Self-Esteem in Music Therapy

The second of the three foundational principles of music therapy is the bringing about of self-esteem through self-actualization. One underlying goal that we are constantly working on with our clients is increasing self-esteem. In order for children to be able to relate successfully to other people and become functional members of society, they must first obtain a certain level of self-awareness and confidence.

Two pioneers of the music therapy field, Paul Nordoff and Clive Robbins, explain the process of developing self-esteem through music as the “awakening of the music child”. They define the “music child” as the innate sensitivity to music that is present in every human being. Essentially, there is a “music child” hidden in each of us that has the potential to connect with and grow through music. They explain that the awakening of the music child through active music-making “increases the individual’s self-awareness and allows an individual to discover meaning and joy in the therapeutic experience, which leads to developing communicative intention in his or her musical response” (Darrow, 2008, pg. 64).

Music is an extremely versatile tool that is an effective medium through which to develop and foster self-esteem in children. Firstly, music is a means of self-expression. Since it can be both a verbal and nonverbal form of communication, it provides many opportunities for the expression of emotions and feelings. Perhaps a child comes to music therapy after a long day at school; the child is feeling frustrated because he has been unable to understand the academic concepts taught in his classroom. During improvised instrument play on the xylophone, the child plays extremely fast and loud; he is able to release his feelings of frustration through instrument play. Music is a safe and non-threatening way for children to engage in emotional expression.

Secondly, music activities are “very adaptable and can allow for success at many different levels of achievement”(Peters, 2000, pg. 60). For many children, music is something that is not only enjoyable, but it is something in which they can succeed. A child who struggles with academics or communication or socialization may find great solace in the feeling of accomplishment they enjoy when they engage in music. As music therapists, it is our job to set our clients up for success. We craft each intervention with the clients’ abilities in mind, ensuring ensure that they will experience some level of success in each session. When teaching new skills, we begin with low expectations before we begin to challenge the client. By allowing them to experience initial success, we increase their self-esteem and the likelihood that they will re-engage in the future. We use prompts, cues, visual aids, and even adapted instruments to give support to our clients and guide them toward success.

Lastly, music therapy provides a safe environment in which the clients can explore their talents and abilities as they learn more about themselves and begin to develop self-esteem. In music therapy, we often provide our clients with opportunities to make choices. Giving children the opportunity to be in control in a safe environment will help them build confidence in their leadership skills. Perhaps we ask a child if she would like to play piano first or drums first; neither answer is wrong! The child gets to make a choice encouraged by the knowledge that there is no wrong answer. Consider a drum improvisation between a therapist and child. The child gets to choose if he will drum fast, slow, loud, or soft, and the therapist matches his choice. By constantly providing our clients with choices, we are helping them become more comfortable with independence. They can learn to make decisions and take the lead in a safe environment with the guidance and support of a therapist.

            Twice a year, our clients have a chance to perform in a recital for their friends and family. This is a culmination of the practice and process of engaging in music therapy interventions. By performing in these recitals, our kiddos have a chance to showcase their abilities they have worked on so hard on to achieve. Each recital, we see the confidence and self-esteem grow in our kiddos as they create and present wonderful music for the community to see!

- Alaina Brommer, Music Therapy Intern

References

Darrow, A. (2008). Introduction to approaches in music therapy (pp. 64). Silver Spring, MD: American Music Therapy Association.

Peters, J.S. (2000). Music therapy: an introduction (pp. 60). Springfield, IL: Charles C.    Thomas.

Interpersonal Relationships Through Music Therapy

March is Music Therapy Awareness Month! In honor of this, the Therabeat Team is spreading awareness by answering the questions: what is music therapy? why is it effective? I will be dedicating the next few blog posts to the three principles that form the foundation of music therapy and help to explain why music therapy interventions are so effective. According to Gaston, the “father of music therapy”, the following 3 principles are the primary source of direction in music therapy:

1. The establishment or reestablishment of interpersonal relationships

2. Bringing out self esteem through self-actualization

3. The utilization of the unique potential of rhythm to energize and bring order

For this week’s post, I will discuss the first principle: the establishment or reestablishment of interpersonal relationships. One of the criteria for becoming a functional member of society is developing the ability to successfully relate to those around us. This can be a difficult skill for anyone to learn, but especially for those who struggle with developmental delays or other disabilities. Luckily, many of the skills we use in human interaction can be accessed through music! In the words of Gaston, “Music, by its very nature, draws people together for intimate yet ordered function” (Peters, 2000, p.60).” In music therapy, we create musical experiences between two or more people (either client and therapist or client and other clients). These musical experiences provide opportunities for clients to explore communication and interaction.

There are several reasons that music is an effective mode to foster important interpersonal skills. Firstly, music serves as a unifying influence. When multiple people are making music together, the music serves as the common experience. This unifying experience can open the door to the establishment of relationships.

