by Krista Winter, MA, MT-BC, Neurologic Music Therapist

Today at work, I broke my guitar. It was 100% my fault and definitely preventable. In fact, I’ve had a few close calls before of the exact same situation that led to the incident. My first thought after turning a pale whitish-blue, as observed by my very gracious supervisor, was, “Do I go home now?” Fortunately this was only a brief thought, I had my brand new Oscar Schmidt Autoharp waiting to be more utilized, and as a vocalist I thought, well there is always my voice. I knew I could continue on with my sessions, but for a brief moment I felt the “crutch” of the guitar.

So I charted on the patient I had just seen—who, by the way, later expressed his sincere empathy for the situation—took a few breaths, and went into see the next patient with the autoharp in hand. It was the ideal instrument for this session, and the autoharp allowed for new elements of structure and opportunities for active participation that the guitar would not have provided. Also, I felt a renewed sense of creativity and energy in the session with a patient with whom I have been working for a relatively extended period of time (in a hospital setting).

This unfortunate incident—which will be fixed—resulted in a needed boost to my professional development. What experiences have you had as a Music Therapist regarding a broken “main” instrument, loss of a “crutch” in the midst of sessions, or self-induced instrument accidents (non-life-threatening) that resulted in either you needing to cancel sessions or drastically change your treatment plans in the moment? I know we all have them and will have them again. I think it can be helpful to talk about them and grow from them. As I drive 45 miles to the nearest guitar store in Joplin later today, I will cry and grieve for my loss, but for now I’m going to see what other creative sessions I can have with the hospital patients.

Adapted from “Government Relations Treasure Hunt” by Carol Ann Blank
Published in Rx Music (2008)

In an effort to make issues related to advocacy a bit less foreboding to the average Jane or Joe, I have designed a Treasure Hunt. Here are the rules:

Do not freak out.
Do not do this while driving.
Share what you find. The more things you share, the more points you get.
Points are totally arbitrary and are not redeemable for any good or service.

Ready? Go!

1. Take these instructions and go to your computer. (5 pts)
2. Go to your favorite search engine (Google, Yahoo, etc) and type in the name of your state and “state” (New Jersey, state or West Virginia, state). (5 pts)
3. Click on your state’s official website (2 pts)
4. Bookmark this page so that you can get to it again. (2 pts)
5. Find your way to the Legislature page of your state’s website. For example, in WV, I found the Legislature when I clicked on a link titled Search WV Code. (10 pts)
6. There are generally “Search” areas on the Legislature pages. Type in the word or phrase of your choice and see what comes up. You might try music or therapy or creative arts or any number of populations (Alzheimer’s, mental illness, addictions). (4 pts).
7. Once the search is run, follow the links to see if there is anything interesting (5 pts). Here are some ways to increase your points:
a. Note whether it is a law or a regulation or a proposed bill. (5 pts)
b. If it is a bill, determine if the bill has passed in the assembly and/or the senate. (5 pts)
c. Determine who the sponsors of the bill are and read up on their profiles. (10 pts)
8. If you find anything interesting, share, share, share. (20 pts)

We all benefit from sharing information. If you have any questions, you can email me at carolannblank@gmail.com. I would love to hear how you did.

by Krista Winter, MA, MT-BC, Neurologic Music Therapist

Winter is slowly turning into spring, snow into rain, and that means the ground will soon be coming back to life. Trees and grass will once again turn green, flowers will be blooming, the joy of Spring! Not so fast, because for some this means struggling to breathe and being wary of the ever increasing pollen count. You might be thinking allergies, but that is a secondary issue to a chronic illness that affects a large percentage of children (and adults), Asthma.

I work at Barton County Memorial Hospital (BCMH), and as of March 8, 2011 we are now certified as an Asthma Ready Hospital—only the 2nd hospital in Missouri to receive this designation. We have 2 Certified Asthma Educators (AE-C), another rarity seeing as there are under 3,000 total in the United States. This all exists in a small rural 24-bed hospital. You might not think this is relevant to you and your practice, but statistically it is very likely that you have at least 1 (probably more) client who suffers from Asthma. According to the Centers for Disease Control and Prevention (CDC), approximately 7.1 million children are diagnosed with asthma, which is just around 10% of the pediatric population. The Asthma and Allergy Foundation of America states that not only is asthma the “most common chronic illness in children” but it is also one of the leading causes of school absenteeism AND hospitalizations of children.

