Mental Health Day Treatment Update

Long time no write! My fingers have been occupied typing progress notes. I just wrapped up my program at the Psychosocial Rehabilitation and Recovery Center (PRRC) this week. I facilitated 4 group music therapy sessions addressing a variety of goals, including self-expression, awareness and appropriate expression of emotions, group interaction and cohesion, and the use of music as a coping tool. 

As much as I love everything I'm doing here, the PRRC mental health day-treatment center may be my favorite experience. I'm going to miss this group of guys! We really had some neat interactions, and it was rewarding, (and challenging) group to work with. 

My first week was focused on emotional expression and group cohesion. Each group member shared their current emotional state with the group by 'playing their feelings' on a djembe; the group talked about everybody's rhythm, and what it said about how they were feeling. One Veteran said, "I couldn't have done this a year ago. I couldn't have shared how I felt. I have come so far." Then we had a group rhythmic improvisation where I told everyone to play their instrument while trying to ignore or drown out everyone around them. They did it, and hated it. Group members said it was confusing, it didn't sound good, they didn't know what to play. So then we played again, but this time I told them to listen for a 'hole' in the music, and try to fill it. The change in the group was amazing! They listened and waited to come in; as the rhythm increased, they started making eye contact with each other and smiling. When we talked about it afterwards, several group members said that playing from that perspective made the rhythm make sense, and they felt like they knew what to do. For individuals with a mental health diagnosis, isolation is a huge struggle, either because of their symptoms or because of the stigma they experience. But drumming with the group gave them a sense of purpose while interacting socially, and it was beautiful to see.

Another session, we wrote "Coping Skills Blues". After discussing life stressors and positive vs. negative coping strategies, I passed out fill-in-the-blank blues sheets. Each Veteran wrote two verses, one expressing a problem or question they had, and the second expressing an appropriate response or answer. Then everyone had the option of presenting their scenarios to the group by singing their Blues song (and playing a tambourine if they so desired. And they did! Almost every group member sang a solo for the group, improvising their own melody with their words. Even one gentleman who's hands were shaking so badly that the tambourine rattled, sang his verse in front of everyone. It was a huge accomplishment for some of my guys. Afterwards, they were so proud of themselves! Even though it was scary to do, they felt good afterwards. Some of the Veterans even asked if I had extra blank Blues sheets so they could keep writing them. 

This Friday was my last session with them, so I asked the group members to share some of their positive experiences from our sessions. Their replies:

"It was really interesting. And, this was the first time I've felt really able to follow along with a group. That was really big for me."

"I have more energy after sessions."

"I've learned a lot about how music can help in my recovery."

"I just liked getting to listen to music, and spend time with my friends."

I think I could write a book with everything I learned, working with this group. I really am sad to leave them! But next week I start working with the substance abuse inpatient program, which will be a whole new set of experiences. I've got about seven weeks left in my internship, and about 7,000 things left to do, haha!

Prayer request: Between the cold Virginia air and the hours and HOURS of typing a week, my elbows haven't felt too friendly lately. Please pray that my elbows last another 2 months, that the pain doesn't interfere with my work, and that I can have the energy to finish well!

Halfway Point

I am officially at the halfway point of my internship!!!! It's going so fast, and I can't believe how much I've already done here. Our midterm exam/self-evaluation is Wednesday, November 5, so prayers that morning will be greatly appreciated!

The past week has been quite hectic. It was Halloween week, and apparently Virginians take it very seriously. We've been part of several different holiday festivities, including a party up on the ward where we were the band. It has been fun to see the patients excited and engaged in all the activities, and to see the creative costumes they came up with. One lady even attached a broom to her wheelchair so she was "flying" down the hall.

This week has also been full of observations at the PRRC, which is an intensive mental health day treatment program. Veterans enroll in the program, and attend classes during the week. Many of them struggle with PTSD, as well as mood disorders such as depression and bipolar disorder; some of the clients are recovering from substance abuse, or other mental health problems. Because veterans must apply to be in the program, (it is not a mandatory treatment program), most of them are highly motivated to be there, and actively participate in the group therapy sessions. Therapy groups are led by social workers, clinical psychologists, and peer support specialists; topics include practical coping skills, mindfulness, mental health education, even healthy diet and lifestyle choices. 

