Board certified music therapist Gloria McDaniel has 27 years experience in a large metropolitan school district near Houston, Texas, working with students from 3 to 21 years old with a wide variety of abilities and exceptionalities. In this AMTA.Pro symposium, Gloria discusses the necessity of intense detective work in music therapy, watching for subtle clues that help therapists discern the needs of individuals and develop effective strategies and interventions to meet those unique needs. Gloria also talks about the need to sniff out evidence and follow leads to develop new music therapy positions or to expand programs. Her persistent detective work helped launch the music therapy program in her school district in 1982 and has lead to the expansion of that program this fall in spite of economic restraints.

[display_podcast]

– + – + – + –

Detective Work in Music Therapy
September, 2009 AMTA.Pro Symposium

Gloria McDaniel, MT-BC

My name is Gloria McDaniel, and I welcome my colleagues to this AMTA.Pro symposium focusing on Detective Work in Music Therapy. The past 25 years have taught me that music therapists should have an alias of “Sherlock Holmes.” We often find ourselves playing the role of a detective, watching for subtle responses that occur in response to the music, the therapeutic relationship, or interactions between individuals in a music therapy group. My experience is that intense detective work is often required to identify strengths and needs, to discern pressing issues, and to develop options for addressing challenges we encounter in our clinical work.

Please note that in this discussion, names have been changed in the examples that follow to protect the privacy of the students/clients.

One of my very first early childhood classes was a group of children ages 3-5 with a variety of special needs. Charles was a typically developing 2 ½ year old when he was burned over 85% of his body by a water heater explosion. Charles suffered from multiple impairments and required a tremendous amount of care from family members and school staff. I noticed that seizure activity occasionally occurred when musical instruments were played in his classroom. It seemed wise, under the circumstances, to avoid using instruments and to only use our voices during the group music therapy lab. The only other viable alternative was to limit Charles’s participation in the music therapy lab group. Fortunately, I took time to scout out more details about triggers for his seizure activity, and discovered that his seizures were occurring in response to metallic timbre – jingle bells, jingle taps, tambourine, small cymbals, and metal xylophones. Charles was, however, able to tolerate sounds of the woodblock, guiro, guitar, and soft drumming sounds – instruments with warmer, more natural materials of wood and skin. With careful observations, collaboration with other staff in the classroom, and specific planning, we were able to include Charles for the entire music therapy lab and eliminate almost all seizure activity that happened during that time.

Eddie was a 5th grader with autism in one of my music therapy labs with an elementary school developmental class. Although Eddie made vocal sounds, he was non-verbal. Eddie often covered his ears with his hands in the classroom or in response to various sounds, indicating sensitivity to sound. I was also able to work with Eddie’s family in the home/community setting. His mother was concerned because it was difficult to take her sound-sensitive son to the store, restaurants, or other public places. For example, if a short excursion to the grocery store required waiting in a line for the cashier, the mom usually found it necessary to leave before she could complete her purchase. We recognized that unexpected and unfamiliar noises was one factor in Eddie’s aversion to public place, so we made audio recordings of those sounds to help prepare him for the real-life experience. We recorded the variety of sounds in the grocery store, including the beeps of the scanning machines at multiple registers all happening at once in random patterns, the announcements over the loudspeakers, and the sounds of the clerks and customers chatting. We also recorded the humming of the refrigerated coolers and freezers, coke machines, etc. Mom used the recordings at home to let Eddie hear bits of those sounds every day, interspersed with other things he preferred listening to. This desensitization process, exposing him in the comfort of his home to some of the sounds he would be hearing in the community, eventually allowed Eddie to get away from home and enjoy community activities with his family.

Another one of my early music therapy experiences requiring a little detective work was with a student in a grant funded program for children with visual impairment, birth to age 3. Sam was a toddler with multiple impairments, and would only listen to sounds from the Fisher Price toy The Bee Says. This was a toy requiring someone to pull the string which made the bee spin to select the animal and make the animal sounds. Sam’s family and caregivers were getting frustrated with the fussing and tantrums that occurred when they tried to introduce new songs or activities. His demands for the animal sounds also made it difficult for the family to watch television or listen to music. Sam simply would not tolerate the other sounds. But, we did notice that he occasionally quieted some with commercial jingles. In order to help build Sam’s tolerance for the other sounds in his environment, and to help prepare him for entering early childhood classes in the fall, we made recordings of The Bee Says, pulling the string several times in a row, alternating with very short segments of less-preferred or non-preferred sounds. We gradually decreased the length of The Bee Says and increased the length of the non-preferred sounds. By the time he was elementary school, Sam was cooperative with listening to anything and everything without the tantrums. Sam passed away during his high school years, but he put away The Bee Says early in life so he could enjoy many years of spending quality time with his family and friends.

