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

We Are the Champions

2017-06-11 19.41.38.jpgAt a recent party, we realized that MTCCA interns numbers 11 through 18 were all in attendance (pictured left to right: Tara Harwell, Becca Paoni, Kristin Hurley, Marissa Phillips, Chiara Francolino, Brandon Wright and Shannon Flaherty).How great it was to have 7 of our current and former interns together at once. Click here to view their spontaneous musical performance.

Top “Learnings” During Internship

These past 6 months have been a blur of learning experiences! It is so hard to narrow down what my top “learnings” have been because I have learned so incredibly much. I am not remotely close to the therapist I was 6 months ago, and thank goodness for that! I’ll try to synthesize the top 2 areas in which I have noticed the most growth in myself.

  1. Confidence! If you had told me 6 months ago that I would reach the point where I would feel confident in my ability to facilitate therapeutic change for a client within a session, I would have laughed in your face. Now, confidence does not mean I have the impression that I’m done learning and improving. I still have so much to learn! But this confidence means that I am no longer feeling floods of self-doubt when I enter my sessions. I no longer feel like I need to script and plan out every second of my sessions. Confidence means I’m finally to the point where I can trust my instincts. When I’m trusting my instincts, I can be myself. And when I’m myself, the client benefits from a more authentic therapeutic relationship, which leads to faster learning and goal achievement!
  1. As it turns out, I can teach! I had never thought of myself as a very good teacher. These past 6 months, I have been put in many many MANY teaching situations, from adapted piano and guitar lessons with children and teens to teaching the Clavinova (read: electric piano) to older adults. Initially, I was TERRIFIED by the idea of having to teach. And many times I felt I was just stumbling through each lesson. So, of course, I was amazed when my older adult students told me that I explained things very well and that they were able to easily understand my instructions. Now, I am no longer terrified of teaching. What’s more, I may even ENJOY it sometimes! I think this speaks volumes to the amount of practice I’ve had over the last 6 months, trying to relate to each one of my students in their unique learning styles, and breaking information down into small pieces. I’m grateful that I can walk away from this internship knowing that I developed a skill a never thought I had or would have

It’s been a wild learning ride, and the above to learning areas are just the tip of the iceberg. I am SO grateful for this experience and for the tools it has given me to become a more successful therapist.

  • Chiara

Introducing Brandon

20160911_195501Brandon is currently completing his Bachelor of Arts in Music Therapy from California State University Northridge (CSUN). His primary instrument is alto saxophone and he also enjoys playing flute, guitar, and hand drums. Prior to studying at CSUN, Brandon worked as a Rehabilitation Instructor at United Cerebral Palsy, and then as a 1:1 Instructor at The Learning Academy, a non-public school at T.E.R.I. Inc. in Oceanside. During this time, Brandon worked with individuals aged 6-22 who have behavioral and learning challenges. At CSUN, Brandon’s practicum experiences included working with medically fragile children, individuals with autism and cerebral palsy, adults with developmental delays, and adults with chemical dependency.

Something’s Touching Me!

Your body is always touching SOMETHING. What an interesting thought that most people don’t spend too much time dwelling on. That’s because the brain with a well-regulated tactile sense only briefly makes note of the thing that the body is touching, and then ignores it in favor of more important thoughts and sensations it needs to process. But for a person whose tactile sense is out-of-sync, the textures of certain fabrics or presence of a tag on their clothing may be a source of extreme discomfort and the cause for much distress. Or they may lunge at you for a bear hug because they crave the feeling of deep pressure squeezes. Or they may not seem to notice that their hand is on a hot pan until they have a third degree burn. These are only a few examples, of course. The main point is, our tactile sense helps us determine what we are touching and if the things touching us at every moment of every day are harmful or helpful. An out-of-sync tactile sense may make a person overresponsive to stimuli, underresponsive to stimuli, sensory seeking, or a combination of these, or may make it difficult to determine what the tactile stimulus is or where it is touching.