Next week, sessions will include music therapy!!! I will be leading music therapy group sessions on Fridays at PRRC for the next month. Laura and I will also start a therapeutic choir on Tuesdays, which is promising to be an interesting endeavor. We've already had requests for music ranging from death metal bands I'd never heard of, to Handel's Messiah. We will have a good time creatively working with the group to choose music everyone is relatively happy with! Also next week, we will start observations at the inpatient substance abuse program. Laura will be working there while I'm at PRRC, and then we will swap. We are working much more independently now, which is both fun and a little intimidating. I will be getting lots of new experiences over the next several weeks; it almost feels like my internship has started over, with so many things changing. But I'm still excited about what I am doing, and the mental health experiences are really confirming to me that this is the direction I want to pursue after internship.

On a fun note... this week was "Peak Week" for the trees changing colors! I had loved driving around the mountains looking at all the beautiful colors covering the mountains. Of course, this weekend was gloomy and cloudy, so I couldn't take many good pictures of the mountains, and a camera really can't do this incredible beauty justice anyway. But I caught a few pictures of the trees around campus to share with you!

Group Ideas!

Hello all! I've missed my weekly updates these past couple weeks. Right now we have so much to do, and so little time to write about doing it, haha! I wanted to take this blog post to share some of our recent groups and interventions, and suggest some adaptations. I hope these ideas help!

1. When planning a group on your own, flow is important. Themes are an easy way to keep your group going; you can pick a topic, or coordinate your theme to match the season/holiday. Holidays and seasons are especially great, because they give you an overarching idea to plan your groups around, and can increase reality orientation at the same time. Double whammy!

2. Have an idea of your overall structure beforehand. For example, when we lead groups for the community living center, we some basic features we always try to hit: 10 minutes of physical activity to warm everyone up and get them moving and talking, 20-30 minutes of a cognitive activity, and then an exercise activity. Breaking up your time into chunks will help you plan your activities more strategically. 

3. Plan AHEAD OF TIME how you will compensate for environmental factors, or adapt your activities to meet the needs of individual group members. No, you can't plan for everything, but it's good to have strategies in place beforehand for some scenarios. For example: If you plan a group for 8 people, and 15 show up, will you be prepared? Or, if you plan for 12 people and only have 3 attend? If a group member is non-ambulatory/non-verbal/non-hearing, will they be able to participate? What if a group member cannot read or count? These are all questions we have to plan for during our weekly groups here.

So, now I have a few specific interventions we use that hopefully you can take and adapt for your own groups!

Warm-Ups/Icebreakers: For warm-up activities, don't be afraid to turn on background music, and actively engage with clients without worrying about your guitar. Blow up balloons and see how long you can keep them in the air, (our 92-year-old patients LOVE this), do some stretches, bust out some egg shakers and have a jam session, kick a ball around the circle, do some dancing, or pass an instrument around the circle, giving everyone a chance to solo.

Cognitive interventions: Musical "Name that Tune" and Music Bingo are always good options. Divide up into teams, give each team a word like "Love", "World", etc., and see how many song titles they can list that have that word in them. I just did a song-writing activity where I gave the group a letter, and they listed all the places they could think of that started with that letter; we then wrote our own verses to Johnny Cash's "I've Been Everywhere". Play Hangman with song titles, and sing the song once someone guesses it. (note: if you need a PC version of Hangman, draw your man ahead of time, and erase a piece for each incorrect guess. The object is to guess before all the parts are gone. We renamed it "the disappearing man"). Give group members instruments, and assign them each a word; they will then play their instrument when you sing that word. (e.g. tambourines play when you hear the word "star). 

Physical interventions: Use music to cue movements while doing chair exercises. Get some large dice, and label one with movements and the other with numbers; group members take turns rolling, and do the movement they roll, the number of times that they rolled. One of my favorite activities ever was when we got paddle drums and foam balls, and hit balls around the circle to each other; the drums make an awesome sound, and everyone loved it. If your clients are ambulatory, try some dancing or aerobic activity. (just be careful which populations you are working with). For a more relaxing session, use live music to cue deep breathing and progressive muscle relaxation.

