“The total person sings not just the vocal chords.” – Esther Broner

A couple of weeks ago I wrote an entry on therapeutic voice lessons. This week I will focus on the adapted voice lesson and what it entails, how it differs from a therapeutic voice lesson and who would be appropriate for this type of therapy. Keep in mind, that this is my own model that I am still developing as I practice. However, it is also based on my own experiences and is something that I hope to evolve over time and through different client experiences.

What is an adaptive voice lesson?

By my own definition, an adapted voice lesson is a structured voice lesson conducted by a board certified music therapist that focuses on meeting therapeutic goals related to speech delays, difficulty with emotion recognition, self-expression and self-regulation, decreased self-esteem, limited vocal range secondary to pre-existing diagnosis, apraxia, aphasia, etc. Many times, I would try to design my goals for clients to support the work that they are doing in speech therapy to implement a multi-disciplinary approach. For example, I may create a tongue twister that mimics an exercise they had in speech therapy, put it to a tonal pattern that modulates up and down and then use it as a vocal warm-up before singing a song chosen by the client.

How does an adapted voice lesson differ from a therapeutic voice lesson?

The goals in an adapted voice lesson are different from the ones addressed in a therapeutic voice lesson. The goals in an adapted voice lesson are more didactic then psychotherapeutic. The focus is more on supporting the improvement of speech, social skills, appropriate self-expression and communication. These goals, although still client-centered, are directed more by the music therapist. The goals addressed in a therapeutic voice lesson are more directed more by the client and are more psychotherapeutic or even existential in nature. Therapeutic voice lessons are also structured less by the music therapist and more by the client where as the music therapist implements the structure in an adaptive lesson.

Who is appropriate for adapted voice lessons?

Well, this one varies. In the past, I have had clients with many different diagnosis and yet they all had the need to improve the ways in which they communicated, to improve speech, to increase self-regulation, to build and enhance their social skills, and to encourage self-expression. However, the largest commonality was their love of singing and music.

In closing, I would argue that the largest component in the success of any voice lesson is that the client loves to sing. It really doesn’t matter how well a client sings. What matters most is that the client has an intrinsic motivation to sing that brings them a sense of satisfaction and that they have a generalized desire to study the vocal instrument in some capacity. So, the commonality between an adapted voice lesson and a therapeutic voice lesson is that the client loves and wants to sing. The therapeutic goals may be different, the diagnosis may vary, but the outcome remains the same: each human being has the right to reach his/her full potential through the capacity of his/her very own and uniquely constructed instrument — the voice.

Questions? Comments? Feel free to leave a message on this blog or email Tori at tori@tempotherapy.com

Dear Ms. Guerriero,

I have been enrolled in Tempo! Music Therapy for several years. I am extremely fond of this service that you provide. There are several other music services I know of. However, I particularly signed up for your service for three reasons. Special needs clients get to learn music, music is beneficial to everyone, and children have the opportunity to participate with parents.

Somehow, special needs clients never get the opportunity to learn music or attend musical events or programs. This is extremely disappointing for them and their families. I can imagine how left out they’d feel. But, Tempo! Music Therapy doesn’t leave special needs children out of the equation. They treat all children equally and everybody gets a chance to learn and succeed. In addition, special needs children develop more confidence and they feel like people care for them.

Music is definitely beneficial for everyone. Music makes everyone’s mind much calmer and more focused. This gets all the anxiety, stress, or depression out of the body. Once a person is successful with music, they will begin to feel that confidence in other areas too. The music programs are never extremely challenging so you would be able to handle this. Believe it or not, this even makes people more determined. People can become famous musicians and have an incredible amount of knowledge from this program. I don’t even understand why anybody wouldn’t sign up for this awesome program.

Furthermore, children have the possibility of participating with their parents. This is helpful because people need someone to support them when they get anxious. If the child is getting nervous, the parents’ presence along with the music teacher will definitely make them feel comfortable. Besides, children don’t have to learn the notes and music all by themselves. Music teachers will also guide the students in how to play and what to do.

There could be several other uses for Tempo! Music Therapy other than special needs patients participating, music being beneficial to everyone, and children having the opportunity to participate with their parents. Thank you very much for providing a fine service to everyone. I have never experienced a better music program than this.

