Kathryn Trujillo’s Internship Reflection

How it started:

I first became interested in the Music Therapy (MT) field when my maternal grandmother moved to assisted living in 2015. With my small electric keyboard and guitar in hand, I visited her when she was moved to hospice care. Not knowing I was providing relief through music, I did see the impact that familiar songs had on her level of agitation and her short-term memory. My nana sang Johnny Cash’s “Ring of Fire” without missing a single word. She was then able to have a brief, cognizant, and presently-oriented conversation with me afterwards. I walked out of the room, and through happy tears, told my husband “this is what I want to do. I want to continue helping others through music.” 

Applying to Therabeat:

During the pandemic, I completed my 2nd year of graduate school and searched online for MT practices that were beginning to open up again for clinical internships. Therabeat, whose mission statement is “We use music therapy interventions to enhance the lives of individuals of all ages & abilities,” truly caught my attention. This private practice, run and owned by women, was breaking glass ceilings in GA and genuinely caring for their community. As I learned more about each MT-BC on staff, my desire to be an intern with Therabeat grew. I am very blessed that my husband, our dog, and I were able to pack up our life in CA and travel  2,500+ miles across the country to work with and learn from Team Therabeat.  

Lessons Learned:

Though Team Therabeat and the internship experience taught me a multitude of lessons, here are two lessons that truly impacted me and my therapeutic practice: 

1. Session plans and ISO-principle
   Before each session, I prepared detailed session plans which included an order and clinical breakdown of each intervention. Though I was prepared and had thought through each intervention purposefully, if the client needed to be met where they were at that particular moment, I leaned into the ISO-principle and provided interventions that would benefit the client most where they were. I have learned to prepare a plan, but to also hold space for flexibility so that I can see through the plan and into the therapeutic moments.

2. Co-treating is such a pleasure!
   My bachelor’s degree from Saint Mary’s College of California, is in Kinesiology with an emphasis on Health and Human Performance. During internship, I expressed interest in wanting to co-treat with Physical Therapy. I had always wanted to see how both of my career interests could work together, and only In Harmony Pediatric Therapy provided me with the opportunity to see both Physical Therapy and MT in action. During one particular session, I worked with a client on independent living skills while the PT walked the client through an obstacle course. Our obstacle course was specifically set up to cue and prompt recognition of each safety sign I was prompting the client to sing and think about. Together we taught the client what signs to look for and what they mean, while also providing tangible and tactile feedback related to each safety sign with a musical and physical prompt. The purpose of the combined intervention was to improve the client’s self-esteem and provide them with a sense of increased independence when outside of the clinic. I hope to continue co-treating and creating unique interventions in the future. 

Thank You Team Therabeat 

Thank you Team Therabeat for investing in me, for trusting the care of clients to me, for providing a safe space to learn and grow in therapeutic practice, and for truly providing a wholesome internship experience. I feel more confident in myself, in my ability to turn feedback into practice, and in the prayerful choice to pursue MT as God has called me to.

Why Music Therapy Works

Humans are inherently musical beings. For centuries different cultures have used music to connect, communicate, celebrate, mourn, express creativity, connect with each other or a higher power, rituals, traditions, and more. Individuals respond to music with their whole bodies, i.e emotionally, physically, cognitively, and socially. A study put forth by Bernardi and colleagues, showed that as a group, those who are singing together entrained to the same breathing patterns and had lowered heart rates (Bernardi, et. al, 2017, para 2). Their study is one example of the many health benefits music has. Other literature provides evidence of reduced stress, lower heart rate, improved blood oxygen saturation levels, distraction from stress, and increased bodily movement, among others. Music activates both hemispheres of the brain and therefore can also provide a means of communication when verbal speech is limited. Music therapy (MT) works when traditional treatments have failed or are no longer appropriate for individual clients. 

MT works because of the relationships between the MT-BC and the client, the client and the music, and the music and the MT-BC. In the MT field, this is called the Iso-principle. The iso-principle sets MT apart from other professions. The iso-principle simply means “meeting the client where they are at”. MT-BCs who are attentive and practice intentionally, can use the iso-principle to gain trust and therapeutic rapport effectively. Studies have shown that individually tailored music-based interventions reduce stress, lower heart rate, improve communication, improve social skills, increase self-esteem, cue and promote physical movement, excite to maintain attention, and more. MT works because humans are inherently musical, the entire human body experiences music, and the therapeutic relationship between the MT-BC, client, and music facilitates desired change. 