Andrew is a 5th grader diagnosed with autism. When he was only 3 years old, he was in our music therapy labs in his early childhood classroom. At the beginning of the year, he was very calm and intensely observant during music therapy. One day when I came into the classroom with my guitar, Andrew began running around the room. He became very flushed and his heart was racing as he ran around the room. Because he did this every time I brought a guitar, his teacher naturally assumed Andrew was afraid of the guitar. Over a period of several weeks I tried leaving the guitar case in the hallway, or planning the session with no guitar and only introducing the most familiar material. When I did not bring a guitar, Andrew would keep running up to me excitedly as if asking about the guitar. One time he even went in the hallway looking for it. Over time, I began to think that Andrew was not afraid of the guitar. I told his teacher I thought he was just excited about the guitar, and did not know how to regulate his emotions or express his delight at seeing a guitar. As it turned out, his father was a drummer, and had a small ‘band’ that rehearsed in their home. Andrew had exposure to electric guitars there, and he was excited to see a guitar at school! I have not worked directly with Andrew or his class in several years, but he is still ‘mesmerized’ with the guitar. Andrew comes up and stares at my face when he sees me at school. Even six years later, he still becomes very ‘bouncy’ and ‘excited’, not able to focus on work or following directions if I am anywhere in his visual proximity. What appeared to be fear and flight was actually excitement that was virtually uncontrollable.

Jane, a 20-year-old high school student diagnosed with OHI and anencephaly, was one of my homebound music therapy students. When I first started working with her in 6th grade, I noticed Jane responded to touch with numerous clonuses or tremors in her hands. Jane was able to make some very slight head turns, primarily from approximately mid-line to her right side. Favoring her right side may have been due to the placement of the bed and furniture in her room, an arrangement that required everything to take place on the right side of her hospital bed. I began working almost exclusively on her left side for the majority of each session to encourage use of the left side of her body. Jane’s caregivers angled her bed from the corner to allow more access to her left side, but due to limited space, there was no other option for furniture and equipment placement in the room. Because Jane makes minimal responses, I have had to gradually learn all of her very tiny, almost unperceivable responses. She is able to communicate in very subtle ways, but I must be very alert to pick up on her cues. For example, Jane is quick to close her eyes or exhibit stridor, breathing deeper if she did not like a certain instrument, song, or visual support in her music therapy session. One fall I presented a large, flat, bright orange Jack-o-Lantern, and Jane closed her eyes immediately. I said, “Well, I guess you don’t like my Jack-o-Lantern, so I’ll put it away.” As soon as it was out of sight, Jane opened her eyes. This was not a one-time occurrence. Jane typically enjoys participating in the session, but she does not hesitate to close her eyes or draw her hand away from things she did not like. Scouting out these clues help me know how to structure learning experiences and plan meaningful music therapy sessions for her.

Sometimes the participants in music therapy pick up cues from each other. Four years ago, I was working with a class of seven high school students with one teacher, two paraprofessionals and a music therapy intern. The room was very small, so we sat in a tight circle of chairs. At one point, Mark, one of the non-verbal young men with autism who had been a student of mine since elementary school, pulled his chair up and sat knee to knee with me for the entire session. Over the next weeks, Carl, JR, and George, three of his fellow students, also non-verbal young men diagnosed with autism, followed his lead with one person sitting knee to knee for the entire session each week. In the same classroom this past spring, the students were given different instruments. We noticed the students all watching each other, taking turns playing without any cues from any adult staff. They were playing with varying tempos, rhythms, volumes, watching each other and looking around the circle, taking individual turns playing solos as well as playing in a group. It was interesting that they were cueing off each other rather than following the lead of the teacher, two paraprofessionals, two music therapists, and a music therapy intern in the group. It was one of those magical music therapy moments you wish could last forever.

As this current school year began and we were visiting classrooms to set up schedules, the anticipation and excitement of seeing this high school group grew. When we stopped by for just a few minutes, Carl, one of these non-verbal young men, got up from his desk totally unprompted, walked across the room and shook hands with us. Another one of the young men, JR, who was sitting on the floor having a break stood up and came over to us as well, just as Carl was leaving to go back to his desk. Seeing the generalization of social skills we’ve worked hard to develop and support through music therapy is extremely rewarding!

Steve was an ambulatory, very bright student in elementary school, but when he was ten years old, he was diagnosed with Adrenoleukodystrophy, a rare degenerative disorder diagnosed in 1 of every 17,900 boys worldwide. I have shared music therapy with Steve in the schools since junior high school. Now that the 25-year-old has graduated, I provide private music therapy services for him through CLASS (Community Living and Support Services) funds. Steve has multiple impairments and requires total care. He has extremely limited voluntary movement, but his swallow reflex and eye blinks are visible. When I started working with him twelve years ago, I noticed he could express dislike or displeasure through a furrowed brow and frown. I was able to determine fairly quickly that Steve did not like any of the drums or metal sounds – especially jingle bells – or the middle and high octaves of the flute. He responded well to the tactile vibrations of the guitar and dulcimer, and seemed to really listen to singing. The first time I used the QChord with him was about eight years ago. After full year of trial and error with positioning, hand over hand assistance on the sound plate, and just plain perseverance with this instrument, Steve began producing sounds under his fingertips on the sound plate. Due to the severity of Steve’s motor limitations, some of the QChord sounds are obviously related to the rise and fall of his trunk during respiration. One of his nursing staff commented on the value of the QChord as a motivating force to encourage him to breathe more heavily and deeply in order to produce sounds. In addition to his controlling breathing to make music, Steve appears to make some purposeful but visually unperceivable movements with his hands to produce sounds on the sound plate of the instrument — sometimes with just one hand, and sometimes with both. He seems to be able to make sounds heard one at a time as well as multiple sounds clustered together. Through extensive ‘detective work’, I have been able to determine Steve’s personal preferences for rhythmic accompaniments on the QChord. Steve uses eye blink responses at times to communicate ‘yes’ and ‘no’, but these responses are not always consistent from week to week. I have noticed over the years that if he is able to give eye blink responses, they will be consistent throughout the session. The litmus test to see if he is actually communicating with me is to play the polka rhythm. If he is able, Steve will ALWAYS respond to the irritating Polka rhythm with two distinct blinks!