Time is Flying

This past Friday was my two-month anniversary at the VA hospital. I can't believe I'm already 1/3 of the way through with my internship! Time is simply flying by. I've already gone from observing, to co-leading, to leading sessions on my own. I have my first patient, the start of my own caseload, and on Tuesday I will lead a group, solo, for the first time. 

G4V is in full swing now. The more I observe and take part in that program, the more I realize the value of it. All the guys in the program are so supportive of each other; especially in the therapeutic group, some of the guys who have been through the program before stay and volunteer for the beginner's class time. They provide musical, and emotional, support for the new veterans. I believe that fostering an atmosphere where the veterans can support each other is sometimes the best thing we can do for them. These veterans understand each other in a way I never could. They understand the struggles of PTSD and anxiety, losing a child, battling diabetic neuropathy, or simply trying to master the guitar at the age of 70, because they've experienced it too.  I can try to offer support or empathy, but the reality is I simply haven't shared their experiences. Sometimes our job as a therapist is just to provide a place where clients can support each other, in a safe environment while pursuing a common goal. And now  that I am witnessing that sense of community, I realize how important it truly is. 

Time to answer a question I hear a lot! When I tell people I'm a music therapy intern, they usually want to know, (after making the face that says 'what is music therapy?'), who do I work with? What does a normal week look like? Well, a normal week right now starts off with individual sessions. We may see patients who have Parkinson's, multiple sclerosis, or multi-infarct dementia. On Monday nights we have two therapeutic sessions of G4V, for clients who struggle with PSTD, anxiety, depression, chronic pain, cognitive disorders, and diabetic neuropathy. On Tuesdays we do a cognitive stimulation group for long-term care residents, and attend an interdisciplinary team meeting. Then we have more individual sessions. We see several different patients who have suffered a CVA (stroke) every week, and each patient has different goals: regaining speech oral motor coordination, attention control training, regaining use of upper extremities, working with aphasia, and breath control. We see patients individually for mood disorders, depression, and PTSD. We also have sessions for physical disabilities resulting from traumatic injury, such as a car wreck, or brain damage from various causes. One afternoon a week during lunch, we provide live music for long-term care residents, and usually bring volunteers with us to help out. And every Friday afternoon, we do bedside music sessions on the palliative/hospice care unit. It's a busy schedule, and I'm always seeing something/someone new! 

Two Months Down

So many things happening, so little time to write it all down! The past two weeks have been packed. This past week was the start of the new Guitars for Vets series, which will last through November. I was unfortunately ill, and not able to go to the first session :( however, we had a lot of prep work to do, making phone calls, putting binders together, and getting to play with a very fun donation: 9 guitars! The national G4V organization only funds 6 guitars per chapter per series, and we have a waiting list of more than 60, so donations are the way we can help more veterans faster. We're also beginning preparations for the Holiday Extravaganza already. Each year at Christmastime, staff and patients combine to put on a giant, hilarious musical production. It is a highlight of the year here, and lots of people have already been considering their act for months. Lots of patients also try to "torment" the interns as much as possible during their act, so I am anticipating a lot of difficult requests in the next few months, haha!

One of my more interesting moment these past weeks was when I walked down from the hospital floor to the clinic to meet a patient, and met the entire Virginia Tech football team in the stairwell! The "Hokies" were coming to visit the residents of the community living center, and I happened to run into them, literally. It's difficult to get down a stairwell with a guitar when there is a linebacker coming up the other way.

Internship responsibilities are progressively increasing! I have finally learned my way around the computer systems without asking for help every 5 minutes, which means I can complete most of my paperwork independently. The other intern and I are now responsible for the weekly cognitive stimulation/reminiscent session at the community living center, as our first independent responsibility. We also co-lead individual sessions in the clinic now, and I even facilitated most of a by myself this week. I completed my first assessment, with supervision, last week, and will hopefully have my first patient of my very own within a week or two! I'm so excited to start my own caseload. Our midterm evaluation and test is coming up in October; I'm already studying, and working on case studies. And planning sessions, and learning music... we're always busy!