In other words, this is a serious problem and many of our clients will be affected, both children and adults. Asthma occurs out of sight in the persons’ airways, which become constricted and swollen when triggered by external (and at times internal) factors. It can look like someone is just “out of breath” when in reality the air cannot get through the airway and could become a serious life-threatening problem. Unfortunately due to its outward “invisibility” many people do not take it seriously, and children suffer humiliation by coaches, peers, even parents. The good news is, although asthma cannot be cured, it CAN be controlled (American Lung Association). Between the physical manifestations of asthma and the emotional affect, Music Therapy can provide great benefits.

First of all, for any Music Therapist looking to work with the asthma population or related issues such as COPD, I recommend reading “Music, the Breath and Health: Advances in Integrative Music Therapy” edited by Ronit Azoulay and Joanne V. Loewy. Second, educate yourself on Asthma itself. I have attended the nationally certified 6-hour workshop, “Becoming an Asthma Educator”, and borrowed resources from Certified Asthma Educators (who are also Respiratory Therapists). Fortunately I work with two AE-C’s and have gleaned great information from listening closely and collaboration.

The main themes within Asthma Education include teaching students to identify symptoms and triggers, the 3-Step process (I will explain in a moment), and how to properly use the various medication devices (which can be very confusing). The 3-step process is what students need to do when they are having an asthma attack. 1) Stop and sit down, 2) Tell and adult, 3) Take medication. There are many sub-topics that are addressed with students within these topics, but once the student gains this knowledge they are much more likely to be successful in controlling their asthma.

Ways to implement Music Therapy in treating clients with asthma. At BCMH we have incorporated Music Therapy into the Asthma Education program in 3 ways:

1) Inpatient services
2) School assemblies (for all students) and 3-week education (asthma students)
3) Educational Presentations (for caregivers including parents, teachers, daycares)

*Currently the AE-Cs do home visits that do not include Music Therapy; however we are discussing the possibility of Outpatient referrals specifically for participants in the Asthma Education program who have severe anxiety and psychosocial problems.

Goals for inpatients with asthma include increasing respiratory efficiency, teaching age appropriate relaxation skills (which also addresses proper breathing techniques), providing accurate age developmental stimulation if the patient is long-term, and providing opportunities for expression and identification.

Since music is so closely related to breathing and respiration, I have written a few songs that mirror “belly breathing” (or diaphragmatic breathing) lyrically, melodically, spatially, and rhythmically. Interestingly, during one of our sessions, the Asthma Educator was teaching two young boys how to properly use a spacer with their inhaler, it takes breathing coordination, and when I added a simple melodic support on the glockenspiel that mirrored the appropriate action, the boy immediately improved. Since there were two boys I had the boys take turns playing the glockenspiel while the other practiced using the spacer so they were helping one another.

Another favorite song I adapted to a familiar tune uses egg shakers:

“Shake, shake, shake out my ________ insert specific stressor or anxiety of client (3X)
And…stop shaking egg shakers…take in a big deep breath.”

It is a simple song but it incorporates two important elements: naming the client’s trigger and deep breathing techniques for symptom control and relaxation.

Using wind instruments: recorders, harmonicas, slide whistles are also great ways to improve breathing techniques, increase client confidence over asthma symptoms (as reported in several research studies). Using scarves also provides a great age-appropriate way for younger children to see the effects of their breathing as they blow to make the scarf “fly” to a song such as “Somewhere Over the Rainbow” or musical improvisation.

These are a few ways I have implemented Music Therapy in the treatment of asthma, and it has been a very successful addition to the BCMH Asthma Education program. Most importantly, make sure you are “Asthma Ready” for any clients you might serve who could possibly have asthma.

I would love to hear your comments and suggestions as I expand my knowledge in this area. Feel free to contact me at krista.winter@bcmh.net.

by Leah G. Oswanski, MA, LAC, MT-BC

“You have cancer.”

These are, arguably, the three most frightening words you can hear from your doctor. In fact, the diagnosis of cancer can be so traumatic that at least 20% of patients with an early-stage cancer and 80% of those with recurrent cancer display post-traumatic stress disorder (PTSD) symptoms (National Cancer Institute, 2010), which may include difficulties concentrating, insomnia, irritability, repeated reliving of the event and feeling detached. Cancer diagnosis and treatment impacts the entire system: family, friends and co-workers. Depression and PTSD symptoms are not only common in patients, but in family members and close friends (“caregivers”) as well. In my music therapy practice, at least 40% of my caseload is made up of caregivers!