-Kathryn Trujillo, Music Therapy Intern

Reference

Bernardi, N. F.m Snow, S., Peretz, I., Orozo Perez, H.D., Sabet-Kassouf, N., & Lehmann, A. (2017). Cardiorespiratory optimization during improvised singing and toning. Scientific Reports. https://www.nature.com/articles/s41598-017-07171-2.pdf DOI: 10.1038/s41598-017-07171-2

Family-Centered Music Therapy in the Home

December 1, 2021

Kathryn Trujillo 

Family-Centered Music Therapy in the Home 

Thompson, from the University of Melbourne in Australia, elaborates on the widespread approach of family-centered therapy practice through reflection of case examples and personal experience. Thompson reflects on the family-centered practice model and applies it to Music Therapy (MT) so that early intervention services can support families with children with special needs. From this article, music therapists (MT-BCs) can find support and rationale for a solid family-centered practice method for MT specific sessions. MT, as a field, offers practitioners and families flexibility, in that they are able to travel to family’s homes. Thompson focuses on “promoting interpersonal engagement between children with Autism Spectrum Disorder (ASD) and their parents” (Thompson, p.109) in natural settings, such as their home or preschools with their peers and carers there. 

According to literature found by Thompson, ASD is “a group of neurological disorders with lifelong implications. It is diagnosed based on impairments in social interaction, communicative behavior, and repetitive and stereotyped patterns of behavior or interests” (p.109). There are many approaches to interacting with individuals with ASD, to treating particularly undesired behaviors, and improving communication between both child and parent, or between the child and their peers. Family-centered practicing therapists encourage family participation and collaboration during one-on-one sessions. The central tenet of family-centered practice is that “practitioners and families strive to work together in partnership with an emphasis on building the capacity of the family” (p.109). Family-centered practitioners truly focus on relationships and supporting the parent and child bond. 

MT-BCs provide fun and enjoyable music-based sessions to encourage participation from all or any member of the family in the safety of their own homes. While working with preschool aged children with ASD, Thompson says that “the active participation of the family in MT sessions is considered an essential part of working with them” (p.110). In a home setting, MT-BCs are able to gather more information about the child with ASD through observation of interactions with other family members, the family dynamic, and in the natural family environment. Together, the family and MT set goals and objectives based on goals identified by the family. 

While providing services in the child’s home, MT-BCs are able to share their professional skills with the family. Through reflection, Thompson outlines components of family-centered MT sessions. They are as follows: family-centered practice theory, attune to the child’s mood and behavior, following the child’s lead, enticing the child with motivating activities, presenting with positive affect, acceptance, and affection, MT presenting as a play partner, keeping the child’s anxiety low and assess the need for structure, choice, or control, matching the child’s abilities, and understanding social communication development theories, and finally allowing the child to initiate engagement. By providing therapeutic approaches and interventions within the child’s daily routine, Thompson found that it promotes interpersonal engagement and early social and communication skills which are goals often identified by both the family and treating MT-BC. Family-centered MT sessions allow for growth in interpersonal communication, rapport, and inclusion of all members of the family while providing fun and engaging interventions for the child with ASD. 

Reference: 

Thompson, G. (2012). Family-centered music therapy in the home environment: Promoting interpersonal engagement between children with Autism Spectrum Disorder and their parents. Music Therapy Perspectives, 30, p.109-116.  

Older Adults with Dementia

The population of people who suffer from dementia range from age 65 and older (Keough et al., 2017, p. 182). Previous studies have shown positive linkages between implemented music therapy sessions and positive outcomes amongst patients with dementia.The use of music therapy has increased with this population due to research showing positive patient outcomes. Music therapists utilize music as a tool to connect with individuals with dementia to a subjective state of reality. Statistics demonstrate that approximately five million people possess a form of age-related dementia (Keough et al., 2017, p. 193). Universally, this number is much larger, ranging from 35 to 48 million people (Shibazaki, 2017, p. 468). Worldwide, those diagnosed with dementia require over $818 billion in treatment and care (Shiltz et al., 2019, p. 17). Thus, efforts to combat the detrimental and expensive condition are an urgent necessity.

Dementia is a syndrome that psychologically “affects memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgement” (McDermott et al., 2018, p. 256). Clinically-accepted symptoms of dementia include memory loss, inability to perform simple tasks, personality and behavior changes, and increased levels of agitation (Shibazaki, 2017, p. 468). Such behavioral and psychological symptoms appear in more than 80% of diagnosed dementia patients (Shiltz et al., 2019, p. 17). However, even as the human memory disappears, musical skills and the processing of music are amongst the last to leave (Shibazaki, 2017, p. 268). 