Prayer requests! As grateful as I am for my free housing, it turns out that living in a hospital room long-term gets kind of depressing, and waking up to "Code Blue! Code Blue!" in the middle of the night isn't much fun. Please pray for happy days, peaceful nights, and for the thermostat in my room to get above 65, haha. 

I also need prayer for interactions with one particular patient. We have one patient who is horribly, terribly disfigured. So much so that it is difficult to even look at them. Music really connected with them, and they enjoyed their session a lot. Please pray for peace of mind and strength of stomach (I'm not being flippant, it was really a difficult visual to cope with). Pray that I can focus on showing love to someone who needs it, to see the person instead of their disfigurement. Pray that I only remember the joy we experience in sessions, and I can leave all other memories at the door. 

Medical Music Therapy: What they don't tell you in class

After finishing my sixth week here, I finally feel like I've gotten the swing of the hospital routine, at least a little bit. As thorough as my classes were, there is no real way to "be prepared" for the medical environment until you are actually in it. For my blog this week, I wanted to share a list of real, (and humorous), list of things I have learned from working full-time in a hospital: 

1. There is no 5-second rule. There is no 3-second rule. Any food dropped on the ground is immediately and irrevocably lost forever.

2. Wash your hands BEFORE, and after, using the restroom.

3. Nurses are superheros. 

4. The intensity of the itch on your face is directly proportional to the level of infection control contact precautions on any given ward.

5. It is almost impossible to play a guitar while wearing latex gloves.

6. Once you learn the definition of horrifying medical terms like "fecal emesis", you will forever imagine that it took place on every surface in the hospital.

7. When in doubt, you have three choices: "Amazing Grace", "Home on the Range", or "You Are My Sunshine".

8. Patients who say they like "every" kind of music, do NOT like every kind of music. They like a very specific kind of music, and they want you to guess what it is.

9. No matter how many times you tell people that you are actually a professional in an accredited field, you will still be referred to as "the music lady" at least once a day.

10. Hand sanitizer is a way of life. Until, that is, you realize that the .01% of bacteria germ-ex doesn't kill, happens to be one of the most horrifying stomach conditions known to mankind. 

11. Never underestimate the importance of talking. Yes, patients enjoy listening to music, but sometimes they need you to listen to Them too.

*Note: the Medical Center does an excellent job with infection control, and this post is not intended to reflect badly in any way on the hospital. I'm just new to the world of disease control and prevention!

Finding music in all people

This past week we had the chance to put together a special performance at the hospital. For months now, some of our in- and outpatients who come for individual music therapy sessions have been practicing songs to perform; this week we coordinated a Variety Show, which took place at the community living center on campus. The performance was meaningful in two ways: the residents and medical staff appreciated our time and effort to give them a concert, and the outpatients were able to use their skills developed in music therapy to give back to another group of residents. It was a fun and crazy effort, with a wide selection of music ranging from musical theater and classic rock, to bluegrass and gospel. Some patients performed their own lyric rewrites of favorite songs; others sang solos, accompanied themselves on guitar, or played instruments. It truly was a variety of performances and styles, and the whole thing was a hit.

We have a wide range of patients: a wide range of diagnoses, limitations, and abilities. Some of our patients have played music since they were children; for others, their first exposure to music performance was in the music therapy clinic. We practice music THERAPY, not music education, so natural talent is not required; very often, we spend our time in the clinic making a "joyful noise", to quote my supervisor. Our job as music therapists, (or music therapy interns), is to discover how to use our own talents to make our patients' abilities shine. We use our voices and guitars to direct the spotlight to the patient standing beside us; they are the ones who deserve the credit for the bravery they show in performing. 

I'm sure anyone who remembers the terror of grade-school piano recitals would like to argue that performing is not therapeutic at ALL, but for the people we see here, it can be an incredibly cathartic experience. Performing gives our patients, many of whom have significant disabilities, a chance to give back. The ability to do something for other people is quite honestly something that most of us take for granted. It's an ability I took for granted, until I came to this hospital and met beautiful, precious people who felt like they had nothing to offer. An integral part of our role as music therapists is providing the means and opportunity for our patients to share with someone else. My own talents and abilities are meant to support, not impress. It's a different way of sharing music with people, but the applause is even sweeter when it's for the patient standing beside me.