So, how does music therapy fit into the profound experience of cancer? How can it help?

Because music is an inexpensive, highly portable, non-invasive medium, it is actually an excellent modality to utilize during treatment, whether it’s before or after surgery, during chemo or radiation treatments, or at home. As the coordinator of the Jeffrey Frank Wacks Music Therapy Program at the Carol G. Simon Cancer Center (a part of Morristown Memorial Hospital) for the last nine years, I have found that the primary reasons that people seek music therapy services are to decrease anxiety, manage treatment side effects, and to creatively process the intense emotions that arise during treatment. Research has pointed to the fact that decreasing stress and anxiety, and dealing with difficult emotions are all helpful while undergoing treatment because the fewer stress hormones you have circulating, the better your immune system functions!

At our center we have a variety of music therapy and music performance programs to address these goals for inpatient and outpatient clients and their families, including: active/receptive music therapy sessions (which may include songwriting, improvised music for relaxation, singing, instrument instruction, entrainment methods or lyric analysis), Vibroacoustic therapy utilizing the Somatron Clinical Recliner, Sound Meditation groups that teach vocal toning, Healing Through Drumming workshops, Strolling Harp and weekly musical performance programs in our lobbies and hallways.

So, you might be thinking, “That’s great if I am treated at your center — but how can I help myself with music if I do not have access to a music therapist?”

Fortunately, there are many ways to utilize music therapy techniques on your own. First, I would invite you to look at your own current musical collection — because working with what moves YOU is the most important thing. What makes you feel relaxed when you put it on? What makes you feel like moving and grooving? What brings good feelings, or negative ones? Make a playlist on an iPod or on a CD that is reflective of what you are trying to achieve, and use it! For example, if you want to be reminded of happy, upbeat things while you are receiving chemo, fill your playlist with songs that bring happiness to your mind — or if you want to focus on relaxation when you are awaiting surgery (or during surgery!) or for insomnia, use music that you find relaxing. Of course, we all feel differently day by day about songs that we hear, and some days the happy songs don’t feel so happy. But you can make yourself several playlists and utilize what works for you in the moment.

If you are not sure what works for you as far as “relaxing” music, go to iTunes or Amazon.com and type in “relaxation music,” then take some time to listen to the sound samples from many different CDs or artists to figure out what might work for you. At the center, music from Chuck Wild’s Liquid Mind series and Janalea Hoffman’s Musical Acupuncture and Musical Massage CDs are really popular ones you might want to check out. Also, ask family and friends what they like and see if you can borrow it — just keep in mind that everyone is very different when it comes to what music relaxes them. If you like guided imagery or positive affirmations with your music, I would recommend checking out www.healthjourneys.com, which has great audio and video resources.

Breathing is an important piece of relaxing the body. When we breathe in a shallow fashion we tend to tense up, and therefore the body is in disharmony with itself. A great way to deepen the breath is through singing or toning (vocalizing one vowel sound like “ohm” or “ee” for the length of a breath). It makes NO difference if you think that you can’t hold a tune — just create sound and breathe! If you are uncomfortable, do it in the shower, or in the car where no one can hear you, but let your voice come out strong and feel yourself breathe more deeply, feel your body begin to relax as your vocal cords resonate and harmonize the mind, body and spirit. It seems sort of silly, but I assure you that the effect of vocalizing for even just 10 minutes a day can make a major difference in your well-being.

And finally, attend musical performances as much as possible that you feel increase your quality of life — perhaps an orchestral concert, or your favorite rock band. See if anyone in your community holds a drum circle or any toning/chanting circles — yoga studios often have some of these offerings — and plan to attend to see if it is helpful for you. Involve as few or as many people as you want in these ventures!

For any questions or feedback, please feel free to contact me at:
Leah.Oswanski@atlantichealth.org

By Krista Winter, MA, MT-BC

You might wonder how music therapy can exist in a 25-bed hospital located in a small town of fewer than 5,000 people. I know I was skeptical when I first responded to a job posting for a full-time music therapist at Barton County Memorial Hospital in Lamar, Missouri. Having been raised in a small Kansas town about this size, I raised my eyebrows at this idea. Yet I applied, interviewed and accepted this job with its challenges and possibilities. The CEO later informed me that he had posted it as a full-time position because he didn’t think he’d be able to find someone for part-time. He’s since revealed that it takes at least one full-time person for this job.