These are just a few examples of challenging detective work in music therapy over the years. My experiences are not unique, but, hopefully these clinical stories will give you inspiration to continue searching for clues that help you enhance the relationships you have with your clients and to use music effectively in the therapeutic setting.

This detective work doesn’t stop with the individuals who participate in music therapy. Sometimes we must spend time and energy sniffing out evidence and following leads – sometimes into blind alleys – when developing new positions or starting new music therapy programs. Our skills as detectives are also useful when dealing with agencies or boards or decision makers. When I started pursuing my career in 1982, I often found myself wearing my Sherlock Holmes hat as I searched for clues and inside information – tips that would lead to a job as a music therapist.

I started my career at the bottom of the pole as a paraprofessional in a self contained classroom for elementary school students diagnosed as emotionally disturbed. I worked in that capacity for two years at two different campuses, and a third year in an intermediate campus with an 8th grade class of students diagnosed ED. During those three years, I was acclimating myself to the world of a large suburban public school setting while at the same time trying to educate employees in the district about music therapy. I talked with special education and regular education classroom teachers about music therapy. I provided an after school in-service on progressive muscle relaxation with music for the faculty at one of the elementary schools. I was given permission by the elementary school principal to do some ‘music therapy labs’ once a week with the students in the emotionally disturbed classes where I worked as well as with the resource classes. I talked to diagnosticians, other related service providers (speech therapy, occupational therapy, and school psychologists), resource and regular education teachers, program coordinators, and special education administrators. There were roadblocks all along the way – budget, lack of knowledge about music therapy, lack of knowledge about the benefits to students in a school setting, and questions about the training and credentialing of a music therapist. At the time, CBMT was not in existence, so I was just an RMT – registered music therapist.

After three years as a paraprofessional, I did not see any possibilities on the horizon, so I interviewed with an adolescent psych facility in the north part of the Houston area. I was offered a job where I would have been low-man on the totem pole of employees in the ancillary therapies department, a position that would have required working evenings and every other weekend. I just could not sign that contract with a toddler at home and a husband busy with high school band schedules. In desperation, I went back ‘one more time’ to pursue the possibility of music therapy in the school setting with the director of special education. I made the appointment hoping to gain information about how to approach the school board, thinking that was the step required for getting a music therapy program in the school district. We had a conversation very similar to those we had had in the past, discussing hypothetical scenarios, intervention strategies, and music therapy program structure. The director pulled out a large binder from behind her desk containing the state board of education guidelines. She noticed music therapy had been added to the approved related services section, and then said, “How about five days a week?” Needless to say, that was an incredible turn of events. Twenty-four years later, I am still working for that same district.

Our district’s program has grown over the years, and, given the tentative economic times in 2009, could even be called a booming success. We have two full-time board certified music therapists, and have just added a part-time music therapist to our staff, a position we hope to grow into a full time position soon. We conduct weekly hands-on music therapy labs through programmatic consult, providing services to approximately 500 students. We provide services to all of the PPCD (early childhood) and self-contained life skills elementary classrooms for students with developmental disabilities in our district. We provide services to students in our PreK/PPCD inclusion classes, work with elementary students on a self contained alternative campus for severely emotionally disturbed students. We provide music therapy as a related service for medically fragile homebound students and other collaborative IEP students on several of our campuses, including intermediate and high school. Music therapists in our district provide staff trainings for special education as well as general education, collaborate and consult with other related service providers, and have a wonderful support network of faculty and administration in our district.

So, I encourage you to sharpen your skills as a detective so you can scout out clues and follow leads to help you reach career goals, and, most importantly, to give you the ability to discern specific needs of the individuals you serve so you can develop music therapy interventions and strategies to address those unique needs.

Again, I am Gloria McDaniel. You can contact me via e-mail at kmmcdaniel@sbcglobal.net. I am a board certified music therapist employed by a large metropolitan school district in the Houston, Texas area since 1982. I work with students ages 3-21 who present with a wide range of abilities and exceptionalities. I provide services to these students both individually and in small or large groups, in inclusive as well as self contained settings. I also do private contract work with clients through the CLASS program in Texas. Please feel free to comment on any aspect of this AMTA.Pro on-line symposium, Detective Work in Music Therapy.