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

Haaaave you met Music Therapy?

You know when you hear someone say, “If I had a nickel for every time I’d heard that…”
Well, at the risk of sounding cliché, if I had a nickel for every time I heard something like, “Music therapy? What is that?” I’d have… more nickels.
The funny part is, even though I’ve run across countless music therapy questions during my school and intern careers, I haven’t always felt satisfied with my quick explanations. If you think about it, you only have a small window of time to capture your inquirer’s attention and leave them with a good first impression of music therapy. That’s a lot of pressure!
Fear not, music therapy friends. I have compiled some of my favorite tips, imparted upon me by some wise music therapists, for being an effective liaison to the world of music therapy. By following the presented steps, you should walk away from each of your introductions to music therapy feeling confident that you made a positive impression on your audience, established yourself as an informed authority, and that you contributed to the health of the music therapy discipline in general. Nice job.
Side note, if you feel so inclined to share or reuse the infographic, please refer credit back to The Music Therapy Center of California.
Happy music-making!
~Esther
Introducing MT Infographic

No Therapy Is An Island

You’ll hear music therapists tell you time and time again, “Music therapy is an EVIDENCE BASED field!” What we do it backed by empirical research, and we’re very proud of this fact. However, the fact that the field is supported by research showing the efficacy of using music as a therapeutic tool for accomplishing non-musical goals does not make music therapy a lone-ranger in the world of therapies. There’s a key phrase I used in the previous sentence: “non-musical goals”. This means that the goals we are addressing in music therapy are similar to the goals our client’s are working on in their other therapies (speech, occupational, physical, behavioral, and cognitive rehabilitation therapies, etc.). So, in the Neurologic Music Therapy branch of our field, in particular, when setting up our interventions for addressing a non-musical goal, we like to use a model called the Transformational Design Model (TDM).

Transformational Design Model! It sounds like a superpower. And in a way, it is. It’s the superpower model that transforms non-musical interventions into musical interventions. Because music therapy has the same functional structure as other therapies, music therapists use this model to see where the overlap is with other fields, and then how the addition of music to a treatment intervention can benefit the client. But wait, there’s more! This superpower model transforms the functional music intervention into functional, non-musical real-world application. In short, we’re not going to let you walk around singing the steps to making conversation. We’re going to help you generalize the information you learned through music, so that when you apply it to everyday life, you’re doing it in a socially acceptable and sustainable (functional) way.

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I know you’re dying to find out how one mere mortal can acquire such a superpower. Well, lucky for you, we can let you in on the bare bones of the model. I take myself through these steps every time I develop an intervention for a client, and it helps ensure the quality and efficacy of my interventions. Ok, are you ready to be transformed?

  1. Asses the client’s strengths and needs
  2. Develop the goals and objectives
  3. Research how a non-music therapist addresses this same goal and design a functional non-musical intervention
  4. Translate step 3 into a functional musical intervention
  5. Transfer step 4 to functional, non-musical real-life application

This model is a superpower not just in the fact that it transforms a non-musical skills into a musical experience and then back into a non-musical skill, but also in the fact that it allows multiple therapeutic fields to see their overlap. The more therapists from varying fields can work together, the more well-rounded the treatment plan becomes, and the more the client will benefit. Go transform something!

-Chiara

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.

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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.
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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

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

 

Move That Body – Patterned Sensory Enhancement

First of all, let me give a special thanks to Veronica May, MT-BC, NMT for coming to The Music Therapy Center to, in her words, “brickity break down” some Neurologic Music Therapy physical and sensorimotor techniques for us, and give us specific tools to use with our clients. The following information is based on her helpful instructions.

Music motivates movement! That is why there is a whole category of neurologic music therapy techniques that address physical and sensorimotor goals. One technique is Patterned Sensory Enhancement (PSE). PSE uses the elements of music – harmony, dynamics, rhythm, melody, tempo, and duration – to mirror a specific movement. It is used in motor rehabilitation, maintenance, or modulation.

In PSE, music is not only motivating movement, but it’s also illustrating the movements. When a music therapist chooses what type of music to play and how to play it in order to facilitate a specific movement, he/she must take all the elements of music into consideration: 1. Timing elements: meter, tempo, pattern, form; 2. melodic elements that indicate spatial aspects of movement: pitch, dynamics, sound duration, harmony. In addition to musical elements, the music therapist must also be aware of the elements of the movement his/her client is being prompted to do. What are the steps involved in making the specific movement? Where is the force of the movement coming from?

