Audrey’s Top Ten Internship Learnings!

Hello everyone! I can’t believe it but I am already at the end of my internship! This has been a goal that I have had for so many years, and I am so excited to finally be at the culmination of my education! I am so thankful for this experience that I have had, and so grateful to take all of my learnings with me.

Here are my top ten learnings from this time:

1. Spending an entire session on sensory integration and calming down is not a waste of a session!

I know so many clients that need to feel centered and calm when it comes to sensory stimulation and that absolutely nothing will get done if they are over or under stimulated. It is just as important to help our clients get what they need at that moment, and learn how to calm themselves down and self-regulate. This is not a waste of time!

2. Growth happens in the scariest places

The Most Famous Inspirational Quotes - OMG Cheese

I remember the first time I was asked to cover a group for another therapist all on my

own. I was terrified and not sure if I would be able to do it! I remember feeling insecure

and nervous about my capabilities, but in the end the session went amazing! It is such a good feeling when you step out and try something new, and it goes amazing! It brought me so much confidence both in the skills I already had, but also in the benefit of trying new things. I love seeing how I am now confident leading sessions for clients I do not

know, because I have had the opportunity to step out of my comfort zone.

3. The power of themed sessions!

I never thought about using themed sessions outside of specific holidays before internship, but it has turned out to be one of the best ways for me to plan! It makes it so much easier to narrow down your session ideas, keeps things unique and interesting for your clients, and helps with things like reality orientation for your clients and understanding what is going on in the world around them.

4. The brain is incredible

WOW there is so much I didn’t know about the brain before coming to internship! Learning about neurologic music therapy and the power of music in the brain has been astounding. Neuroscience is amazing. There is so much we don’t know yet, but there is so much value in understanding the research behind what you are doing so that you can use those tools to focus on exactly what will work for your clients. I have learned so much about the brain and how I can use this to directly influence change and growth for my clients!

5. The power of singing a capella

As a vocalist, I knew my voice would be a strength of mine in sessions, but I did not realize how useful of a tool this would be, mostly because I don’t have to carry an instrument around with me when I sing! My instrument is a part of me, which makes it so easy to focus entirely on the client and what they may need in the moment. Singing a capella is also so beneficial for transitions between interventions in group sessions. I have found it very effective to sing the melody of a song for a “Name that tune” exercise in between interventions. This keeps clients engaged, but keeps my hands free to gather up or pass out instruments during transitions.

6. Time Management is essential

Internship can be really overwhelming and busy, but I found that setting myself up for success with good time management was the best way to keep myself from becoming too worn out. At the start of busy days I would take a few minutes to write down the top three things I wanted to accomplish that day. From there, I would make a list of other tasks that were less essential but I still wanted to get done. By creating a strategy for my little chunks of work time throughout the day, I was able to manage my time very effectively.

7. It’s not the end of the world

It’s easy to feel frustrated or upset when a session doesn’t go as planned, but I have learned to realize that this is a time of learning, and my supervisors know that I don’t know everything! Giving myself grace and understanding when I mess up and being okay with failing has been so healthy for me during this time. It’s okay if you mess up! It’s not the end of the world! “Failing” at something is one of the best ways to learn.

8. Don’t be afraid to take action

A huge learning curve for me, especially at the start of my internship, was to trust my gut and step in if I could see a client struggling or becoming overwhelmed. If you see a client becoming overstimulated or you can see a client may become aggressive or anything of the like, especially in a group setting, trust that you have the tools to do something about it before it escalates, and have the confidence to take action!

9. Be open to change and new ideas

When I first moved to San Diego for my internship, I was positive I wanted to go back home to Washington state after I finished my internship, but as time went on I realized that I wanted to be open to more options! It is so important to learn to be open to life changes, especially in a career like music therapy that can change so quickly! Being flexible and willing to try new things in your career will take you far!

10. You can totally do it!

I remember freshman year of college hearing that I would have to do an internship after college, and it seemed daunting and impossible. It is so easy to look at the mountain in front of you and think there is no way you can do it. I learned to take it one step at a time! Even if it seems overwhelming, just take the next step towards your end goal and you will be successful! One step at a time.

Thank you for reading my blog posts for the past 6 months, I am so thankful for the opportunity to share my learnings with you!

