Sessions That Are Working

Before the holiday weekend this past week, I had an newsworthy session with my most challenging client – let’s call her T. A few days before our scheduled session, I received an exciting text from a family member of T’s saying, “She has been waking up the last 3 mornings and verbalizing ‘mo’ for ‘Good Morning’! It has been consistent each day”! This was the best news I had received from the family since I started working with them 5 months ago.

One of the biggest challenges I have met while working with T is the complete mystery of getting to know someone and their preferences through limited eye contact, no motor movement, and no verbalizations. The best way I could make decisions was based off whether or not she laughed at a choice. Laughter had been meaning “yes” and no laughter had been meaning…? No? Maybe? Undecided? No opinion? I began to become frustrated with myself and my inability to read minds as I struggled to determine the music she connected with the best. It also happened to be that her family, aids, and past therapists were suggesting contradicting musical choices. Country? Rap. Contemporary Christian? 1990’s pop. New Age Relaxation? I have tried just about everything.

And like most humans, most days it appeared that T’s preferences changed based off of her mood. Except, how could I best determine her mood? Once, during our Hello Song, I gave her a couple of mood-based choices, or feelings, with the help of the Feelings Flashcards [which, by the way are amazing. Check them out here if you are missing a manipulative like this]. When we got to the feeling of “sad”, she laughed. Alright! She made a choice based on the above defined communication skills. But, if she was sad, why was she laughing? I could not make a determinate decision that “sad” was the feeling she was experiencing based on the contradicting facial affect and responses. So, how does that help with choosing our music for the day?

To hear that T had begun to verbalize was the most amazing news. I began to wonder how much my role as her music therapist had played into her ability to produce that “mo” sound each morning? I’ve stated in other posts that T’s progress is one that has been extremely gradual. At the end of a session, her progress is documented in the finest of details, because that is where you can see the progress. If you look generally at her goals, you might think that she will never get there, which is also what her doctors and therapists said at the beginning of her recovery 5 years ago.

With some research, I began to implement more structured beginnings to our sessions to encourage her best ability to participate fully in the interventions and exercises planned. After our Hello Song, we started with stretching/warming up. We all do this with everything else in life when working on goals, so why would I let T’s inability to stretch on her own change this? I began to notice that she often relaxed during these simple hand-over-hand stretches, occasionally appearing to drift off. Allowing her body, which is always so rigid and unable to move, to become relaxed is an important key to working towards various goals. Stretching is quickly followed by breathing exercises, which may seem complicated for someone who has little control over their mouth, tongue, throat, and body, but this is the first exercise that I really began to see her concentration and determination to focus. In our NMT (Neurological Music Therapy) styled breathing exercises, I began to receive the most sustained eye contact T has ever given me. Breathing exercises are then followed by some OMREX exercises, focusing on oral motor movement and facial shapes. For weeks, we had been working on these exercises, with very small, incremental responses.

Until now.

However, when I say T is “verbalizing”, I mean simply that she is now producing sound. It is amazing how we take our ability to communicate for granted. When that ability is gone, a moan, grunt, or audible sigh can be the biggest breakthrough. Our session last week was the most alert and enthusiastic I have ever seen T. Not only did she continue to make sounds throughout the session, but she began to slowly produce these noises on cue in one or two exercises.

I am confident that, in combination with T’s other therapies, music therapy has played a large role in her progress. Below, is one of my favorite videos that puts everything we learn in music psychology and neuroscience into simple, straightforward, layman’s terms. If you have ever been confused, doubtful, or have had reservations about music therapy, its research, and evidenced based practice, please, do yourself a favor and watch the video below.

“Playing music is the brain’s equivalent to a full body workout”. For T and her traumatic injury (TBI), her brain needs all the exercise it can get to heal and re-learn the skills she was meant to have.