In this series, we are exploring how music therapists do live music differently than other musicians, even though it may not be easy to see. This is part two of a ten-part series. You can find an introduction and links to all ten posts here.
#2. In-The-Moment Adaptations
No matter what kind of musical interaction a music therapist is facilitating, we always start by considering the client’s needs and goals on a given day. Sometimes the session plan is highly structured and well-thought out in advance, but sometimes the plan has to change to meet the needs of the group or individual on that particular day. In fact, sometimes the plan has to be pretty flexible from the outset, ready for the adaptations that will surely be required. I have found this to be especially true in my hospice work.
Imagine this one-on-one scenario:
Joe is doing a one-on-one music therapy session with Gina, a 96-year-old hospice patient living in a nursing home, who has end-stage cardiac disease and moderate dementia. You hear Joe sing “You Are My Sunshine” and “Singing in the Rain” while strumming his guitar, and you think Gina might have chimed in with a word or two. When you peek around the corner, you see Gina looking intently at Joe and smiling. When you walk back down the hall again, you hear Gina and Joe laughing at something. How nice for Gina to have this music man come to visit!
What’s going on?
From the outside, it may appear that Joe simply thought of a few songs off the top of his head to sing with Gina. It’s true – Joe may or may not have written down a formal plan for this session, spelling out which song to sing when.
Or, on the other hand, it may look like Joe has some kind of “set list” of songs that he performs for ladies of a certain age. It’s true – you’ll hear music therapists singing “You Are My Sunshine” a lot more frequently with folks in their 90s than people in their 60s.
The bigger picture, however, is that Joe was choosing music based on the client’s goals and needs on that particular day.
Music therapists are ready to adapt.
As discussed in the last post, Joe isn’t playing “You Are My Sunshine” just because he really likes that song. Rather, he has some kind of goal or purpose in mind. He might be singing “You Are My Sunshine” in an early session with Gina to assess whether she will sing a familiar song. His purpose is assessment. Or, he might choose that song to support a conversation about the warm weather outside while they watch the birds at the feeder outside Gina’s window. The goal is reality orientation and helping Gina find joy in the moment.
But what if Joe arrived one day, planning to talk about the lovely weather, but Gina was curled up in bed, crying as Joe had never seen before?
Music therapists prioritize client goals over session plans.
In this case, Joe ditches his plan to talk about the weather and focuses on what support Gina needs at the moment. Perhaps Gina has become tearful from remembering that her eldest son has died. Knowing that Gina used to sing “You Are My Sunshine” when her children were young, Joe might offer this song as support for her grieving. Rather than using this song as an assessment tool or a vehicle for a pleasant social interaction, Joe offers it as a validation for Gina’s emotions and as a way to honor her history as a mother and her love for her son. Either way, Joe does not force Gina into a cheery conversation. Today is not the day.
This flexibility is central to the effectiveness of a music therapist.
We make plans for our sessions. Really good plans, based on clients’ goals. This lays the groundwork for music therapy.
By themselves, though, these plans would be limiting. They’d only work for the person and the circumstances originally conceived, not what might be happening on a different kind of day.
That’s why music therapists can’t really provide a protocol for which songs to play on which day to help Margie stay calm. Music therapists’ ability to make sometimes subtle adjustments in our musical interactions makes all the difference in the effectiveness of music therapy.