Secondly, music creates a non-threatening environment. For some kids, social interaction can be scary and unnatural, but playing a drum with another child is fun! Music is a safe, familiar medium through which we can practice and develop interactive skills. Music is something that is relatable and enjoyable to most people, which is something we can take advantage of as music therapists!

Lastly, music can provide many opportunities for nonverbal communication, which can eventually lead to verbal communication. Musical imitation, for example, “initiates a nonverbal form of communication, perhaps, an approximation of positive interpersonal interaction” (Hanser, 1999, p.62). As a child bangs a drum loudly, the therapist matches with a loud choppy strumming pattern on the guitar. A musical interaction as simple as this can be the beginning of the formation of an interpersonal relationship. By matching and imitating the musical choices of the children, we are validating their contributions to the musical “conversation”. Experiences such as this can build trust between the therapist and client and can also instill a sense of confidence in the child.

I had the privilege of seeing this principle at work last week during a session between one of our music therapists and a child with Autism Spectrum Disorder. Children with ASD often struggle with developing appropriate social skills and establishing meaningful connections with others. In this session, the music therapist and child created a musical puppet show together during which the child had the chance to improvise a song. As the child made musical choices in the moment, the therapist supported her musically on guitar. The therapist’s guitar music provided structure amidst exploration and spontaneity. This improvised song was a musical experience that brought unity and synchronicity to the therapist-client relationship. As the client continues to partake in musical experiences such as this one, she will begin to transfer the skills she is learning through music to non-musical situations and to relationships outside of the music therapy session.

This is just one example of the many ways we use music to help our clients learn to establish interpersonal relationships each day. In summary, “through participation in carefully structured therapeutic group music activities, individuals can gain insights and skills that will help them relate more successfully, appropriately, and responsibly towards others” (Peters, 2000, p.61). Stay tuned for next week’s post on Principle #2: bringing out self-esteem through self-actualization!

-Alaina Brommer, Music Therapy Intern

References

Hanser, S.B. (1999). The new music therapist’s handbook (pp. 62). Boston: Berkeley Press.

Peters, J.S. (2000). Music therapy: an introduction (pp. 60-61). Springfield, IL: Charles C.    Thomas.

Behavior Management: Positive Reinforcement

In the first month of my music therapy internship with Therabeat, Inc. I have had the opportunity to work with a wide variety of people of different ages and diagnoses. While every session is unique, I have seen one very important commonality that is always present: positive reinforcement. Positive reinforcement is an important and effective behavior management technique that we use in every session. The definition of positive reinforcement is “the contingent presentation of a stimulus following a response that increases the future probability of that response” (Madsen & Madsen, 285). The idea behind positive reinforcement is that we reward positive behaviors in the hopes of increasing the likelihood that they will repeat.

Behavior management can be a difficult art to master, and developing a positive approach to behavior management can be an even more challenging task. Yet, developing and using a positive approach to behavior management is an essential part of being a music therapist. In a setting where you are working with clients toward meeting specific goals and objectives, knowing how to control and shape the behavior of your clients in a positive way is crucial. Anyone who works with children- teachers, parents, therapists- could benefit from a well-stocked file of knowledge on this topic.

Behavior modification is based on cause-effect relationships. What consequence does a child associate with a specific behavior? Therefore, positive reinforcement is all about pairing positive “consequences” with desired behaviors. Earlier, the definition of positive reinforcement mentioned the presentation of a “stimulus”; this stimulus could be any kind of reward such as verbal praise, a smile or nod, or even a token such as a sticker or lollipop. (In music therapy, we like to use music as a reward!).

Choosing which kind of reward to use will always depend on the individual. “Reinforcers must be chosen with specific individuals in mind...something that functions as a reinforcer for one student may not necessarily function for another” (Madsen & Madsen, 285). Of course, we always want to make behavior modification as easy and manageable for ourselves as possible; so, if mere verbal praise is enough to motivate a child, then stick with that! However, some children do not respond as well to verbal praise; for some children, a pat on the back is not as motivating as a trip to the prize box. It is important to think about the individual when considering your choice of reinforcement. Figure out what motivates the child and use what works best!

    Another important aspect of behavior management to consider is your schedule of reinforcement. When you are first beginning to target a certain behavior, the more praise the better. “Initially, it is far better to give too much reward than not enough” (Madsen & Madsen, 57). During this time, children are functioning on external motivation; their behavior is motivated by the reward they expect to follow it. However, the goal is to encourage intrinsic motivation to take the place of external motivation as the primary reason for a behavior. So, how do we achieve this transition from external to intrinsic motivation? Considering your schedule of reinforcement is the best place to start. While at first, we may reward a behavior every single time it happens, we eventually want to start thinning our frequency of reinforcement. As we begin the process of thinning, our schedule of reinforcement will change from a fixed schedule to a variable one. This means that rather than presenting a reward every time a behavior is displayed, we only present the reward sometimes. By giving rewards randomly, we are teaching the child to “go for longer and longer periods of time before receiving payoff” ( Madsen & Madsen 73). When you have reached a variable schedule of reinforcement, a naturally occurring reinforcer will eventually take the place of the need for an external reward. When this happens, the child has become self-motivated and has transitioned from an external motivation mindset to an intrinsic motivation mindset.

