Perceptions

If you are a music therapist, likely you understand the above paradox. People's perceptions are all different about what "music therapy is".  Hence why we need a “elevator ride” length pitch on music therapy in our back pocket at any moment in time. Starting a new position I have been asked to explain what music therapy is multiple times in the past week alone. AND if you have any experience as a MT (even as a student or intern) you may have already encountered some preconceived notions and well... to be honest... annoying comments/assumptions/generalizations that people may make. For example: My first day out in the field with my new colleague we were greeted at a facility by their front desk personnel with a cheerful,

“Oh great! The entertainment is here!” I kind of assumed that my fellow MT might brush it off and go on her way, but instead she politely corrected the lady across the desk with a short, simple, and non-judgmental educational statement on what she was actually there to do. The employee's eyes widened slightly, you could see the wheels turning in her head as she understood just a bit more about “what music therapy is”. She was genuinely interested and impressed. I had that old familiar PSA theme running through my mind, "The More You Know"...

We all have that cousin, or friend of a friend, or neighbor that at some point says to us, “You paid all that money to go to school and learn to be a music therapist! I'm a (enter other non-music therapy related credentials here) and I just sing to/play a CD for my patients/kids/dog!”

I have a basset hound but she wont sing with me. I've tried. Maybe I'm NOT a music therapist...

Well, that's fantastic that you sing to them. Really. It is. Music is a fantastic and powerful part of care giving. HOWEVER! When I drag a guitar, computer, industrial sized hand sanitizer, sanitizing wipes, song books, paddle drums/xylophone/electric keyboard/ocean drum/thunder tube up to a patient's bedside it is not a grand entrance for the “Annie Walljasper Music Hour”. I'm on a mission. I've taken time to plan and prepare. I've created goals to work on for each client. I've checked up on, studied, and planned out the best way to serve their diagnosis. I do more than sing. I do more than play the guitar. I watch every little action and reaction. I change my approach on a dime. I create goals for patients, I develop ways to achieve those goals. I collect data and prove to doctors, nurses, social workers, as well as insurance companies and the government that what I am doing is clinical, beneficial, and appropriate. It's a clinical and evidence-based way to assist others in order to help them accomplish social, emotional, physical, mental, and spiritual goals. In order to reach those goals, I use music intervention. It's THERAPY, and I use music to do it. 

Furthermore, in order to "do music therapy" you must be a credentialed professional who has completed an approved music therapy program. Music therapists take courses in everything from biology, anatomy, and psychology to acting,

There are many fantastic colleges and universities who offer
music therapy education... the University of Iowa is just one of them

conducting, orchestration, and movement to voice lessons, music research, music theory, and music appreciation. Not to mention specific courses such as "Music Therapy in Special Education" or "Music Therapy and Older Adults". After completing coursework and studying hard, our young budding music therapist goes on to a six month internship. They must apply, interview, and successful secure and internship and then work (normally 40 hours a week) more often than not without pay. Interns gain real world experience and truly get a taste for what it is like to be a full time employed MT - at least I did.

AFTER you complete all 1,080 hours of your internship it's time to start studying up. There's a big old certification exam. The CBMT Board Certification examination consists of a 150 question multiple-choice test, you are allotted 3 hours to complete it, and it costs a pretty penny (if I do say so myself). Now, some of you may ask "Why? Why get certified?" The credential MT-BC is to provide an objective national standard that can be used as a measure of professionalism. Basically having the credential allows the public to identify qualified practitioners who have passed a national exam measuring the knowledge, skills, and abilities necessary to competently practice in the field of music therapy for the given year. So, they KNOW that they are getting someone who knows what they are doing and are doing it with intent... not just playing a CD. Also, it's a way to hold me accountable for my actions. If I am not working within my scope of practice (meaning if I am pretending to know how to do something I don't know how to do) or if I am doing something unethical or illegal, there is a certification board who will hold me to higher standards or will revoke my credentials. When you finally take the test, you find out right away as to whether or not you passed. Thank God, because just waiting for the results to print off was a torturous wait itself. If you passed, you then get mailed an official certificate that looks like this:

Isn't it beautiful? I think so. So, then you frame it and hang it in your office... or in your car if you work for hospice. I might put mine on a chain and just wear it around. I'm the Flava Flav of music therapy,

"Yeah boooiiii!"

And then? Well, then you GET A JOB! Oh an every 5 years you either have to have continuing education credits or you have to retake the test... darn that whole keeping you accountable thing. ;)

Whew, I'm tired just thinking about all that work! But you know what, it's totally worth it. Everyday I am honored to share some of the more intimat

Lessons learned....