Audrey Cosgrove, MTI

Travel Themed Session Plan Inspiration

One of my favorite things to share is session plan ideas, because I know how valuable it is to have new ideas and get inspired by what others are doing! I have been using these interventions with a few of my groups and they have been really successful! Here are some ideas for your own session plans: 

 

Question of the Day: Where Do You Want to Travel? 

  1. MT uses a melodic cue to prompt the question to each client individually 
  2. “Where Do you want to travel?”
  3. MTI will sing “Conversations”, and ask each where they would like to travel
  4. Adaptation: MT can use a visual with photos of different options for answers for nonverbal clients

 

Songwriting: In the Jungle

  1. MT introduces and sings song “In the Jungle” with group 
  2. MT explains that we will be rewriting the song with different places and different animals to make our own song 
  3. MT gives each client the opportunity to pick a location and an animal to fill in blanks of song 
  4. Group sings new verse together 
  5. Example: 

 

In the ________________________

The mighty _________________

The ____________ Sleeps tonight 

 

  1. Places:  
    1. Jungle
    2. City
    3. Forrest 
    4. Dessert 
    5. Rain-forest 
    6. Arctic 
    7. Ocean
  2. Animals: 
    1. Peacock 
    2. Elephant 
    3. Puppy 
    4. Bear 
    5. Lion 
    6. Dolphin 
    7. Polar Bear

 

Sing-A-Long with Instruments: Song choice: Travel Themed

  1. MT prompts one client to pick a song from the song choice visual (photos representing each song)
  2. Group sings song and plays instruments together 
  3. Song options: 
    1. She’ll Be Comin’ Round the Mountain
    2. A Whole New World 
    3. Home on the Range 
    4. Fly Me to the Moon 
    5. This Land is Your Land
    6. I’ve been Workin’ on the Railroad

 

Relaxation:  What a Wonderful World 

  1. MT prompts group to take deep breaths all together 
  2. MT sings What a Wonderful World, prompting client to continue deep breathes 

 

Attention: Travel Visuals Listening

  1. MT passes out pictures of different travel items to each client (passport, globe, suitcase, car, airplane, etc.)
  2. MT prompts group to listen for their object for their chance to hold it up for the group
  3. MT sings song  “We’re Going on a Trip” (any melody or words works for this intervention. One option that works well is using the melody of “She’ll Be Comin’ Round the Mountain”)

Travel Attention Song:

We are going on a trip 

Together today 

We have lots of things we need to bring along  X2

 

We need a SUITCASE 

To pack all of our clothes 

Who has the suitcase 

Lift it in the air! 

We need a PASSPORT 

So we know where to go 

Who has the passport 

Lift it in the air! 

We’ve got a SUITCASE and a PASSPORT 

(song continues with each new item added on and then reviewed)

3. MT sings this song until all items have been done

 

I hope this helps you think of some new ideas for your session plans! 

 

See you next time!

Audrey Cosgrove, MTI

Transforming your Interventions: The Transformational Design Model

The Transformational Design Model

Have you ever felt lost for how to address a certain goal with a client? Maybe you’ve never worked with that population before, addressed their specific goals, or are simply at a loss for inspiration? This past week I learned about one of the most useful models to make sure every intervention is functional and effective, called The Transformational Design Model (TDM)!

The Transformational Design Model, developed by Dr. Michael Thaut is a system to help therapists translate research into functional clinical practice. It ensures that each intervention is backed by research and intentional goals, which in turn brings the best results for clients! This model also ensures interventions are generalizable back to the clients daily life, which is an essential part of the process. It emphasizes a patient-centered rather than discipline-centered therapy and also helps music therapists to avoid two weaknesses: 

  1. An activity-based approach in which generic musical activities are adapted to therapeutic goals 
  2. The use of therapeutic music techniques that address therapeutic goals very broadly and generally, and are only weakly related to functional therapeutic outcomes

There are five parts to The Transformational Design Model: 

  1. List the client’s strengths/needs
  2. Write out one goal/objective you would like to focus on (based on their needs) 
  3. How this goal/objective would be addressed by a non-music therapist (speech therapist, physical therapist, teacher, etc.)
  4. How could you add musical stimuli to that exercise? (don’t just write a music experience-add music to the experience above). 
  5. How could you generalize back to the normal environment? (fade the music)

Example TDM: 

  1. Strengths & needs: Client has great rhythm and songwriting skills, and loves creating new songs. Client needs improved emotional awareness and coping skills for handling difficult emotions
  2. Goal: Increase ability to calm down when upset 
  3. Non-music therapist: Drawing out what how to calm down, writing a poem or brainstorming ideas 
  4. Create a songwriting intervention centered around coping strategies and ways to calm down when upset. Music helps to concrete these ideas in one’s mind and makes them easier to draw from memory when a situation arises. 
  5. Generalization: Create in session scenarios to practice calming down and using techniques written in song. 