         Studies have shown that increased exposure to music can increase development of one’s neural network functioning, steady the heart rate, decrease blood pressure, reduce high hormonal stress levels and inflammatory cytokines, and provide decrease in pain levels (Sorrell, 2018, p. 15). Music therapy utilizes diverse, therapeutic interventions that can include singing, playing instruments, listening to music (live or prerecorded), creating music, socializing, communicating and expressing (Shiltz et al., 2019, p. 18). Common goals that are targeted in music therapy sessions for older adults can include improving quality of life, increasing positive self-identity, enhancing social experiences, and improving communication (Schall, Haberstroh, & Pantel, 2015, p. 113).

A recent study that specifically analyzed music with dementia, “Music as a Healing Art in Dementia Care,” states that individuals diagnosed with dementia have the ability to retain their clearest memories from the music. Specifically, music that they preferred between the ages 10 and 30 (Sorrell, 2018, p. 16). Music therapists are able to provide a space for engagement and progress in clients through music therapy sessions. For example, research demonstrates that clients with dementia who have been provided music therapy sessions stimulated by active music engagement and active music listening had a high increase of positive social participation (Keough et al., 2017, p. 183). A study, by Ridder and Gummensen that explains the process of music therapy treatment and its benefits on those with dementia, shows improved socialization skills through increased eye-contact and increased initiation to socialize or express personal thoughts (2015, p. 7). Communication is another positive effect from music therapy with this population. Studies have provided evidence that music therapy treatment has improved retention of speech, language (Sorrell, 2018, p. 16), and improvement in breaking repetitive speech behavior (Keough et al., 2017, p. 186). Another impactful category researched to show positive effects is the improvement of mood and quality of life. Music therapy decreases anxiety and depression, and minimizes symptoms of agitation and aggression (Sorrell, 2018, p. 16). These are a few of the many studies that provide clear evidence to show positive effects of music therapy on adults with dementia. 

Music therapy sessions with clients who have dementia can focus on social skills, reality orientation, general quality of life, or client-specific needs (Keough et al., 2017, p. 183). Sessions can include musical improvisation to create dialogue for communication (Ridder & Gummesen, 2015, p. 6), group activities, such as singing, group drumming, and movement activities to improve socialization skills (Keough et al., 2017, p. 183), and utilizing musical instruments as a means of communication to enhance daily skills (Shiltz et al., 2019, p. 18). These are several examples that show what music therapy can provide in sessions, however there are endless interventions music therapists can implement to meet needs. 

While dementia is a devastating condition in the population of older adults, these individuals are positively affected by the music interventions that music therapists create to alleviate symptoms of dementia and tasks that provide the practice of healthy coping mechanisms. 

-Hanlee McCart, Music Therapy Intern

References

Keough, L. A., King, B., & Lemmerman, T. (2017). Assessment-based small-group music therapy programming for individuals with dementia and Alzheimer’s disease: A multi-year clinical project. Music Therapy Perspectives, 35(2), 182–189.

McDermott, O., Ridder, H. M., Baker, F. A., Wosch, T., Ray, K., & Stige, B. (2018). Indirect Music Therapy Practice and Skill-Sharing in Dementia Care. Journal of Music Therapy, 55(3), 255–279. https://doi.org/10.1093/jmt/thy012

Mette Ridder, H., & Gummesen, E. (2015). The use of extemporizing in music therapy to facilitate communication in a person with dementia: An explorative case study. Australian Journal of Music Therapy, 26, 6–29.

Schall, A., Haberstroh, J., & Pantel, J. (2015). Time series analysis of individual music therapy in dementia: Effects on communication behavior and emotional well-being. GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry, 28(3), 113–122. https://doi.org/10.1024/1662-9647/a000123

Shibazaki, K., & Marshall, N. A. (2017). Exploring the impact of music concerts in promoting well-being in dementia care. Aging & Mental Health, 21(5), 468–476. https://doi.org/10.1080/13607863.2015.1114589

Shiltz, D. L., Lineweaver, T. T., Brimmer, T., Cairns, A. C., Halcomb, D. S., Juett, J., Beer, L., Hay, D. P., & Plewes, J. (2018). “Music first”: An alternative or adjunct to psychotropic medications for the behavioral and psychological symptoms of dementia. GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry, 31(1), 17–30. https://doi.org/10.1024/1662-9647/a000180