From my previous post I have been thinking a lot about what exactly I did to earn such a wonderful email. I have been working with the previously mentioned patient for four months now and while I have seen a HUGE change in her I also realize that I am learning a lot and have much further to go. However, lessons I have learned about being a music therapist include the following:

1. Don't be afraid of the silence.
    Learning about therapeutic techniques, I'd assume you have heard people say "Don't be afraid of the silence" but that is an exceptionally hard lesson to learn. But IT IS SO TRUE. Be calm. Take time to gather your own thoughts. Recognize that the patient you are working with may need time to process their thoughts and feelings as well. Let a question hang in the air awhile. If you don't get an answer it's ok, you can move on. But if you wait you may just get an answer you weren't expecting. Don't just string every song you can possible think of together so to avoid the silence, because in reality - you are avoiding the therapy as well. We aren't there to just play a bunch of songs and "perform"... the music is there to assist the therapy. And I'm really coming to realize that a lot of therapy is being done in the silence.

2. Don't rush.
     This particular patient takes a while to gather her thoughts and then vocalize them. I watch another person interact with the patient once and she talked and talked to the patient but she didn't take the time to really sit and patiently listen. I have learned to just sit and wait and listen. If I don't understand what she is saying I ask her to repeat herself (which can be a painstakingly long task) or I give myself time to process and think harder about what she might have said (which reinforces the first point).

3. Don't assume you know anything.
     I don't even know 1/16th about music therapy. It amazes me that even in my 5th month of internship I am faced with new situations or new challenges - with patients I have been seeing for 5 months! Read, read, read. When I went back and read about Parkinsons Disease I understood this patient that much more.

4. Be present in the moment.
      I am exceptionally lucky to be an intern right now. I do not face the pressures of "productivity" that my supervisors and the other professional do. I can sit with my patients and spend as much time as they need with me. Sometimes that means I am with someone for 10 minutes, and other times I am there for 2 hours. I don't know what would be the "correct" time but I am glad I don't have to look at my watch and worry about fitting everyone in on one day. Sitting with the patient and being present in the moment not only allows me to be more relaxed and attentive, but it also communicates to the patient how important they are and that they are cared about.

There are more things I've learned but for now, these are good starting points... and one that I want to talk about will likely take up it's own post. So! Be sure to check back soon.

After silence that which comes nearest to expressing the inexpressible is music.
~Aldous Huxley

BEST.EMAIL.EVER

I am truly not trying to brag or wave my flag or toot my own horn or however the euphamism may go...

BUT!

I recieved the best email of my life this morning and wanted to share. I am so incredibly humbled right now. I am so PUMPED to feel like I actually can make a difference. This patient is the patient I am working with on a case study right now, trying to show that while a client may be declining (this patient has a Parkinson's Diagnosis) music therapy can in fact improve self esteem, depression, and ultimately Quality of Life. This makes me feel like it's WORKING! Aaah! Music therapy R-O-C-K-S.

Anyway... here's the email (name and location has been edited to comply with HIPAA) if you are still reading this far into my rambling:

________________________________________________

Ann-

I made a social work visit to [patient] yesterday at [assisted living facility].  She was in a crabby mood but that’s besides the point.

She kept asking “where is the music lady?” and later started calling you by name!  When I was leaving, she said about 3 times, “make sure ann knows where to find me.”

Just thought you should know what a great job you are doing and what a difference you have apparently made for [patient]! Keep up the good work!

________________________________________________

<3

Seniors say the darndest things

Today we went to a new facility that I will be taking over during the rest of my time at Seasons. One of the facility's employees wanted to see music therapy in action, so off we go to see some the patients signed on to our services. We get settled into a quiet room, the patient was sleeping peacefully. As I start to play the patient's roommate walks in - having freshly showered. In order to give her some privacy my male audience excused himself from the room, and closed the curtain around myself, my advisor, and the patient. As I hear him close the door behind him, I also hear the squeaky clean resident yell after him, "Suck my d***!!" I look over at my advisor with what I am sure were eyes as big a saucers and holding back a laugh.

Throughout the rest of the session, thinly veiled (one hospital curtain separation) commands such as
"shut the hell up" wafted over my improvised guitar playing. But then the kicker came...

The roommate pulled back the curtain, looked at us, whipped the curtain back into place, called out, "EAT MY SHORTS!!" and stormed out.