 

This model is so helpful for going back to the basics and making sure that your interventions will make a real impact on your client! 

I hope this model is helpful for you!

  • Audrey Cosgrove, MTI

Valentine’s Day Inspiration!

Valentine’s Day is just around the corner, so it’s  a great time to share some fun Valentine’s Day Interventions and exercises.  I am so excited to get the chance to do some themed sessions for Valentine’s Day, it is such a fun holiday!

 

Songwriting: I Love the Mountains

Materials: Songwriting sheet (for lyrics), heart tree and hearts (made via google images-see image below), expo marker, visuals for non-verbal clients

Goal areas: emotional expression, decision-making/choices, social connection with peers

  1. Music therapist introduces and sings song “I Love the Mountains” with group and prompts group members to sing on “Boom-de-ada” portion or play along on instruments
  2. Music therapist shows group “Heart tree” to place hearts with what clients love
  3. Music therapist asks group what things they love, using visual of options to prompt answers, especially for non-verbal clients
  4. Music therapist writes down client response on a heart, and prompts them to place it on the tree
  5. Once all hearts have been filled and all clients have answered, music therapist puts these into song “I Love the Mountains” 
  6. Music therapist sings song and acknowledges what each client said (if done in a one-on-one session

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Social Skills Hearts:

Materials: social skills hearts (made via google images and text-boxes), tambourine or other container to pass, bluetooth speaker 

Goal: social skills, social interaction, making choices/decisions

  1. MT puts hearts with social skills questions written on them inside of a tambourine 
  2. MT plays the song “Count on Me” by Bruno Mars on bluetooth speaker 
  3. MT prompts clients to pass tambourine around the circle.
  4. When the music stops, whoever has the tambourine draws a heart out of it and answers the question inside 
  5. This continues until all clients have answered a question/drawn a heart
  6. Adaptations: : for non-verbal clients, create a visual with photo options for answers to each question, so that everyone can participate! You can also use a microphone to motivate verbal responses from individual clients, or have verbal clients ask the question to their friend to promote socialization. For individual sessions, clients can drum along or play an instrument with the song until it pauses, and then choose a question.

 

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Heartbeat Instruments: Attention

Materials: instruments, colored hearts taped on instruments

Goals: Attention, color-matching, cognition

  1. MT passes out instruments to each client, with different colored hearts attached to each. 
  2. MT prompts group to listen for their heart color for their chance to play/have a solo
  3. MT sings song to the tune of “She’ll Be Comin’ Round the Mountain”

If you have a RED heart play your instrument

If you have a RED heart play your instrument

If you have a RED heart x2

If you have a RED heart play your instrument

  1. MT sings this song until all colors have been done
  2. Adaptations: Provide opportunity for clients to make a choice for what color is chosen next (visual for non-verbal clients)

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I have also used the song “Side By Side” to work on lower body movement (PSE), because this song is great for prompting side steps! For upper body, a great song to use is “Can’t Help Falling in Love with You” because it is in ¾ time signature, making it great for smooth fluid movements! Below are some other song ideas to use for Valentine’s day.

Song ideas for Valentine’s Day:

  • Can’t Help Falling in Love With You: Elvis Presley 
  • You’ve Got a Friend in Me: Toy Story
  • With a Little Help From My Friends: The Beatles
  • Can You Feel the Love Tonight: The Lion King
  • All You need is love: The Beatles 
  • All I Have to Do is Dream: Everly Brothers
  • My Funny Valentine: Babes in Arms
  • Bicycle Built for Two (Daisy Bell)
  • Love Me Tender: Elvis Presley
  • Side by Side: Patsy Cline
  • You are My Sunshine (Valentine)

I hope those ideas give you some inspiration! 

-Audrey Cosgrove, MTI

 

Finding your Strengths

As a requirement before starting my internship at The Music Therapy Center of California, I was required to take the “Clifton Strengths Finder” test. At the time, I didn’t realize how beneficial and insightful this test would be for me. I have always been a fan of any sort of personality test, but this one gave me a new kind of understanding about how I work best and what I am good at. Clifton Strengths Finder is an online test you can take that gives you your top 5 strengths out of a list of 34 options. Your results are personalized, and it gives you lots of information on each strength. My strengths are: Discipline, Empathy, Achiever, Communication, and Woo. 