Sincerely,
A 6th grade student

A few years ago, I began to develop a model for therapeutic and adapted voice lessons. For the purpose of this blog entry I will focus on therapeutic voice lessons. Therapeutic voice lessons are just what they sound like. It’s therapy within a structured voice lesson. People can participate in therapy for a number of reasons: anxiety, trauma, eating disorder, depression, etc. Some people have a hard time talking about their life difficulties and therefore aren’t always able to engage in a therapeutic relationship. In a therapeutic voice lesson, the participant is engaging in a therapeutic relationship not only with a board certified music therapist but also with the music. More importantly, he/she is also engaging with the self through his/her experience of the voice. So, where you live in your body your voice lives in your body.

We have so many defense mechanisms, both adaptive and maladaptive, that manifest in the physical body and therefore affect the vocal musculature and function. We start to compartmentalize our voices as we do our thoughts and feelings. We become unaware of how we use our voices as we do our thoughts feelings as well. Therefore, when we start to use our voices in UN-habitual and exploratory ways we start to make discoveries and develop insights into how life and development has affected the voice and the psyche.

So, who is appropriate for therapeutic voice lessons you ask? Well, maybe you. As a musician and singer, voice teacher and music therapist, I have heard these words many times: “I wish I could sing…” For many people that is where it ends. People only wish. They wish, but they don’t act on it for many reasons. But I bet you the biggest reason is because they just don’t know what they are going to “do” with voice lessons especially if they aren’t going to perform. Music-making is, most of the time, NOT about performance. It’s about process. Therapy is NOT about a destination. It’s about process. Many people love to sing. Many people need therapy. Why not have both? Why not learn a skill and gain insight at the same time? Why not have an experience in beauty while working through sometimes painful life events?

Singing is not just for the shower, the car (with the windows up) or American Idol contestants. And therapy is not just for the leather couch. We all have a voice and we all deserve to be heard. Moreover, we all deserve to be expressive, SING and be in a safe environment while doing so.

Questions? Comments? Feel free to leave a comment on this blog or email me at tori@tempotherapy.com

The quick answer is YES! Yes your child can participate in a structured yoga program. Yes they will be successful. And yes you can help them even if you have never practiced yoga before.

I’m sure most of us know what yoga is and may even be familiar with the different types of yoga out there. So here’s what it means to me and why I think it can be beneficial for individuals with special needs. Yoga is a means of connection…connection with the self and therefore a means of connecting with others. It supports one’s ability to connect breath with body, body with mind, and then one’s mind with one’s inner self that many might refer to as spirit or soul or heart or fill in the blank. This is possible no matter what your ability.

Thankfully, there’s a plethora of research out there about sensory integration now and the benefits of it. What could be more appropriate then to try a physical practice like yoga using the living, breathing, feeling, sensory-based human organism? One of my teachers taught me, “Yoga isn’t something we do. It’s something we experience.” We can all experience the movement of our breath. We can all experience the movement of our bodies. What’s even more beautiful about it is that we can all experience it together. Publically. In a room with others of all different abilities because there’s NO YOGA OLYMPICS! There’s no test or evaluation or even a competition. Yoga is about operating at one’s present ability no matter what that might be.

So if your child has special needs and you’re not quite sure if he/she would be able to participate in a yoga group, try this…try having them take 3 deep breaths. Moreover, don’t just tell them to take deep breaths. Do it with them. They might not be able to do it at first, but maybe you might struggle with it at first too. Hold his/her hands. Look at them whether they give you eye contact or not and direct your breath. Focus on your child and the present moment and tell them you are doing so. Try it once a day for a week. What do you notice? How do you feel? How does your child feel? If you can do that, you are practicing yoga and mindfulness. To quote Jon Kabat-Zinn, “Mindfulness means paying attention in a particular way; on purpose, in the present moment and non-judgmentally.”

In closing, keep your eye out for some yoga offerings in the future. A good yoga class is one where individuals feel a sense of safety in the environment. We are here to provide that no matter what we offer. There’s more to come on yoga and the special needs individual. Stay tuned!