How does this affect my work as a music therapist? I can start by considering the environment of my treatment space. What is the client’s reaction to the texture of the chair he/she is sitting in? For some of my clients with tactile sensory needs, sitting on a fuzzy pillow that buzzes provides the tactile sensations they need to be aware and in control of their bodies. For other clients, sitting on a rubbery and bumpy cushion serves this same purpose. What is the client’s reaction to the carpet? I have clients who prefer to have their shoes off during sessions. One such client likes having the afore mentioned rubbery cushion under his feet. From which direction is the air conditioning blowing and is it blowing directly on my client? I’ve barely scratched the surface of tactile elements to consider in the environment of the treatment room, but you get the picture.

child-playing-with-rice.jpg

What about my choice of instruments I use with my clients? Does the client seem to want to touch textured things? I have many clients who are more engaged in our interventions when they play an instrument like the cabasa (picture below), which allows them to rub their fingers along the bumpy beads. Other ideas of instruments with great sensory feedback are guitar strings, chimes, hand drums, ocean drums, and resonator bells. The cabasa is one of my favorite instruments because it acts as a great massager, providing sensory input to arms, legs, backs, and soles of feet. For clients who are seeking tactile sensory stimulation, instruments like the cabasa can provide this in an appropriate way. Encourage the client to play the cabasa (or other instrument) and use it to provide sensory input independently. This way, the client is learning to self-regulate his/her out-of-sync sensory systems.

 

3317_cabasa_a.jpgOr for clients with an overresponsive tactile sense, choose instruments that don’t have a rough or uneven texture. Then encourage them to explore tactile sensations using the texture and vibrations of various instruments. This could help reduce defensiveness to certain tactile sensations.
Tactile_Sensory_Kit_6.jpg

As with all other sensory systems, there are so many things to consider when your child or client has an out-of-sync tactile system. Hopefully the ideas and considerations discussed here have sparked some ideas and increased your awareness of needs related to the tactile sense. Now, I challenge you to stop every now and then and become aware of the sensations on your skin and the things touching your body. Then imagine what it would be like if you could not seem to get enough of or control one of these sensations. How would you fix that?

-Chiara

Reflections

What a journey the past 6 months of internship has been!  One year ago at this time I had no idea I would be moving to San Diego and building a life here.  I had no idea how intense life as an intern would be or how exciting the process of stepping out of the intern shoes and stepping into life as a new professional would be.  These past 6 months have taught me patience, confidence, and what it means to be invested in your dream.  There have been many lessons I’ve learned throughout internship, and I did my best to summarize my top learnings below.

1.      Your therapeutic relationship with the client is most important
While this may seem obvious, it was a valuable lesson I was reminded of through my experience as an intern.  So often it’s easy to jump into sessions with clients and get so absorbed in the goals and interventions that you forget that you haven’t yet earned the client’s trust.  The therapeutic relationship is really what makes music therapy effective – it is 100% essential to the clients success within therapy.  With time, I learned to breathe, be more present, be more aware of the client’s responses/what they are giving me and became comfortable adapting in the moment.  I also learned a great deal about building rapport with a wide range of personalities and different individuals.  Some clients connect with you through silliness/cutting loose a bit, some through structure, and others simply with time.  I learned to get to know my client’s and give the relationship time to grow before expecting them to trust/listen to me.

2.      Importance of professionalism and communication with parents/families
My experience in the field so far has taught me the vital importance of professionalism and communication.  I value clear and open communication and have come to understand how important this is in the workplace.  I have learned to communicate clearly with parents and families and (when possible) always keep them in the loop.  Within this lesson, I learned the importance of consistency, timeliness, and honesty/transparency as a measure of communicating respect and professionalism to the families with which you are working.

3.      Know your professional values
I have held several jobs in music therapy since beginning my degree.  Each has taught me more and more about what I value as a professional.  Sometimes the administrative end of music therapy can be equally as important as the therapy itself.  Sometimes small, logistical details determine whether you will be happy and well balanced, or overworked and burnt out.  I am learning to advocate for myself in these areas as well as cultivate a reputation for myself based on my personal values as a music therapist.

4.      Actively build/expand your skill set
There is always room for improvement, or as my mom told me often growing up “Learning is a lifestyle”.  I realized throughout internship how easy it is to get into a groove or routine where you’re comfortable, you and your clients know the drill and you rarely feel the need to mix it up.  However, mixing it up is where you’re challenged and where you grow!  I am inspired to expand my skills (particularly on guitar) as well as my repertoire of music.  Because we are in such a unique and fun line of work, it is a joy to get to be creative every day in the way you lead songs, present information, and address goals.

5.      Love where you are –> trust the process
The universe kept hitting me hard with this lesson, especially throughout internship, until it started to begin to scratch the surface of making it’s way into my head.  Many times we wish we were someplace we’re not – gotta learn to love and accept where we are.  Even if I don’t have years of experience (one day I will!) or am not the most knowledgable on certain subjects, I have to remind myself to breathe and accept where I am and be gracious with myself.  This proved to be particularly tricky when dealing with families or facilities who also wish you had more experience than you do.  All in time, all in time.  The difficulties will pass, the knowledge and expertise will come with experience, just trust that you are where you need to be.  I am where I need to be.