I couldn't make this stuff up... even if I tried.

Midterms

We interupt this blog for a brief musical interlude. Shaking your hair, air guitar, and all out rock star behavior is allowed and encouraged.

Thank you. You may resume reading this post.

Half way there! Holy COW! Where did the summer go? There are days when I feel like I did back in June... brand new and uncertain. But there are just as many days where I feel like I've been doing this forever. Not "forever" in a bored/burnt out sort of way but rather a confident, self assured professional sort of way. It's hard to believe the growth and change I have undergone in the fleeting three months I've had so far as an intern. It's hard to imagine that in just three more I will be preparing for the board certification exams and looking for jobs. It's sad to think that I might not find a job in hospice, which in all sincerety I have come to love. It's exciting to think of all the other possibilities and populations I could start working with. It's especially exciting to start earning a paycheck again... my husband loves that idea.

It has been three months since I started my internship.As I hit the midterm point of my internship, I am amazed at the growth and change I have undergone. My guitar skills have grown by leaps and bounds. My comfort level with patients has shocked me. My documentation skills have come a long way and I see that crossing over into my every day conversations. When people ask me about music therapy I am able to explain the profession more and more clearly, more concisely, and feel more confident doing so.

Don't get me wrong though, there are times when this internship can be challenging. Of course! It can be emotional, it can be frustrating trying to learn music and refine my music skills, and finding the balance or pacing in a session. I am learning to be more comfortable with other professionals, collaborate with them when working with clients, and communicate my opinions, ideas, and observations. I am working really hard to see set backs and challenges as a great indicator that I am at the half way point and after an initial improvement it is time for even more growth. I am being pushed even further and I know that it is for my good. The challenges are making me a better therapist, and I really appreciate that.

You may now press play for the 5th time again and resume the party.

"Hospice is like a box of chocolates"

I have really come to understand that in hospice, you never know what you're going to get.

I have a client who I just love. He is hilarious. Apparently, he is exceptionally inappropriate with other people who care for him (earning him the title of "dirty old man") but with me he's just downright funny. I ask if he would like some music and he says yes. Then, before I even get the guitar case open he hollers, "Well, come on then!" or "Let's go!" He sits and listens to the music with his eyes closed and responds after a song has completed by saying, "That was beeeeeeautiful" or he'll comment, "That was an oldie but goodie". Sometimes he'll say, "You left me in left field with that one". I'm really not sure how to take that last comment...

On the other hand I see a client who is always in bed, normally asleep, and NEVER responsive. He's a hard one to see because while it's easy just to play some improvised bedside music, its frustrating because it's hard to tell if he even hears it, let alone responds positively.

Last Thursday, I went to go see this client. It was my last stop of the day and the facility is close to home so it's easy to stop by on my way out in the morning or on the way back in the afternoons. I signed into the facility, made my way up to the patient's floor, and found his bed empty. Inside I thought if this guy died and no one told me, I'm going to be frustrated. I ask a nurse passing by where the patient is, and she directs me down to a common area where I have never been before. And there he is! Sitting up in a broda chair. Awake, alert, and oriented x1. WHAT?! I hardly even recognized the man. I introduced myself and he responded! Said a very clear yes to wanting music and talked to me through the entire session. Yes, he was also talking to a few hallucinations, but where did this come from?! He SANG ALONG with a few songs and when I placed my guitar on his lap for vibro-tactile stimulation, he even tried strumming a few times on his own!  I was flabbergasted. We had such a great time together talking about his past and singing songs that I stayed for longer than I have ever spent with him. The time flew by!

I think I floated home... thinking about how different each day is for everyone. You have to go into each session as if this will be the last time you see that patient and do the best for them every time. And honestly, once you think you have someone "all figured out"... you don't. You never know when something will happen from "out in left field".

Yes, hospice is like a box of chocolates... you never know what you're going to get. 

and it's really oh so sweet.



I would have never guessed...

This morning when I woke up and got ready for another day at internship, I thought about music. I ran through the quickly becoming memorized songs in my mind. I sang "Paper Moon" as I showered, reviewing the Dm and Cm7 chords in my head. As I drove I thought about "Chatanooga Choo Choo" and "Boogie Woogie Bugle Boy"... and how I need to learn more Frank Sinatra.