 

Enough with the technicalities! How about some examples for how MUSIC can ILLUSTRATE and FACILITATE MOVEMENT!

Example: Knee lifts from a seated positionSeatedKnRse2

First, where is the force of the movement? The LIFT, because this is going against gravity. Therefore, the “force” – or most emphasized – part of the music will be on the lifting motion.

 

Second, let’s think about the music.

  1. Meter: Knee lifting is like marching, so we would likely want a march meter (i.e. 2/4 or 4/4). Find a song, or plan your improvisation in that meter.
  2. Tempo: At what speed do you want your client making each movement? Choose the tempo that is most appropriate for your client’s age and motor challenge. Remember, slower tempos are sometimes harder for clients to maintain because there is less auditory info happening between each beat.
  3. Pitch: You want your client to make an upward movement, so instinctively, you play higher pitches to cue the lifting movement (e.g. a high C chord), and lower pitches to cue the lowering movement (e.g. low C).
  4. Dynamics: In this case, dynamics will help you emphasize the pitches that cue the lifting movement. Play the higher pitches louder and the lower pitches softer. E.g. Loud high C chord, soft low C.
  5. Duration: You can cue how long you want your client maintaining his/her knee in that lifted position by sustaining the high pitches (e.g. sustained high C chord), or making those same pitches very shor
  6. Harmony: Harmony doesn’t play a crucial role in this knee-lift example. But it can tie in to the emphasis piece. Emphasize the lifting motion by making the high pitch a chord (e.g. high C chord), and the low pitch just a single note. I’ll give another example. A clenching movement may be associated with a dissonant chord, while a relaxed/releasing movement may be associated with a consonant chord.

– Chiara (the new intern!)

Lions and tigers and….. public speaking!? Oh my!

If you are a music therapist, you know the feeling – you’re on an airplane or in an elevator when someone asks you what you do for a living.  The 30 seconds that follow have the potential to forever shape that individual’s understanding and view of the vast world of music therapy.  No pressure!

The vital importance of being an effective communicator and speaker cannot be over stated.  Whether your field is music therapy, marketing, or dog sitting, you have the power to help others understand the value and efficacy of your work.  So much about an individual brand or company is communicated in the initial, first-impression conversation and it’s crucial that you are prepared.

Recently in symposium, we discussed the (slightly overwhelming) topic of public speaking/presenting/communicating effectively.  Here are some helpful take aways if you’re looking to boost your ability to persuade, engage, and win-over others.

  1. Know your audience! Before you are able to effectively “sell” anything (whether services, an idea, a suggestion) to anyone, you first have to understand why it matters to them.  If you were speaking to a woman who has an 85-year-old mother with Dementia, do you think you would describe music therapy differently than if it were a man with a 4-year-old son with Autism?   Knowing your audience is so important to understanding how to effectively communicate with a variety of people.  When beginning a conversation, practice asking quick questions to get to know the person, where they’re coming from, and what they’re looking for in music therapy (or any other topic/field you may be discussing).
  1. Know your material. If you are educated, knowledgeable and well-rounded in your area of expertise, you are already set up for success to be an amazing communicator!  Remember, you are the expert.  Own what you say.  Use confident language like “we do” and “we are”, and be prepared to answer a variety of questions that might arise.  If you truly know your material, whether it is a 60-minute presentation, or a quick exchange in line at the grocery story – it will make all the difference in your confidence and will impact the other person’s quickly-forming opinion of you and of the field.
  1. Focus on the message, not on yourself. This is key!  As soon as we stop worrying about what the audience/other person is thinking of us, or how our voice sounds, or what our hair looks like, etc. etc., our message immediately becomes more impactful!  Focus on exactly what you want to communicate and on the power of your message.

For more helpful tips, visit Toastmasters.org.  They have a variety of free resources, from articles and videos to podcasts and conventions.  Some of the above tips were drawn from the following video:

And remember, haaaaave fun with it!

haaaaave fun with it

-Marissa

Fun with letters M & P

Neurologic Music Therapy group was led by Becca this past week in symposium.  She presented a TDM (Transformational Design Model) on one of her clients who is working on a speech and language goal of improved articulation.  She is using an OMREX intervention with kazoo as an initial step to address this goal area.

After Becca presented, the team got creative thinking of ways to expand this intervention to include language.  We discussed the importance of always tying breath support exercises with functional speech and language.  In order to put this into practice, we split into two groups and created interventions that focused on 2 bilabial consonants: p and m.  In less than 30 minutes, we created songs with visuals that focus on each of these letters.  The videos of our final products are included below, along with the chords/lyrics and visuals!