While reflecting on these lessons, I was drawn to record a piano piece that in a way represents the ebb and flow of internship for me.

 

Here’s to the future and all that lies ahead!

-Marissa

AEFCT – Learnings from Applied Behavior Therapists

Behavior serves a function.  From infants to the elderly, humans behave the way they do for a reason.  When it comes to our clients, addressing the reason can sometimes be the first step towards making progress in their goal areas.

Recently in symposium, Shannon Wallace and Maryann Le of AEFCT came to present to our staff on “Function of Behavior Training”.  (Find out more about AEFCT here: http://aefct.com/)  Their presentation opened my eyes to several important factors to consider while working with clients.

A key concept in knowing how to address the behavior of a client is understanding the function of the behavior.  I learned that this is a phrase commonly used amongst behavior therapists that basically answers the question: why is the client doing what they are doing?  Is their behavior seeking to gain the attention of somebody or to meet a physical need (are they hungry.. thirsty.. need to use the restroom)?  What is their specific purpose for what they are doing?  Sometimes this can be a very tricky question to answer.

Consider the fact that many of the behaviors we as therapists view as “challenging” are behaviors the client probably views as functional, because engaging in them gets their needs met in one way or another.  Maybe screaming at the top of their lungs in the store gets them the toy they wanted (mom gives in to alleviate the situation).  Maybe engaging in disruptive behavior in the classroom gets them out of doing difficult work (they are removed from classroom for disciplinary purposes).

The 3 functions of behavior are:

  1. Positive reinforcement (behavior produces an outcomes that is desired by the child)
  2. Negative reinforcement (maladaptive behavior like escape or avoidance)
  3. Sensory Regulation (maladaptive behavior occurs in order to regulate the level of input from environment)

First determining the function of behavior helps us understand how to appropriately address it.  According to Shannon and Maryann, “When we know the antecedents and consequences of behavior, we can intervene in ways that provide an appropriate behavior that achieves the same function.”  This was one of the biggest lessons I learned through this presentation: the importance of providing an appropriate alternative to undesired behavior.  Since this time, I have been applying this principal in many of my sessions.  This includes things like redirecting a client who hits the table vigorously with his palms to playing a drum in order to receive that sensory feedback as well as redirecting a client who constantly asks what’s next by helping them give positive compliments to other group members.  Always be thinking how you can provide clients with a functional, appropriate alternative.

One final important aspect to consider is being on board with the parents with your strategies and approach towards behavior.  It is important that you are handling the behavior in a way that is congruent with how the parents are handling it at home.  Although this is not always possible, when it is, it can be extremely effective for the client.  Discuss strategies and approaches with your client’s family in order to determine what is best for them.

I’ll leave you with a short story of how these ideas have manifested themselves over the past month of my internship.  I have been working for 5 months with a non-verbal 8 year old client who, ever since I started with him, will manage to have a handful of my hair at some point in almost every session.  I have worked so hard on developing my “mom” voice, being stern, changing my affect, letting him know that is not okay, singing songs about having “gentle hands” and practicing what that looks like, redirecting him to a drum or other instrument or ignoring the behavior.  Although some of these tactics have seemed to work in the moment, we had a session 2 weeks ago where we were in the middle of an intervention at the piano together and I felt like we were connecting more than we ever have – he was sustaining eye contact, following directions, smiling at me – we were communicating so much nonverbally to each other through our playing.  I look down at him and he’s smiling so huge and then suddenly he reaches out and grabs two handfuls of my hair.  In this moment I realized that my assessment of the function of his behavior may have been off all along – maybe the reason he is engaging in this behavior is because he wants to communicate something to me and doesn’t have a way to do so.  I didn’t struggle against him or whip out my stern voice and say “not okay”, I instead maneuvered my head so that I could make eye contact with him and just looked at him with a neutral affect, locking eyes – simply letting him know I was there and present with him.  After a moment, he let go, no words were said and we continued with the intervention.  Since this time, I have been motivated to give him absolutely every opportunity to make a choice, communicate with his device, and request activities in an attempt to provide him with a means to communicate whatever it was he was trying to say by grabbing my hair.  Through my clients I am learning countless lessons about the function of behavior, communication and human connection.

-Marissa