Music Therapists Do It Differently: Supporting Movement

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 ten of a ten-part series. You can find an introduction and links to all ten posts here.

(P.S. Are you loving this series? There’s more where that came from! Jump on our email list for specialized, exclusive content, just for subscribers. Click here to subscribe.)

Our bodies have a natural tendency to move with music. In fact, classical music concerts are kind of weird for the expectation that people are to sit quietly in assigned seats. The truth is music and dance have almost always gone hand in hand, in cultures around the world. It just feels natural – and really darned good – to move in time with music. You could even say that moving to music is musical all by itself.

"Methinks it's time for a conga line."

“Methinks it’s time for a conga line.”

Still, dancing and moving to music are not that common in the live music situations you might encounter in an eldercare community. Most often, I see folks listening quietly to entertainers, applauding quietly at the end of each song. When it gets a little jazzy, you might spy a few people tapping their toes, or clapping to the music if the performer tells them to. If you’re lucky, some brave soul may stand up and start dancing to the music, and for a brief but brilliant second, you think maybe a dance party is going to get going. On the other hand, if the poor entertainer is performing during a party while people are being served refreshments, her audience will be too busy with conversations and snacking to get into dancing.

I’m not sure why this is. Do we expect our elders to be polite and sedate? Are they just tired or hurting to the point that moving doesn’t feel good? Or are our seniors embarrassed to be seen moving the way they do now, rather than how they did decades ago?

In any case, I know two things to be true:

  1. Most people should be moving more. Research has demonstrated that regular physical activity can lead to improved mobility and strength,  better sleep, preserved cognitive functioning, decreased depression, and stronger feelings of self-efficacy and personal control. Yet adults over the age of sixty-five are the most sedentary age group.
  2. Moving your body as a form of musical expression feels great. People have always known this on a human level, but now neurological research is starting to show us why movement and music go together so well, too.

This is why I deliberately encourage movement to music when I am doing live music with older adults. Rather than just hoping for people to “get into the music” and move spontaneously, as you might do in an entertainment-oriented program, I view movement as an important form of musical communication and consciously facilitate movement to music. This is one more way that music therapists do live music differently.

#10. Supporting Movement

Sometimes music therapists are very direct in facilitating movement to music with verbal, visual, or tactile cues; and sometimes music therapists focus on reflecting and amplifying the movement that arises spontaneously for people that are doing music with us.

Let me share some examples of how this works.

Directing Movement

Imagine Janet’s music therapy group in a memory care community. One song fitting into her “weather” theme is “Over the Rainbow.” Knowing that the wide range of this song makes it difficult for many of her clients to sing, Janet plans to integrate movement with this song. She demonstrates expressive arm movements to match specific lyrics (e.g. reaching one arm over the head to draw a rainbow shape for “somewhere over the rainbow”), then leads the group by singing a cappella and demonstrating the movements visually. When participants have the arm movements learned well, Janet adds a guitar accompaniment, for an even more layered musical creation.

Planned movement experiences could work in a one-on-one session, too. For example, maybe Jennifer knows that her hospice patient Maude craves touch. Rather than playing guitar, Jennifer often holds Maude’s hands and sings a cappella. When Maude seems to have the energy, Jennifer says, “will you dance with me?” and sways Maude’s hands gently while singing, “My Bonnie Lies Over The Ocean.” If Maude resists this movement or feels tense, Jennifer stops dancing with her, but on some days, Maude seems to take over moving to the beat. Jennifer notices that Maude is more likely to make eye contact and smile on these occasions.

Reflecting and Amplifying Spontaneous Movement

Of course, those planned experiences aren’t the only ones that get participants moving to the music. Perhaps Janet is playing “Singin’ in the Rain” as several residents sing along, and she notices that Glenda, who is usually pretty withdrawn, looking up in her direction and kind of waving her fingers to the beat. Janet says, “you’ve got the beat, Glenda!” and taps her guitar in imitation of Glenda’s movement. In this case, Janet is supporting movement in a different way: reflecting and amplifying Glenda’s movement.