After starting my internship, I have found that understanding my strengths and how I work has been more useful than ever. First, both discipline, achiever, and communication have been very helpful for my internship, as they all provide me with the drive to get things done in an orderly manner and efficiently in some way. I am driven by accomplishing tasks, getting things done by (and often earlier than) due dates, and checking off my to-do list. In terms of internship, this has been extremely helpful as I am able to stay focused on my tasks and get things done quickly.  

Next, Empathy has been very prevalent as I am working with all sorts of different people. It is so valuable to have empathy as I work with my clients, because it helps me to understand how they may be feeling and what they need. I feel as if I got more than my allotted amount of empathy. I feel deeply for people and want to help them in whatever way I can. Looks like I went into the right career! This has also helped me to see how I can work well in a team, as I want to be supportive and caring towards others I am around.

Lastly, my strength of Woo has been very helpful for me to understand during this time in my life. During internship, you are meeting so many people, that for some it could be overwhelming and exhausting. For me, I LOVE meeting new people and finding ways to connect with and understand them. I am not intimidated by strangers, and I love striking up a conversation with those around me. I have noticed during my internship that I have felt a strong desire to get to know everyone around me very well, and to understand who they truly are. I love knowing more about people than just the surface level, and my tendency is to desire that they would want to know me too! 

After researching my strengths more and understanding what they mean in my personal life, I have also come to realize that almost all strengths can have a negative and a downside, that you must be aware of. For me, I realized that with discipline, communication, and achiever, I can become so addicted to working and getting things done, that I have a hard time slowing down and resting. I even sometimes work during my lunch break, because I love shrinking my to-do list and feeling like I got something worthwhile done with my time. For empathy, I realize that sometimes I can feel for people so much that it can overtake me, or cause me to lose focus on what I am doing. My feelings can get in the way of my ability to work or accomplish a goal. I need to stay centered and not let my empathy become out of balance. Empathy is a two edged sword. Lastly, being a woo, I can sometimes be so focused on winning someone over, that it can become unhealthy. It has been helpful for me to see that as long as I understand my strengths and how they could become negative, I am able to keep things in balance and remain healthy and positive. 

Understanding yourself and your strengths and your weaknesses can be an extremely enlightening thing. I have found that this is especially prevalent during internship. This is an intense and changing time in my life, and this has magnified my strengths in a new way. It has been a really important time of self-discovery for me so far, and has helped me to understand how I work best on my own as well as on a team. 

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I would highly suggest looking into your strengths if you haven’t already! 

https://www.gallup.com/cliftonstrengths/en/254033/strengthsfinder.aspx

See you next time!

-Audrey Cosgrove, MTI

Juliana’s Top 10 Internship Learnings!

Hello everyone!

It is hard to believe that my time at internship is quickly coming to an end! I know everyone says that internship is the time where you learn and grow as a music therapist more than you ever thought you could, and it is absolutely true! I feel more confident than ever that I have learned the skills and gained the experience needed for me to be sent out into the real world. This blog post is to share some of my top learnings during internship!

1. You ARE capable

Confidence was one of the biggest things missing from my toolbox of strengths when I first entered internship. I felt that I had the academic knowledge enough to set myself up for success, but still felt inadequate and scared to facilitate in front of large groups of clients, singing unfamiliar songs, etc. However, internship really forced me to push myself out of my comfort zone and try new things. I am not sure when it happened, but I realized at some point into my internship, I could confidently and comfortably get up in front of a group of 40 clients and not think twice about it. I was entirely focused on my facilitation skills and client responses, which is exactly where I needed to be. Which brings me to my point: You can do it!!! 

2. The power of the EZ-220 

The EZ-220. Absolutely life changing. For those of you who do not know, the EZ-220 is an electronic keyboard from Yamaha that has many useful features for sessions. We use it for almost every group session that we have, as it is fairly accessible and portable. The feature that I use most are the backbeats, which can help with engagement, attention, and helping to make the music that you facilitate sound more full. There are different styles of backbeats, including 8 and 16 beat, swing, ballad, rock, and much more! There are also different voices on the keyboard, such as wind and string instruments, and the standard drum kit which we often use in sessions, and a great “follow the lights” feature as well. AND, the EZ-220 is also equipped with many pre-recorded songs! The keyboard can also be plugged into an amp to project more sound. I would absolutely recommend investing in one if you facilitate a lot of group sessions, here is a link to where you can find one! 