So how does music therapy work in a rural hospital?
I should begin by admitting that I’ve only been here for 6 months (almost) and there are days that I ask myself this question, especially during the times when our census drops below 10 patients (hard to fathom, right?). However, even these days are full of potential, and with each month, they become fewer and far between.

Being in this setting allows music therapy to be available to the community and to be multi-faceted. The program is based in the inpatient unit, but it is slowly being utilized in the Emergency Department and other departments as well. Music therapy quickly became a member of the hospital’s asthma education team, and the fall and spring seasons are busy times at schools, covering a multi-county region several days a month (and sometimes several times a week) doing assemblies and a series of educational sessions. Some students with asthma have more extensive needs related to the disease, and music therapy recently became a part of the plan for one particular patient, as an outpatient service to address developmental and psycho-social needs. This will hopefully become more common with other students, as well. Music therapy also works with the smoking cessation classes offered through the hospital in order to support alternative ways of coping with stress and anxiety. Monthly music therapy groups are even provided at both the local Residential Rehabilitation Center and also the Senior Center.

Students with autism are an underserved population in this region. One of my colleagues commented that she had to travel with her son the two hours to Springfield, Missouri, for the services he needed. Seeing the need, I have set into motion steps to pilot music therapy groups for students with autism at our hospital.

This setting allows for a music therapist to become integral in the community and provide a wide variety of services to a range of populations. It fosters the creativity necessary to think out of the box in terms of what music therapy is and how it operates, and it educates a region that otherwise would be relatively unfamiliar with this field and its benefits. One of the greatest opportunities has been in educating people about music therapy. From hospital staff to the local Chamber of Commerce, I have given numerous presentations in which I am able to explain that “I am not here to teach, and I am not here to entertain.” I’ve had one student job shadow me, expressing interest. The educational opportunities extend beyond this small town and into the entire four-state area, as I am one of the only music therapists in this region.

Personally, one of the most important decisions I made was to live in a town about 30 miles away from where I work. This allows me to maintain the ethical boundaries of a therapeutic relationship with patients and let music therapy be an integral part of a small community.

As of yet, I have not met any other music therapists who work in a rural hospital setting such as this in a full-time position. If you are reading this and you are in a similar position, please contact me, because I would love to compare notes! Otherwise, I encourage music therapists to jump at opportunities that seem impossible and to even seek them out. In my experience, rural settings are greatly underserved by allied health providers, but they too have great needs that can be addressed by music therapy.

Contact Krista Winter at krista.winter@bcmh.net

Krista previously worked at Tempo! PA before relocating.

I’d love to say that I like every song I use in a therapy session or class, but that’s not the case. A perfect example is the song “Tingalayo,” which is a Caribbean folk song. I first learned it in my undergraduate years for my autoharp proficiency, and I remember thinking at the time, “Who would want to sing a song about a silly donkey. Do kids really like this?” At that time, I really disliked the song. Then, one of my clients discovered it and developed a strong liking of it. Next, it showed up in my Music Together training, and then again on this semester’s Music Together’s Tambourine Collection. So I figured it wasn’t going away and I had to learn to like it — or at least have less of a dislike of it.

As with other songs, I’ve forced myself to look at them in different ways in order for me to best serve my clients. I couldn’t let my personal bias or dislike for a song get in the way of my work.  I’ve tried a different presentation of songs to keep it fresh, adding new verses and different techniques to make it playful. But I’ve found that the best technique is to really make it fun for myself and that enthusiasm just seems to take over. Often, just one idea is the spark. Then, the client or the class has another idea, and I have the means to challenge them — to keep building on these ideas to come to a mutually more-advanced place with a song or improvisation.

It’s really not the song, I’ve learned, but my enthusiasm for the song. Kids can always see right through you, and if you are “trying” to put on a happy face, but are not genuine, they will know!

This morning, as I walked into my first class of the day, the students were jumping up and down, asking to sing “Tingalayo.” I didn’t even have my guitar out yet, and they were already on the second verse! The same thing happened in the next class, too. It’s now one of my favorite songs because the energy in the room is tangible each time we sing it!