Again, the same thing can happen in one-on-one sessions, too. Perhaps Jennifer notices Joe nodding his head slightly to her rendition of “Hound Dog.” Jennifer mirrors his rhythm, swaying to the beat while continuing to sing and play guitar. Seeing Joe’s movements get even bigger and more deliberate, Jennifer abruptly mutes her guitar on the line “you never caught a rabbit,” then points at Joe and sings, “and you ain’t no friend of mine.” He smiles broadly and points back at her, while Jennifer strums an appropriately rock-n-roll beat to end the song. Here, Jennifer was amplifying Joe’s movement and showing him where to add an accented movement, too. Now Jennifer and Joe are collaborating in the music on a new, deeper level.

Helping music therapy clients move to music means that they can shift from passive listening to more active engagement in the music-making. What’s more, music therapists see participants’ movement as being an essential part of the music itself.

Facilitating movement to music is one more way that music therapists do live music differently.

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“You Are Here” – A Song From The Perspective of Someone with Early-Onset Alzheimer’s Disease

A while back, I shared a song with you written by Bakhus Saba, a caregiver who had just gone through the heart-wrenching experience of placing his mother in a care facility due to her worsening Alzheimer’s Disease. Now, Bakhus has another song to share. This one is written from the point of view of someone with early-onset Alzheimer’s Disease, with music by Karen Morand, and lyrics by Karen Morand, Dale Butler and Bakhus Saba. With their permission, I have shared the studio recording and the full lyrics below:

You Are Here

God knows what’s happening here
I’m all alone in my fear
“Early onset” is what I’ve been told
I’m too young to be old

All the memories I’ve known
Are fading into the unknown
The life I lived with the people I love
Are ghosts that haunt me now
And I need to know somehow…

You are here
You are near
Hold my hand
One thing remains through the year
You are here.

I look in the mirror and what do I see?
The eyes of a stranger stare back at me
The look is familiar but something is wrong
Like an old forgotten song
Can you help me sing along?

You are here
You are near
Hold my hand
One thing remains through the year
You are here.

All that I know is this moment right now
You may be a stranger but love me somehow
In time you will get to know
Love’s hardest lesson is in letting go

One day you’ll pack up my things
I’ll leave you behind spreading my wings
Forgetting confusion, losing the pain
But I’ll remember your name
And I’ll love you just the same

You are here
You are near
Hold my hand
One thing remains through the year
You are here.Old woman looking in mirror

Bakhus shared with me that this song had a few sources of inspiration, including the novel Still Alice and the story of Jan Petersen, a former CBS foreign correspondent. He also said that the second verse came from his own experience of his mother not recognizing herself in the mirror.

Personally, my favorite line came in the second verse: “The look is familiar but something is wrong/Like an old forgotten song/Can you help me sing along?” I often get to help people sing along to songs they thought they had forgotten, and I know that music can bring back memories in other ways, too. I feel privileged to be together with people at those times.

I hope you find this song as achingly beautiful as I did. If you haven’t already, make sure you hear Bakhus’s song “Still A Child,” too.

Music Therapists Do It Differently: Adding Instruments

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 nine of a ten-part series. You can find an introduction and links to all ten posts here.

(P.S. Are you loving this series? There’s more where that came from! Jump on our email list for specialized, exclusive content, just for subscribers. Click here to subscribe.)

If you’ve been keeping up with this series, I’m sure you’re getting the point now:

Music therapists don’t just stand up, strum, and sing.

When we do live music in clinical sessions, we aim to relate to and interact with our clients through the music, based on their needs and goals in that moment. Sometimes, our clients are mostly listening, in what we call receptive music experiences. But other times, clients become more active participants in the music-making:

#9. Adding Instruments

One key way that people can become more actively involved in musicking together is by playing instruments. As do most music therapists, I carry around bags of rhythm instruments in my car, and I always have a drum or shaker or two with me when I see a client. I don’t always use instruments, however, and this aspect of live music is not as simple as handing out the instruments and asking folks to play.