As we drove to Elgin to meet an imminent patient, who had just signed up for hospice, I thought about creating an environment that would be comforting and peaceful for someone who may die while we were there. As we read over her chart before going into her room I read "90 years old" and preped for my favorites "All of Me" or "Sentimental Journey". I never would have guessed that when her daughters talked about her that she would be described as being someone who while ironing her clothes "jammed" to Van Morrison. Someone who introduced her daughters and even granddaughters to The Doors. We were informed that her new favorite song is "Save a Horse, Ride a Cowboy".

We talked with the family for a while. Then played a few things... "Proud Mary", a few Beatles songs, as we sang "Brown Eyed Girl" I held the patients hand, stroked her hair, and sang close to her ear (she had lost a lot of hearing previously). Then in between songs I looked up "Save a Horse..." on my blackberry

** Thank you technology**

My supervisor looked at me and asked, "Do you know it?"

"You bet!" I replied.

**Thank goodness I went to Monmouth College (ie: cornfields) and fell in love with country music**

It's actually pretty easy to play on the guitar as long as you can get the strum going - basically it's just a whole lot of fun. The patient's daughter got right up close to her mom and we both sang to her. Full volume, truly "rocking out".

By the end of the song the patient had opened her eyes, her brow unfurrowed, she looked much more comfortable and at ease, and her daughter reported that she had squeezed her hand. We decided to end on a positive note... AND the nurse came in pretty directly after (likely wondering what the hell was going on). I can only imagine what anyone walking by thought! I felt like a crazy person real music therapist. This was what it was all about! Making the patient and their family the experts in their own care and meeting them where they are.As we said goodbye, the daughters (through their tears) could not say enough...

"This is the most relaxed she's been!"

"I know she heard that!"

"That was amazing, she hasn't been awake at all today."

"I hope you can come back"

"Thank you"

After I returned to my car, I shot of a few texts of disbelief to my Mom and Dad.

"I didn't know you knew how to play that song" they texted back.

"Neither did I"

When I woke up this morning I knew which songs I could play for clients. I knew the generalizations we make about people's preferred music and I could go from there. I knew we would enter people's lives and share with them our talent. I knew I would be doing something I loved and hoped would change someone's situation.

I NEVER would have guessed that the songs I knew and the generalizations I made would be thrown out the window and yet I could still do my job successfully.

Cheer's Big and Rich - you're music is truly enjoyed by all generations.

The good... and the bad

I have two stories for you today...

The good:

I went to a facility the other day and met with a woman. She had a diagnosis of Dementia, she loved Irish tunes. She laid sprawled in a geri-chair, seemed very agitated, and all alone. At first my supervisor tried playing the guitar by her side but the patient was so agitated and uncomfortable. She kept trying to pull herself up and into a different position. My supervisor wanted me to jump in while she went to find a nurse to help move the patient to a more comfortable position. I got down on my knees, scooted right up next to the patient, reached out to hold her hand, and just sang every Irish tune I knew. (Thank goodness we always celebrated St. Patrick's day in Practicum - and that many residents in Iowa tend to have a strong German/Irish heritage). The patient turned to look at me and in a slurred, toothless, loud voice - she started singing right along with me... Oh Danny Boy, My Wild Irish Rose, I'm Looking Over a Four Leaf Clover, even My Bonnie Lies Over the Ocean... she looked at me, sang every word, and held my hand the entire time. When I ran out of Irish type tunes, I sang Scottish ones. I could have stayed with her forever. This Patient is exactly why I am so in love (already) with this work.

The bad:

There was another storm in Chicagoland earlier this week and as a result caused the worst power outages since 1998 (if I am not mistaken). Facilities were still running on generators and are getting HOT. When it gets hot, windows are opened. When windows are opened, flies get in. When you sing and there are flies in the room you run the risk of having a fly get sucked into your mouth. These are the risks music therapists face every day.

That's all I have to say about that.

First Day

Yesterday (May 31st) was really my "first day". I went into Season's to meet with Lindsey (my supervisor) and Shelby (supervisor of the other intern, Gina). Basically we just did some preliminary information, signed some papers, copied my licence/car insurance and went out for a GREAT lunch! Oh la la...

Today the real fun started. Orientation. Orientation that is going to last for 2 weeks. For 7 hours a day. Wow. I can't really complain though. I think I am still on cloud nine just being there. The greatest thing is that the Executive Director came to talk with us about the philosophy of hospice. We learned about the history of hospice care and the goals of Season's Hospice care. This may sound corny but it sounded like the descriptions and vision were describing me. We talked about hospice in general... my orientation including nurses, administrators, and social work... but I kept feeling like "I can do this. I can really do this well." It really just fired me up to get started.