3. Using themed sessions!

I have previously written a blog post about this which can be found here! But just to reiterate again, using themes can help center your session, provide reality orientation, and can help you gain inspiration and avoid ruts when session planning.

4. Visuals, visuals, visuals!

During practicum in college, I would frequently use visuals for my younger clients and groups, but I never thought to use them for other groups. Now, I don’t go a session without them! Visuals are a really important tool to engage clients, especially to provide an outlet for communication for non-verbal clients. For example, for my older adult sessions, I will put on background music with a specific theme (using Auld Lang Syne during New Years themed sessions), and go around and show photos on my iPad with different new years related objects (the ball in NYC, fireworks), and engage in conversation with the residents. These visuals are especially helpful if there is a language barrier as well. I also use visuals a lot with my groups of adults with intellectual and developmental disabilities, as it helps explain concepts and engage their attention. 

5. Incorporating your primary instrument

If you’re like me, if your primary instrument isn’t voice, it was almost unheard of of using your primary instrument during sessions in college. It was one of my biggest goals to be able to learn how to incorporate it during internship- and it happened! I I use my clarinet all the time in older adult groups and with my adults with intellectual and developmental disabilities! For example, I will use my clarinet during name that tune, to help enunciate melodic patterns for PSE interventions, and if I am co leading with another therapist, I’ll provide harmonies or play the melody. We also frequently have drum circles, so I will facilitate call and response on clarinet and use non verbal musical cueing using it as well. 

6. EZ Play music is your best friend!!!  

If you haven’t heard of EZ play music, it is basically blown up music of just the melody with the notes written in the note heads, and it has the chords written above it. This has been extremely helpful when facilitating songs with older adults, because you are able to play an accompaniment pattern in your left hand while playing the melody in your right hand and singing. This really adds more musical depth, and also helps our residents hear the song more clearly. EZ play books are also really helpful to find more repertoire, as the books are classified by different themes (music from different decades, love ballads, college fight songs, musicals, and much more!) These books are published by Hal Leonard and a link to an example of one on Amazon can be found here! 

7. Take advantage of this time to learn and implement unique instruments

If you had told me 6 months ago that I would be therapeutically using the kazoo during my sessions, I would have never believed you! Along with the kazoo, autoharp is your best friend during PSE interventions as well. I was also recently inspired to purchase a mandolin which I will be implementing in future sessions 🙂 

8. Take the time to address sensory needs for your clients

Before internship, I thought that if you did not facilitate music therapy the entire session or the majority of the session, then it was a failed session. However, now I know that sometimes the most important thing you can do for your clients is to provide them proper sensory stimulation and input so that they can be successful for their next task or the rest of their day. Sensory input techniques can include deep pressure squeezes, using a body roller, spinning in a chair, bubbles and more. 

9. Don’t be afraid of hand over hand assistance!!!

I never really had to touch any of my clients during practicum in undergraduate, and I also thought it was frowned upon. During internship, I learned how to provide effective hand over hand assistance, especially when it comes to older adults and adults with intellectual and developmental disabilities. Hand over hand is especially useful because it provides extra prompting and can help wake up clients if they are sleepy. 

10. Use your internship team as a resource!

Your internship directors, supervisors and music therapists are all there to support you! They are rooting for you and want the best for you. If you ever need help coming up with an intervention or are looking for a specific visual, chances are, someone on your team can help you! Don’t be afraid to ask questions- these people are your best resource and your colleagues for life 🙂 

There you have it- my top 10 learnings from internship! I would love to hear yours if you have completed yours or are getting close to, feel free to comment below! Thank you for reading my posts in the past 6 months! 

 

  • Juliana Hsu, MTI

Guitars in the Classroom AMASE Conference: Meeting Clients’ Sensory Needs:

Near the beginning of my (Audrey) internship I had the opportunity to go to the Guitars in the Classroom AMASE conference, with Julie Guy, who presented on using Music Strategies for Sensory Integration in the Classroom. This was such a great experience for me, as I got to get out into the community during my first week of internship, connect with others, network, and help present on music therapy, all while learning more skills to use in my own music therapy sessions! 