    Another useful tip for developing an effective positive behavior management strategy is to make your praise as specific and individualized as possible. For example, consider a child who shakes her maracas up high after being asked to do so only once by the music therapist. Rather than saying “good job”, the music therapist could say “Sally, I love how you followed my directions so quickly!”. That way, the child knows exactly what she did correctly and exactly what she should continue to do in the future.

Positive reinforcement can be a very effective tool in group settings as well. Consider a preschool classroom that has been handed egg shakers. Many of the kids are shaking loudly and are not waiting for directions, while a few children are waiting patiently with their egg shakers on the floor.  Rather than calling out the children who are misbehaving, the music therapist could say, “I love how John and Sam are waiting patiently with their egg shakers on the ground; they are ready to be good listeners.” By doing this, the music therapist calls attention to the positive behaviors rather than the negative ones, hopefully encouraging the other students to change their behavior in the process.

    As you can see, developing a positive and effective approach to behavior modification is no easy task. It requires practice, hard work, and consistency. However, putting in the time and effort is well worth it when we begin to see positive, functional changes in the behavior of our children. It is important to remember that every child is different and every situation is unique, but maintaining positivity in all things will benefit not only the child but us as well!

-Alaina Brommer, Music Therapy Intern

References: Madsen, C. K., & Madsen, C. H. (2016). Teaching/discipline: a positive approach for educational development (4th ed.). Raleigh, NC: Contemporary Publishing Company of Raleigh, Inc.

Harmony Kids Music Class: learn by playing!

This January has marked two years as part of the Therabeat team. One of my greatest joys has been teaching Harmony kids music classes. Every Tuesday morning I am met with the sweet faces of tiny ones ready to learn. Except, they aren’t aware that they are learning--they come to play, and that is exactly the goal!

We build our Harmony kids curriculum to foster learning, growth & development, and interpersonal skills through musical play. We accomplish this by planning classes that are interactive, structured, and give time for free exploration. In every class, we want to get your little one moving, singing, playing instruments, and playing with their peers.

This Spring, we are offering two different classes for you and your little one as we break in our brand new group room in our new clinic!

Stories & Songs: Mondays 11:00-11:45

Ages 0-5

This is our newest offering! This class will focus on fostering a love of language and the telling of stories. Each month, we will focus on the reading of 1 cherished story book. Your children will get to know these stories through focusing on themes and concepts in the story through movement, singing, and instrument play. This class will  be taught by Hayley Echols, LPMT, MT-BC.

Music & Me Family Class: Tuesdays 11:00-11:45

Ages 0-5

This class is perfect for the whole family! In this class, we will sing, dance, and play instruments! We will be focusing on the play of 1 instrument family each month to learn age appropriate concepts, foster the love of music, work on fine and gross motor skills, and learn how to play with others. This class will be taught by Perry Wright, LPMT, MT-BC.

Call 770-345-2804 to sign up for class today and join the fun!

Registration is $55/month per child. Worried that you might not be able to make every class? Don’t worry! Although we suggest coming consistently to one class, you are more than welcome to come to either Monday or Tuesday Class in order to makeup classes.

We can’t wait to see our new group room filled with bright faces ready to engage in music!

Music Therapy with Generalized Anxiety Disorder

     Anxiety related disorders are being diagnosed at higher rates than ever before. 18.1% of adults in the United States are diagnosed with Generalized Anxiety Disorder making it the most common mental illness in the U.S. Unfortunately; only 36.9% of those suffering are receiving treatment. (Anxiety and Depression Association of America) 

    In 2015, Gutierrez and Camarena completed a study on using music therapy with generalized anxiety disorder. They took a slightly different approach than previous studies by including active and receptive music therapy interventions. The receptive interventions meant the participants weren’t involved in the music making. During the active interventions they used their voices, bodies, or musical instruments to participate in the creation of the music.

     The study utilized receptive MT first and focused on stimulating patients to identify their problematic symptoms. The music therapy then shifted to active while the participants engaged in emotional expression exercises.  Lastly, the music therapy was used to address issues such as self-esteem and assertiveness before final processing and conclusions.

    This study found that those participating in music therapy alongside their conventional pharmacological treatment had significant positive effects. Their anxiety significantly decreased on two different assessments used by the researchers.

     This study is unique in that it specifies how music therapy was used throughout the progression of the sessions. Music therapists can use this information to inform their clinical choices and better serve their patients.

-Lauren Booke, Music Therapy Intern

Gutierrez, Octavio Flores, & Camarena, Victor Andres Teran. (2015). Music therapy in generalized anxiety disorder. The Arts in Psychotherapy 44, 19-24.