intense because of the frequency (5-day week, as opposed to once-a-week), the population group (mental health), and the nature of short-term interventions.

In my first week, I found myself thinking that I could never work in hospital environments. Too hectic, too fast paced, too many changes. Too many people coming and going. No established relationships.

But, by my second week, I began to think that maybe I could after all.

Even though patient turnover is high, we still had the chance to establish several poignant relationships with individuals. It certainly helps to be there everyday. For a person who’s staying in a locked ward for even a few days, the presence of familiar faces, coming to provide stimulation and relief from the boredom they all complain about, can be very comforting.

The interventions we used were mainly singing of familiar repertoire. For a few individuals, an ensemble-like context was created with the addition of a drum. I observed how individuals came alive when they engaged. For that moment, or duration of time, they were no longer defined by their illness, but they were a person, making music with another – being human. Song lyric discussion enabled some of them to talk about issues close to their hearts. Some spoke about the instruments and music they learnt at school. The music became a medium through which they engaged. To a certain extent, it created diversion from over-focus on their clinical condition and provided an alternate means of engagement. Other interventions carried out during our group sessions (which we were constantly stressed about!), such as drum circles, provided an outlet for social interaction and normality, something lacking in many of the patients’ lives as well.

Joining in some of the recreational activity sessions also helped us in establishing relationships with the patients outside the musical setting. These crafts will always remind me of the experience. Of the individuals who are really just human, struggling to find their way as we all are.

 

We must have appeared as strangers to the nurses and staff at first – suddenly turning up with guitars and walking the hallways with instruments. But gradually, we began to receive referrals.

“Could you drop by XX? He’s not very happy about being here.”

“I would like to refer MM, some diversion or distraction might help her…”

“I was going to look for you to refer __, but it looks like you found him already!” (wide grin)

The feeling was very validating and encouraging, knowing that the staff value allied health professionals and were willing to engage with us to provide the best care for the patients.

It’s true that we may only see an individual for a few sessions, but I’ve realised that we should not underestimate what those few sessions can do for an individual. Seeds may be planted, and grow into different things in future. One client said that he was inspired to learn guitar when he got out. Another said he felt that music was something meaningful he could do with his time (as opposed to chain smoking).  And a few others asked for lyrics, chord sheets of songs which meant something to them.

For a few days after I finished placement, I kept thinking of some of the individuals I saw in ward. In short-term interventions, each session is usually treated as our last. Closure is of utmost importance. But… I can’t help but feel that a part of my heart has been left with them.

I can only wish them well.

Wherever life takes them, may they be well and happy.

Expressive Writing

According to Google:

Expressive writing is personal and emotional writing without regard to form or other writing conventions like spelling, punctuation and verb agreement.”

I guess I should explain. A coursemate and I are currently on placement at an acute mental health unit. We conduct MT sessions with the patients, as well as attend some of the sessions the other allied health staff conduct. This session, with expressive writing, was conducted by an occupational therapist. It’s supposed to be a really effective technique to improve thought awareness and alertness, and for emotional release.

“Just let your writing flow”, the OT said. “Don’t worry about punctuation, sentence structure or anything like that. If you run out of things to write, just repeat what you have written. The most important thing is to not stop writing. Take a few deep breadths, and begin.”

With the pen and paper in front of me, I had no idea what to expect from myself. But the moment we were told to begin, I felt the metaphorical switch in my mind strangely click, and my hand started to move.

In the woods walking down a little pathway the road is muddy the trees are tall and they cast shadows on me. I can see the sun coming through the leaves it looks so far away I wonder how we feel the warmth when its so far away. The forest is meant to be green but why does it feel black it must be because of all the shadows. I walk and walk and hear a stream I go closer and closer until I can see it the water flows over the rocks which are wet and slippery. I stand on them careful not to fall. I worry that I may slip but I want to be near the water the water makes me calm and at peace. The sound of the stream is like the hope from the shadows. the footpath is slippery but I continue to navigate I explore the stream see where it leads. Somewhere it becomes a waterfall somewhere it begins.

After some sentences into the writing, I realised my mind was going back to the experience I had just a few days before this session took place – I was expanding on a previous experience.

The woods we were in was nothing like what I had described in the writing, of course. But somehow m mind twisted that, setting the context for when we discovered the stream and I had my first experience walking among rocks like these. And indeed, further up ahead, there was a waterfall.

But those are stories for another time. For now, placement continues, and the stories continue..

From Life to Grief

Just before Monday afternoon’s session, I got a sudden call from R, the supervisor.

“I’ve got rather unfortunate news… Susan (not real name) passed away.”

To say I felt shocked is an understatement. The last time I saw Susan (one of the group), a strong-willed woman in her 60s in a motorized wheelchair, she was still in all her loud jewelry and clothes, singing her heart out, cursing and swearing to everyone’s amusement, and playing around with her iPad and cursing and swearing even more when she couldn’t get it to do what she wanted it to do. She apparently had a lung infection, not uncommon for people with spinal chord problems, and that eventually led to pneumonia, and her feelingly untimely death.

“Do you still feel up to having a session with Di?” The supervisor asked. “Yes… As long as she’s willing to come”, came my hesitant reply. In my mind I was wondering what could I do for Di, who was a close friend of Susan? I knew she would be distraught. They had known and lived together in the facility for at least half a decade, and had shared many aspects of their lives together. Losing Susan was going to be a great loss of emotional support and friendship for Di. R was very supportive in giving advice and pointers on how to approach the situation, encouraging me by saying that he trusts me enough to know that I’ll know the best way to go about it.

Finally, they arrived, we went into our room, and I sat down in front of Di. She spoke quietly, tears filling her eyes.

“It’s so hard,” she said. “I know I have to let her go, because if I keep wishing she’d come back, she can’t go in peace…”

We continued talking for a while. I knew there was nothing I could say that would take away the pain, and this quote came to mind, kindly shared by the Comrade a few days back:
I tried to do that, just being there inside the pain, with her, as close as possible. We then played an improvisation on the keyboard, a peaceful, lyrical attempt at depicting the journey of life and how we’re never sure when each journey will end, but how we’re fortunate to meet our friends and loved ones along the way, making our journey that much more meaningful and memorable.

As the last note faded away, she whispered, with a hint of tearfulness: “It’s a pity we have to stop.”

We sat in silence for a while more.

“The music… Is able to take me away for a while”, she continued. I added, after some contemplation: “Yes… It reminds us that there is something bigger than ourselves”, thinking of all the times when I turned to musical expression to fulfill what the world couldn’t do for me.

“Well… Time will heal all wounds, won’t it?” Di spoke with a sad smile.

“But sometimes we don’t want the wounds to heal completely, do we? We want something left… to remind us of the one we loved.”

“… Oh, yes, that’s true.” And she said that in a more uplifted tone than she had since the beginning of the session. She turned to half-smile at me. “Thank you for that.”

We ended the session shortly after, with her saying that she did feel lighter. But I know the process of grieving is a complex one, never a one-track route. There will be days when one feels that the pain has passed, that life can finally move on, and there are days when the realization of losing that loved one hits you mercilessly all over again, and one feels thrown back into the depths of never-ending sorrow.

I feel bad that I won’t be able to see her over the next few weeks (due to the upcoming hospital placement), at this time when she needs the support and therapy more than ever. I suggested that she try to put her emotions to words, and perhaps we could work on creating soundscapes in the second half of the year. She seemed agreeable, and I hope it will be something that could help her cope over the next few weeks.

Praying for strength for Di to get through this period, and for wisdom to do what is right and best for her.