The challenge of presenting at this event, was that there was such a wide range of skills, settings, and challenges for the attendees with their students. When asked what challenges these teachers experienced in their classroom or facility they worked at, there was a huge list of behaviors such as biting, distracting noises, hiding under tables and desks, running or jumping, rocking, or scratching. Despite the wide variety of people attending this session at the conference, there was an overwhelming amount of difficulties related to sensory seeking behaviors. Almost all of the behaviors that these individuals noted were related to this. I got to hear all sorts of suggestions and ideas for how to handle these behaviors, and I thought it would be helpful to compile them all in one place!

The first thing to understand is that many of these behaviors that come across as aggressive, mean, defiant, or chaotic may directly relate to a sensory processing disorder. These individuals may not be intentionally disruptive, they may just be trying to get the input they need. Clients may be over or under stimulated, and need something to help calm them down or alert them. Below I have listed many different ways to help clients to receive the sensory input that they need.

First, clients who bite or frequently put objects into their mouths, may benefit from using a chew tubes (often called “chews” or “chewies”) which are usually small rubber items. Chewies can be chewed or sucked on when need sensory input to the jaw. Some styles can be put on a necklace so they are always accessible for a client to help calm them down and provide tactile sensory stimulation.

Next, vibrating pillows. I have seen these used in a session before when a client was exhibiting aggressive behaviors, such as throwing things and hitting the floor and wall. The therapist brought the pillow to him and pushed it against his feet as he was laying on the floor, and this immediately helped the client to calm down. These pillows vibrate when pressure is put on them, so a client can squeeze them, sit on them, put in their lap, lean on them, or any other positioning to create the vibration effect. 

e352f64417d07ba80f91431a1ec8e30b-foam-rollers-muscle.jpgLastly, any variety of rollers for sensory input can be very effective! You can use foam rollers, ones used for muscle relaxation, or anything that can provide sensory input for clients who are sensory-seekers. 

tactileeggshakers-setof12_l.jpg

 

Using instruments that may be calming to a client, or provide sensory stimulation that they may be seeking is a great tool. Examples of sensory instruments include tactile egg shakers, which have bumps on them which provides tactile stimulation and the sound of the shakers can provide auditory input. 

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Cabasas are also great source of tactile and auditory input. The cabasa can be rolled along a client’s hands, arms, legs, back, as it may provide a calming sensation for them. 

An ocean drum provides auditory stimulation, as the balls roll around inside the drum, providing a louder sound for clients who may be seeking that. Clients also may enjoy the way that the balls look (visual input) when they roll around in the drum. 

Other items or ideas that may help clients to receive sensory input and stimulation:

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  • Ice cubes or ice packs 
  • A bag filled with sand or rice (can be put on clients lap, or clients can push/pull/lift it)
  • Squeezes along client’s hands, arms, or legs
  • Squeeze balls
  • Bear hugs
  • Yoga balls

There are so many more ideas out there for sensory stimulation for clients who may be seeking this! Do you have any other techniques or tips? Let me know in the comments!!

Click here to access presentation handouts for more information.

See you next time!

Audrey 

PS The Out-of-Sync Child is a great resource to learn more about sensory regulation!

Molly’s Top Learnings During Internship

I’ve learned so much during my internship at The Music Therapy Center of California.  I wanted to share a few highlights in this blog post.

  1. Visuals, visuals, visuals!

I hadn’t made any visuals for clients before internship.  Visuals were extremely helpful when teaching social concepts such as appropriate behavior, practicing academic concepts such as number and letter identification, allowing nonverbal clients to communicate choices using a visual menu, or creating adapted lesson materials such as color-coded staff paper.  Here’s an example of a visual I made to go along with the “Super Student” song for a client:

super student

  1. Write songs for clients!

I wrote my first songs ever during internship.  I learned in school that preferred music is always best, so I didn’t consider writing new songs unless using a songwriting intervention.  However, because children with autism tend to process singing more accurately than speech due to right lateralization, song is often an effective way to teach concepts.  Clients often need personalized materials in order to meet the goal and generalize it outside of therapy. I found there were many songs I could adapt or just change the lyrics (aka piggyback song) to work on the client’s specific goal.  For example, here’s a piggyback song to the tune of “We Are the Champions”:

Conversation Champion

G                 Bm      Em     C   D
We’re in a conversation
G               Bm   C E
Our topic is _________
Am
Gain a friend’s attention
D7
Ask them a question
G
Listen to the answer
C7                                     D7
And ask another question
G
Or make a comment!

