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.

Has it really been a month?

I got to celebrate my one-month anniversary in Salem with some awesome news: A NEW ROOM! The VA provides housing for their interns spending an extended time working at the hospital; so, I've been living in a converted hospital room since I got here. However, it was a very tiny, very hot, very OLD hospital room. My new room is much more spacious, (I can finally finish unpacking), has four beautiful windows, and, blessing of blessings, wifi that works! I have been very grateful for the free housing here, but a more comfortable room is a huge blessing and a very lovely one-month anniversary present from the hospital :)

This past week we've spent observing different, related therapies to gain a better understanding of their purpose, and how music therapy can enhance the therapeutic goals of other disciplines. We've gotten a chance to observe kinesiotherapy, (which is basically using exercise therapeutically), and recreation therapy for patients on the inpatient psychiatric facility. The Salem VAMC is unique from some other VAs in that they provide inpatient treatment programs for substance abuse and PTSD. Later on in my internship I will get the chance to observe and hopefully participate in a four-week substance abuse rehab program, as well as work with PT, OT, and possibly speech pathology. I am really excited about the opportunities we have to work with different therapies; interacting with different professionals just gives us more information to draw from when we design our own therapeutic interventions.

It's hard to believe I've been here a month already. I feel like I've already done and learned so much more than I expected, and it only progresses from here. In the next few months I have projects to do, case studies to write, and will start working more independently as I progress. I am so excited about the possibilities  here.

Peace Like a River

Three weeks down, and I'm finally getting a grip on the routine here. We see so many different people, in so many different places, that it's hard to keep everything straight! Every week we see several outpatients, as well as inpatients, for individual clinic appointments; residents in the Community Living Center, (both individually and in groups); participate in the Guitars for Vets workshop; and spend one or two afternoons on the palliative care/hospice unit. It's enough to keep a girl busy! In addition, we collaborate with recreation therapy and physical therapy as needed, attend treatment team meetings, plan sessions, learn music, and then of course, paperwork!

Since I've been here three weeks now, I've gotten to know some of our patients whom we see every week. It is so much fun to participate in sessions, to come up with goals, and watch the progress being made. It's amazing to see the lightbulb turn on in someone's head as they finally grasp a concept, or master a new skill. Progress is a wonderful thing, and something I am honored and humbled to be a part of. These veterans have been through so much, and it's a precious thing to share their struggles and their successes.

Some sessions are more difficult than others, though. Palliative care and hospice is the hardest afternoon of my week. The three of us bring our guitars, binders and binders of music, a keyboard, and go up to the unit to do bedside music sessions. Our goal is to provide music that each patient enjoys and feels an emotional connection with; sometimes if we pick the right song, it triggers a memory that they share with us. Other times, family members are there, and they are able to share a song with their loved one. Sometimes the patient never even wakes up. Every session is different. But even in three short weeks, I've seen patients come, and pass away. For these sessions, our goal is not progress.

Sometimes I wonder what music can actually do in the face of cancer; what can music do in the face of death, loss, and grief? Then I remember David, and how he played his harp when King Saul was tormented by evil spirits. Music is a divine gift from God which can bring peace, even in the face of the unspeakable. When we bring our instruments and our voices to the palliative care unit, we bring peace with us, the only gift we can give to someone who is dying. It's a hard thing to combat fear and pain with a guitar and a song, but it is also the most beautiful, rewarding thing I've ever done. Please pray this week that I will have peace in my heart, to share with those around me.

Week Two Update

My second week down, and I already feel like my head will explode with everything I've learned! Technically my entire first month is supposed to be spent observing, but my supervisor believes you learn best by doing.... And I've done a lot of doing this week!

On Monday, in addition to our regular clinic hours, I volunteered for a guitar workshop that is leading up to the return of the Guitars for Vets program in September. Guitars for Vets is a national nonprofit organization that makes guitars and lessons available to veterans as a positive leisure activity. The G4V organization sponsors ten-week guitar courses which are led by volunteers following a beginning guitar curriculum; at the end of the ten-week course, vets who participated the entire time receive a guitar. The Salem VA Medical Center sponsors four different groups of the G4V program, and has a two-year waiting list. G4V is technically not a music therapy program, as it is led by volunteers instead of board-certified music therapists; however, the program has a lot of therapeutic benefits, and provides a support system for veterans trying to develop positive leisure habits and good coping skills. Most of the veterans in the program suffer from anxiety, depression, and PTSD, as well as a variety of other service-related disabilities. It was special to see how much this program means to them, and how much they look forward to coming.