Sorrell, J. M. (2018). Music as a healing art in dementia care. Journal of Psychosocial Nursing and Mental Health Services, 56(7), 15–18. https://doi.org/10.3928/02793695-20180619-04

Preoperative Music Therapy for Pediatric Ambulatory Surgery Patients: A Retrospective Case Series

In 2016, Gooding and colleagues sought to understand the effect of Music Therapy (MT) services on preoperative anxiety in children who were receiving same day surgeries in ambulatory surgery centers. 103 pediatric patients, between the ages of 2 and 9 years old, undergoing various ambulatory surgical procedures in a hospital-based ambulatory clinic participated in the MT protocol (Gooding et al., p. 192). Gooding and colleagues conducted a pilot MT program for the patients who elected to receive MT services from board certified music therapists (MT-BCs), prior to their operations. The patients’ doctors provided consent and patients and their families elected to receive MT services. The research done by Gooding’s team is considered a quasi-experimental quantitative study due to the lack of random assignment of participants. According to Gooding, the purpose of this study was to investigate the effect of preoperative music therapy services on “child distress, coping, and anxiety behaviors, parental perceptions of treatment, and parent satisfaction in a pilot music therapy program in an ambulatory surgery center” (p.192). 

The effects of music therapy services on stress, coping, anxiety, parental perceptions, and parent satisfaction were measured and collected from the patients who participated in preoperative MT interventions at the ambulatory surgery center. In addition, background information, how the patient was seated, who was present with them when the MT-BC entered, and the type of surgical procedure they were waiting for was also collected. The researchers relied upon the MT-BC’s observations of the “initial affect, ending affect, and behavioral responses'' (192) of the patient based on the Gale Encyclopedia of Childhood and Adolescence and on the parent-completed questionnaire completed after the MT session. Two standardized instruments were used: Modified Yale Preoperative Anxiety Scale (YPAS-m), and the Child-Adult Medical Procedure Interaction Scale-Short Form (CAMPIS-SF). These tests were administered by the MT before and after MT services. 

The MT-BC collected the data for analysis during each 30–45-minute session prior to the surgery. The sessions followed the same format but were adjusted to meet the needs of the individual patient, their family, and the flow of the surgical center. The MT-BC provided live music, age-appropriate instrument play, singing, and musical games to distract the patient during preoperative preparation. The MT-BC also provided positive reinforcement, distraction, and procedural information when applicable. Most patients showed positive affect towards MT services prior to operation. There were two affect categories: pleasant types of affect and unpleasant types of affect. More children experienced pleasant affects than those that experienced unpleasant affects. Patients responded to the MT interventions by singing along, playing instruments, moving to the music, and by maintaining attention towards the MT-BC. Post-intervention scores--for amount of perceived stress, coping, anxiety, and parental perceptions--were higher and better than the pre-intervention scores. The overall results from the study “suggest that children tended to show desirable behavioral responses and low levels of distress during preoperative music therapy treatment” (p.198). 

Of the parents that were present with their child during the preoperative MT session, 70% completed the Parent Procedure Questionnaire and wrote comments about the services received. Comments included “expression of gratitude, enjoyment of the child and or parent, benefits of MT for the child or parent, praise for the MT-BC of the facility, expressions of approval for the idea of continued preoperative MT, desire for MT in the future, feelings that MT was a pleasant surprise, feelings that MT was a helpful distraction, and statements that they would recommend MT services to others” (p.198). Reducing preoperative anxiety, through MT, improved the experience of both the patient and the parent or guardian with them. 

According to the findings of this study, MT services which addressed preoperative anxiety for both the child and parent, were extremely beneficial. If done well and efficiently to follow the flow of the ambulatory surgical center, MT services would be an asset and improvement upon the ambulatory surgery center’s services. The findings of this study also suggest that MT reduces preoperative anxiety, improves the perception of quality of care, and improves the overall experience for both the patient and their family. Two limitations of this study were the quasi-experimental design and the limited researchers available for data collection. Future studies should consider a truly experimental design and the MT-BC providing services should solely focus on the interventions, while another researcher focuses on data collection. In this study, the MT-BC provided the services and collected the data, which “may have increased the potential for bias” (pg. 198).  

-Kathryn Trujillo, Music Therapy Intern

Reference:

Gooding, L., Yinger, O., & Iocono, J. (2016). Preoperative music therapy for pediatric ambulatory surgery patients: A retrospective case series. Music Therapy Perspectives, 24, p.191-199 DOI:10.1093/mtp/miv031