I'm not going to lie though, going through all the OSHA and HIPAA guidelines, the payroll and insurance information (which don't even apply to me), and the more tedious details are... well... tedious.

So today in honor of my awesome TA and practicum supervisor Sarah, I am going to share some positives and negatives from today. In practicum she limited it to 3 positives and 1 negative but I think I need to add in my own flair and provide some insight to the ridiculousness (it always seems to happen to me)...

Positive

1. I successfully navigated commuter traffic, bought an I-Pass, and made it to work on time.
2. I loved some of the readings from today and want to (will) share them with you in the future.
3. The information shared was not as boring as I was afraid it would be.

Negative

1. I had to have a TB test. I have a diabetic husband, watched a friend give birth, and visited enough hospitals. Needles don't bother me. Unless they are penetrating my skin. Ugh... dislike

Ridiculous

1. I locked myself in the bathroom stall. No joke. I wish I was lying. I was panicking for about 30 seconds until I just slammed my fist on the door and busted out. Yeesh
2. I believe that Orientation is also synonymous with some sort of torture. The air conditioning would kick on and freeze me to death, then the room would warm up, then the air would come on again, etc. About ever 20 minutes. Tomorrow I will dress in layers. It's only 90degrees outside, a cardigan seems appropriate.

1 day of orientation down, 7 (at least) more to go.

Prelude

prel·ude

  –noun

1.

a preliminary to an action, event, condition, or work ofbroader scope and higher importance.

2.

any action, event, comment, etc. that precedes somethingelse.

3.

Music 

a.

a relatively short, independent instrumental composition,free in form and resembling an improvisation.

b.

a piece that precedes a more important movement.

c.

the overture to an opera.

d.

an independent piece, of moderate length, sometimesused as an introduction to a fugue.

e.

music opening a church service; an introductory voluntary.

A new beginning.

Two years ago, on an exceptionally rainy day I drove the hour treck through cornfield to the University of Iowa. Having lived in the Quad Cities for three years I was ready for something new… and I was about to start that adventure. On that rainy day I met a fantastic woman, Dr. Mary Adamek. Former president of the American Music Therapy Association, Director of the University of Iowa Music Therapy Program, and a wonderful mentor. She immediately put me on the right track to completing the music therapy equivalency program (I had previously majored in Music:Vocal Performance at Monmouth College – graduating in 2006). That fall I started classes at the University and within days knew that this was exactly where I was supposed to be.

Fast forward to last November, just after attending the National Convention in Cleveland, OH I set out on my first internship interview. Before convention I talked with supervisors and teaching assistants. I set up mock interviews and rehearsed answers to ensure controlling my impulse to get flustered. While at convention I talked with every professional in Hospice that I could and went to session after session on Hospice care. Friends of mine had interviews scheduled during conference and I picked their brains. My dear friend Lindsay practiced my interview piano piece with me and in my spare time went back to the hotel room to practice my guitar.

So, after conference I returned to Chicago and headed out on my first interview. Things went well… well, except for getting a little lost going there. And the sight singing. And the one exceptionally intimidating interviewer. I felt great about the interview (statements like “Oh! We didn’t expect you to have your pieces memorized” were a boost to my confidence that I had impressed) and at the same time I cried in the parking lot before even driving away. I flip flopped, cried, and prayed for most of the drive home. I wanted this so bad…

“On behalf of all of the music therapists at Seasons Hospice & Palliative Care of Illinois, I would like to offer you a position to intern here starting in June 2011.  Please let me know if you have decided to accept the position.  It was a pleasure meeting you today, and I look forward to hearing from you.”

~ time stamped four hours after my interview

Of course my generally paranoid attitude took this as a “great they don’t have anyone else and have to settle for me”… but in my heart I know I did a great job interviewing and I knew this was where I was supposed to be.

A few months, multiple trips with my car packed to the gills, sweat, tears, worried, and excitement later… I started my internship at Seasons Hospice in Chicago, IL.

This blog is my story… so that if anyone cares to read it might find hope, direction, lessons (on what not to do) or guidance. Or maybe they’ll read about my (mis)adventures and think “thank God that didn’t happen to me” or “that girl is crazy”. But also so that in 20 years when I’m a cranky old MT, cynical and worn down, I can go back and read about this exhilarating time. Just like the beginning of the opera, or the musical… when the lights dim, the audience falls silent in anticipation, and the conductor takes the stand. This time in my life when the prelude begins and the story starts to unfold. While my eyes are still twinkling and my heart is ready to burst with excitement.