I also got to co-lead two sessions with my fellow intern, Laura, this week. One of our patients, let's call her "Star", definitely likes to be the star of the show! She is diagnosed with a neurologically-debilitating condition, and our goals are primarily to maintain breath control and vocal flexibility as long as possible, in addition to providing mood-lifting, positive support. Our sessions are always fun; we start off with silly vocal exercises that make everyone laugh while we warm up our voices and stretch our vocal cords. Then, we sing Star's favorite songs: Broadway hits! We meet clinical goals while singing tunes from South Pacific, Oklahoma, The Music Man, and lots of other musicals I'd never even heard of. 


The highlight of my week, though, was getting to try RAS for the first time. Rhythmic Auditory Stimulus, (RAS), is a neurologic music therapy technique which uses rhythm to assist in gait training. Neurologic music therapy is a medically-based application of music therapy which relates closely to current research in neurology. NMT requires an additional certification beyond the music therapy board certification. My supervisor is NMT-certified, so I'm getting to observe and practice a lot of techniques which go beyond "typical" music therapy.

 The patient who agreed to be my guinea pig, (we'll call him Steve), was partially paralyzed after an accident. My supervisor partnered with the PT at Salem VAMC to try RAS with Steve; after two sessions he was walking again! Steve has progressed past the point of needing RAS, but he agreed to let me and Laura try it with him so we could have the experience. The music therapy clinic in the hospital is small, so we do gait training in the hospital hallways. So, Friday morning I was marching through the hospital backwards while playing Hound Dog on my guitar, trying to sing, cue with my feet, chord, look where I was going, and not get stepped on all at the same time! I got lots of funny looks and laughs, (including from Steve), but it was a wonderful experience to try it!

The clinical experiences I'm getting are incredible; I'm convinced that the Salem VAMC is the best possible place for me to learn. I am challenged every day professionally, musically, and personally. I am settled into my home, and I have found a sweet and supportive church home here. The environment is demanding though, and all thoughts and prayers are greatly appreciated!

One final thought: I learned a joke about HIPAA, but I can't tell you...

Musical therapy? What is that?

        I can't believe my first week is already over! I've seen so many amazing things, and met some precious, precious people. It's been an interesting week, getting settled and learning my way around the hospital. I'm hoping soon I'll be able to find my way from point A to point B without getting lost! Salem VAMC is a big place; most of the buildings were finished in the 1930's, and the historic architecture is both interesting and confusing. 

After spending an entire week immersed in full-time music therapy, I've been revisiting the question I've heard a hundred times before: What is music therapy? Our field is so difficult to define. Music therapy is a recreation, an emotional support, a counseling session, a physical activity, a cognitive exercise, and an artistic expression. Recent medical research demonstrates the profound impact that active engagement in music has on the brain. For a quick summary of music's effects on the brain, check out this video. 

Science is validating techniques which music therapists have used for years. The neurological and physical impact of music on the human body is fascinating. However, music therapy is more than just a neurological tool to use; music therapy involves an intangible element that creates a bond between the therapist and patient. This intangible quality makes it almost impossible to define; music therapy is better experienced than explained. But while I may be no better at explaining what music therapy IS, this week has shown me in a profound way what music therapy DOES. So what does music therapy do?

        Music therapy can:

• Decrease tremors from Parkinson's disease using rhythm, even without medication
• Alleviate a developmental stutter through melodic intonations
• Teach a person how to walk after paralysis following exposure to a neurotoxin
• Improve cognitive function and attention after brain damage due to massive stroke
• Improve gross and fine motor coordination following a stroke
• Give spiritual support to an individual with terminal cancer
• Provide emotional support to individuals coping with depression and PTSD 
• Improve vocal flexibility, speaking quality, and breath support for an individual with multiple sclerosis
• Provide social interaction and cognitive stimulation for individuals hospitalized for long-term care
• Bring smiles to the palliative care unit
• Provide support for family members caring for a terminally-ill loved one
• Give a distraction from chronic or acute pain
• Regulate and increase breath control
• Motivate and reward people for meeting therapeutic goals
• Create bonds and bring joy