 

  1. Parachutes for all!

I used to think that parachutes were only appropriate for children.  However, I found that my adult day program and memory care groups loved waving and watching the parachute.  It’s a sneaky way to get clients move their upper bodies or practice spatial concepts such as up and down or left and right.  Parachutes are not just for kids!

parachute

  1. Power of humor

Humor is a great way to keep clients young and old engaged.  I found that silliness can help young children meet their sustained attention goals, and clients who are tired of working on the same skills may enjoy the novelty silliness provides.  Additionally, you can use jokes or funny sayings that relate to upcoming holidays to assist with reality orientation.

  1. Self-care may change

Internship is very different from student life.  Because there are different demands, I found that I had different needs to address in my self-care.  For example, as a student I had to intentionally seek out quality time with friends because I spent a lot of time studying by myself.  However, when I started internship, I was around other people all day. In internship, I found that I needed more alone time to recharge and function at my best.

  1. Positive redirection

I did not use positive redirection before internship.  I learned that clients are usually more compliant when you tell them what they can do rather than what they can’t do.  When positive redirection does not extinguish maladaptive behaviors, then I consider another approach such as setting a limit.

  1. How to give sensory input

Initially, I was majorly intimidated by providing clients with tactile, vestibular, and proprioceptive input because I didn’t ever need to touch the clients in practicum at my university.  I learned that it can take some trial and error to meet each client’s needs in any given moment of your session.

  1. Kazoo is your friend

I’d like to learn violin, flute, cello, banjo, and many other instruments.  I could use them for name that tune, or just to change the timbre in my sessions.  But until then, I play kazoo.

  1. Caveat to the iso-principle

In school, I learned to always use the iso-principle (musically meet the client where they are at, then slowly shift to where they need to be).  However, I saw that when a child with autism screams because they are overstimulated, playing loud music will only make the situation worse. In that case, it’s best to bring out calming stimuli.

  1. Wake up your clients

Julie taught me that it’s usually best to wake up your older adult clients in memory care if they fall asleep, gently getting in their proximity or tapping them on the shoulder.  They can sleep during almost any other part of their day, so participating in cognitive, speech, and sensorimotor interventions is better for their health and quality of life.

 

Those are 10 of the many things I learned during internship.  What did you learn in your internship? Let us know in the comments below!

-Molly, Music Therapy Intern

Winter/Holiday Interventions

Hello everyone, welcome to another blog post! 

This time of the year is so wonderful because you have the opportunity to do many winter and holiday themed interventions and sessions! I have talked about this a bit before in a previous blog post, but themed sessions that correlate with the time of the year is a great way to implement reality orientation with your clients. Since we live in San Diego and a lot of our clients have never experienced snow either, it is also another great way to teach them about different winter activities and what snow looks like! 

Today, I’ll be sharing some of my favorite winter/holiday themed interventions that we have facilitated over the past few weeks in December. I’ll also share the goals that you can target with these interventions as well.

  1. Build a Snowman

This is an intervention that you can use with both individual and group clients! I use this intervention for attention and listening goals. I printed, cut out and laminated various parts of a snowman, and used three 8×11” pieces of paper as a snowman’s body. For groups, I pass out different parts of the snowman, and within the song, different parts are called, and the client is supposed to hold up the correlating part of the snowman, and then they’re able to put it on the snowman. The parts are held on with velcro, so that they are able to easily detach and reattach. You can do the same thing with an individual client, but have the various parts of the snowman spread out, and then they find the correct part. I have attached a lead sheet of an adapted version of “Frosty the Snowman” that I wrote, along with a picture of my visual after a group of my clients completed this intervention 🙂 

 

  1. 12 Days of Christmas (piggybacked)

This is another intervention that I have created for my groups of clients that also focus on attention, sequencing and listening goals. I took the melody from the 12 Days of Christmas and changed it to the “10 Days of Winter”, and changed the lyrics so that each day is a different winter related object. Some objects I included are mittens, hot cocoa, fireplaces, snowmen, etc. I printed out photos of each object called, with one taking up an entire 8×11” sheet of paper, and then I pass them out to the clients. I explain that during the song, when their objects are called, they are to hold up the picture. This works great with bigger groups as well, because even if they do not have a picture, I prompt them to point at the picture of the object that is called. For example, when I sing “On the fifth day of winter, [facility name] gave to me, 5 snowflakes!”, the person with the picture of 5 snowflakes holds up their paper, and everyone else gets to point at the picture. 