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-Marissa

 

We are all songwriters!

Before starting my internship, most of the songwriting I had done with clients was in mental health populations – mostly adolescent and adult drug and alcohol rehab and clients with eating disorders.  It got very heavy at times, but was often extremely therapeutic and cathartic for many clients.  I believe this shaped my view of songwriting as something narrow and used primarily for deep, personal issues within therapy.  That being said, over the past 3 months I’ve come to view songwriting as an amazing expressive outlet for many young children with developmental disabilities.  Even simple song re-writing exercises (like “All you need is love” for Valentines Day) provide an opportunity for the client to make choices (MEFT – Musical Executive Functioning Training), exercising their executive functioning skills.

What I’ve come to observe, is that many clients with disabilities have the majority of things done for them by parents and caretakers.  When they are given a choice between two activities/songs/etc. they will choose, but when left with an open ended question like “What should we write a song about?” they often have a blank expression on their face and no idea where to start without being given suggestions of different ideas.  But once you help them get the ball rolling, they are full of ideas, imagination, and creativity and the end product is amazing!  For some clients, re-writing the words to a favorite song of theirs is the best bet because they have a clear idea of where the song is going and already enjoy how it sounds.  Other clients have the ability to help write (or independently write!) a chord progression/melody, and this is where you can challenge them to exercise their creativity.  Below is a helpful chart of chords to use in a variety of keys that can quickly spice up any songwriting session!

Somewriting tips

 

When writing songs with your clients, remember that every answer is valid!  As long as what the client suggests is appropriate and relevant, there is no better answer as to what to put in the lyrics than what they give you.  After all, it’s their creation and masterpiece and should have their unique personality written all over it.  If you can, think ahead about the wording of prompting questions you might ask your client in order to generate ideas.  It’s also helpful to think about the goal of the exercise – for example, is your client’s primarily reason for songwriting to express themselves or to practice decision making or leadership skills?  Determine what questions you will ask and how you will go about the process with their particular goal in mind.  If they are practicing leadership skills, let them lead you through the process and if they are struggling, challenge them to find a way to figure it out instead of offering a solution to them.  If their goal is self-expression, validate every answer they give you and do your best to reflect the sentiment of their words in the music you create.  It’s also always a fun idea to record your completed songs and give your client choices of what instruments to incorporate and how they’d like the finished product to sound.

I trust that the joy in your clients face when you play back the final version and they hear themselves singing and making music will be enough to fuel many more rewarding songwriting experiences in your sessions!

-Marissa

Music Lessons for All Needs

Our team recently met to brainstorm essential teaching components, strategies, adaptations, accommodations, methods, and resources for teaching adapted lessons. I want to share with you what I learned in the article “Ten Characteristics for Teaching Students with Special Needs” by Beth A. Bauer.

  1. Consistency is crucial. This consistency applies to the rewards we provide, routine, schedule, home practice routines, time of day and location of the lesson,.
  2. Adaptability, find something that makes sense in their world. Examples include; using stress balls to teach hand positioning for piano, or creating fun mnemonic devices to learn the notes of lines and spaces in the music staff.
  3. Flexibility is a MUST. This flexibility pertains to lessons plans, studio setup and pacing of the lesson. Some days a student may come into the lesson after having a rough day at school and have a melt down. As the therapist “you need to find a way to work on something that will redirect the student away from whatever is bothering them and still be applicable to the lesson.”
  4. Setting Expectations “for students with special needs should be no different from the expectations and goals for students who do not have disabilities. By setting consistent, high expectations for everyone, the students know that we believe in them and that we know that they can be successful.”
  5. Patience, is your  best friend. Patience with repetition, multiple methods, reinforcement and redirection, and patience with getting to know your students.
  6. Compassion. Tell the parents of your students what their children CAN do instead of what they CANNOT do. Treat the child as a person first, without regard for a disability label. Focus on the positive aspects of the lesson, even when there is a meltdown, there is at least one positive aspect to find and share with the parent.
  7. Have a Sense of Humor.
  8. Learn from your mistakes. “We should always try our hardest but know that you will make mistakes. Mistakes are acceptable and the important lesson is that you learn from those mistakes.”
  9. Lose the Ego. Perfection is not everything, and it is not about the therapist. We will learn far more from our students than they will ever learn form us.
  10. Have FUN!!

 

-Kristin