I sit here at home on a day off, though it seems like it’s more of catch-up time than leisure. I spend a little over half my waking hours as a general pediatrician, delving through a combination of check-ups, illness visits, form completion, personnel and parent hand-holding, and returning phone calls. Don’t get me wrong; I love my job and enjoy the challenges and satisfaction of helping other families. This brings me to my family. I have a wife, and 2 teens: a son and daughter. We are meandering the process of planning my daughter’s entrance into college this fall. Ah!..I believe she just secured here roommate situation. She has locked into a school, needless to say.

One of the biggest ongoing challenges is my son, who has high functioning autism. He is in 9th grade, in a public school combination inclusion and learning support. He has numerous outside and inside school supports, therapies and activities, for the most part which he enjoys. He takes a number of medications for behavioral and learning enhancement, which usually work well for him. Still, it can be stressful and frustrating and times embarrassing for my family and I to deal with him. Still, he is usually charismatic and good-natured. Plodding through his homework is frustrating today. I’m filling in for my wife on my day off, since she is dealing with a hospitalized (but improving) father. I often, when at home, reflect on my job as a pediatrician, treating other children with autism, and visa versa while I’m working. A number of parents in our community and my practice often seek out my input on the perspective of both practitioner and parent dealing with autistic youth. I will continue to reflect and report on my adventures with these perspectives.

Tempo! thanks Dr. Salomon for his contribution to our blog, offering a unique perspective on important issues many of our families face. We look forward to your comments and his future contributions.

Have you ever visited someone in the hospital or long term care facility and heard someone playing music for an individual or group of patients? Who was that person? Was he or she a volunteer musician or were they a Music Therapist?

You might think that who the person is and what their position is might not matter. Music can be a tool for distraction, a source of comfort, and a vehicle for focus. But it really does matter who is providing the music intervention. Music is powerful and can conjure up emotions and emotional reactions. While research shows that music can aid in pain management and the expression of difficult emotions, music therapists are uniquely qualified to identify and treat the many issues that face individuals in the hospital or long term care facility.

Music therapists and volunteer musicians bring their love of music to those in need. The most important distinction between the two groups is the educational training of a music therapist. Music Therapists have bachelors, masters, or doctoral degrees from accredited music therapy programs at colleges and universities across the country. They are accomplished musicians in guitar, voice, and piano among other instruments and are trained in treating the psychological aspects treating patients, helping them to process their emotions. Music therapists also learn skills akin to counseling which are used to help patients communicate how they are relating to the music. This type of intervention helps to maximize the benefits of the musical interaction by providing a sense of closure.

For more information on music therapy visit:
www.musictherapy.org
www.tempotherapy.com

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.

While walking into my very first Music Together® class at Granite Farms Estates, an assisted living center in Media PA, I had many questions running through my mind. “How is class going to go?” “How will the residents interact with the children and vice versa?” “How will two very different generations find some common ground?” Over our ten-week semester, I found the answer to pretty much all of these questions in the title of our program, “Music Together.”

It is said that music is a universal language. Not only does it transcend cultures, it transcends through generations as well. One of my favorite class experiences came when I experienced some “technical difficulties.” I had forgotten to bring my CD player to class that week, and wondered what I was going to do for the big instrument play along. When the time came to pass the instruments out, I pulled out my guitar, and began to sing “I’ve Been Working on the Railroad.” I looked around the room and realized everyone was singing with me! We had found a song that stretched for four generations, the children, their parents, their grandparents, and our “grand-friends” (who are the generation of many of the children’s great-grandparents) We had many great experiences throughout the ten week semester, but that was one of my favorites!

Throughout the semester, I watched as the children became the helpers, and passed out the instruments to the grand-friends. During class, they would come up to the grand-friends to trade an instrument or share a smile. A six-month old baby shook a maraca with a ninety-nine year old woman. A woman who had taught elementary music for thirty years watched children get their first taste of rhythm and harmony and remembered sharing those experiences with her students. As the weeks went by, I noticed our grand-friends were walking out of the room singing the “Goodbye Song.”

I was also very grateful to have my own mom and son share in this experience with me. I think that we all learned a lot and enjoyed ourselves! Four generations of people made music together, and any thoughts or concerns I had vanished simply by experiencing the music together.

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.

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.