 

  1. Holiday song fill in the blank 

Holiday songs can be a really great tool to use to help facilitate speech and work long-term memory because a lot of the songs are familiar to most clients. If you are familiar with the NMT technique called MUSTIM, this is a great technique to help facilitate both of these goals. You can facilitate this intervention with many different populations and settings as well, including older adults in memory care, a group of adults with intellectual and developmental disabilities, as well as individual clients. Some of my most used songs for this intervention include Rudolph the Red-Nosed Reindeer, Frosty the Snowman, Jingle Bells and Deck the Halls. For example, in the song Rudolph, there are clear phrases and ends of lines. You can choose to leave off the last word in each line for clients to fill in, or make it more challenging by pausing in the middle of a line. For example, “Rudolph the red nosed reindeer had a very shiny _____, and if you ever saw it, you would even say it _______”. This is a great intervention to scaffold as well, and you can even scaffold it so by the end, they are able to sing the song entirely independently while you provide an accompaniment. 

 

  1. Pass Rudolph 

This is a great intervention to use in groups to allow clients to have the opportunity for a leadership role, and to work on listening skills. This intervention can be done with really any song, but in this case, we chose to use Rudolph because we have a stuffed Rudolph that we use as a prop. Clients are prompted to pass around the stuffed Rudolph, and when the therapist stops playing/singing, whoever Rudolph lands on, that person gets the chance to have a solo. The solo can be done with drums, tambourine, or any other percussion instrument, and they can even sing as well. The other clients are instructed to listen to the other person as they do their solo, and then to clap for them at the end. The therapist can provide an accompaniment on guitar/piano while the client has their solo, and can improvise words based off of what is happening in the moment to the tune of Rudolph. 

There you have it! Some of my favorite holiday interventions I have been using the past few weeks. I would love to hear from you all- what are some interventions that you’ve done? 

Happy holidays and see you in the next post!

– Juliana Hsu, MTI

Communicating with Nonverbal Clients

I (Molly) recently had the amazing opportunity to attend the American Music Therapy Association’s national conference in Minneapolis, Minnesota.  The conference is an opportunity to meet other professionals, share ideas, and learn from cutting-edge research. Today I’d like to share a few things I learned from Peggy A. Farlow’s presentation on strategies to communicate with nonverbal clients.

It can take considerably more time and effort to communicate with nonverbal individuals, but it is essential to provide opportunities for self-expression.  When clients are unable to express their needs, desires, and preferences to those around them, maladaptive behaviors tend to increase in frequency and severity.  Whatever signals your nonverbal client uses to communicate, make sure to verbally state what you see to make sure you understood the client’s meaning. If a signal is unclear, ask for clarification by saying something like, “Did you mean yes?”  If the client gives several unclear signals, they may want to ask or answer a different question. It’s okay to ask, “Is there something else you’d like to talk about?”

The most common communication system for nonverbal clients is direct selection, which allows the client to communicate by pointing to a picture on a language board.  In order to use direct selection, clients need to have selective attention to visual stimuli and motor ability to indicate a choice.  If the client is not able to isolate one finger to point to a symbol on a language board, they can indicate their choice with a stylus, head movement, eye gaze, or even a laser pointer!

pointers

Direct selection can also work with more advanced language boards.  For example, clients who spell can use an alphabet board like the one pictured above to spell out questions and answers.  The therapist should verbally state each letter to make sure they understood the client’s signal.

alphabet board

Indirect selection works well for clients with very limited motor ability.  The client communicates by giving a yes signal when the therapist points to the desired picture on the language board.  Usually, the therapist will point to each row of the language board until the client gives a yes signal. Then the therapist will point to each column until the client gives the yes signal.  In this way, the client can communicate without pointing to the language board.

My favorite part of Farlow’s presentation was learning about the ETRAN system, which stands for eye transfer.  The therapist holds up a transparent language board, and the client uses eye gaze and/or head movements to select a symbol on the board.  High-tech ETRAN systems use a large, plexiglass board, but you can make a low-budget version with sheet protectors!

ETRAN

You can find the slides for Farlow’s entire presentation here.  I hope you’re as inspired as I was!

-Molly, Music Therapy Intern