It takes clinical skill to choose when and how to invite people to play instruments.

"Nice drums!"

“Nice drums!”

Here are some questions I ask myself:

1. Is this respectful and age-appropriate?

For some clients, playing an instrument may be a rewarding way to contribute to the music, but for others, it may feel childish. Much of this has to do with the instruments we use and how we frame the music experience.

In my practice, I use the highest-quality, most ethnically-appropriate instruments I can. So, I might bring in tambourines and frame drums with mallets, then support participants musically as they find the beat to an Elvis Presley song.

By contrast, if you hand someone a cheap plastic maraca and urge them in a high-pitched, preschool-teacher voice to “shake it, Mary, shake it!” – that may feel demeaning or childish. Then again, pairing cheap plastic maracas with virgin maracas at your Cinco de Mayo party may be just the right kind of fun. (See – these decisions take forethought!)

2. Is this musically-enhancing or distracting?

Sometimes, playing an instrument enhances a client’s engagement in the music, allowing them to play an important role in the music even if they can’t or don’t want to sing along. But sometimes the instrument causes a distraction.

Having too many instruments, or participants who struggle with finding the beat, can turn the whole session into more noise than music. Or, someone may be engaged by playing a drum for a song or two, but then feel too tired to keep playing. The music therapist may decide to use fewer or different instruments, to have fewer people play at one time, or to give people permission to listen for a while rather than play.

3. How can I support their music-making best?

Beyond deciding when and with whom to use instruments, the music therapist also has to determine how best to support a client’s music-making experience. Are we going for exploration of various instruments? Syncing rhythms across a group? Playing in parts, like a small ensemble? Targeting particular physical needs? Pointing back to a verbal discussion? (P.S. These musical decisions can point back to creative, social, cognitive, physical, and emotional goals, respectively.)

Always considering what the client’s needs or goals happen to be, music therapists are deliberate in choosing when and how to use instruments in live music-making experiences with clients.

That’s another way music therapists do live music differently.

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We Are Music Therapists

SM Advocacy Badge 2012_250x250Music therapists offer something very different from what other healthcare professionals offer. The difference? We work in and through music.

For a society and a world that is used to seeing music primarily as entertainment, thinking of music as a measure of health and a medium for healing may seem a little bizarre. So, we often rely on metaphors and analogies to explain what we do.

The thing is, the analogies aren’t sufficient. We aren’t just like OTs or PTs or psychotherapists who happen to use music as a tool in our work. We aren’t simply talented musicians who happen to have a lot of empathy and enjoy working with special populations. Rather, we music therapists have a unique therapeutic approach and set of skills based on the high level of clinical musicianship we reach through our education and training as music therapists.

January is Social Media Advocacy Month in the music therapy world. If you haven’t done so already, I encourage you to read the post below from Judy Simpson, AMTA’s Director of Government Relations. The time has come for us to stand firmly in the knowledge that what we offer is unique and valuable.

There is no comparison.

—————————

We Are… Music Therapists!

By Judy Simpson, MT-BC – Director of Government Relations, American Music Therapy Association

When I started my career as a music therapist in 1983, it was not uncommon for me to describe my profession by comparing it to other professions which were more well-known. If people gave me a puzzled look after I proudly stated, “I use music to change behaviors,” I would add, “Music therapy is like physical therapy and occupational therapy, but we use music as the tool to help our patients.” Over the years as I gained more knowledge and experience, I obviously made changes and improvements to my response when asked, “What is music therapy?” My enhanced explanations took into consideration not only the audience but also growth of the profession and progress made in a variety of research and clinical practice areas.

The best revisions to my description of music therapy, however, have grown out of government relations and advocacy work. The need to clearly define the profession for state legislators and state agency officials as part of the AMTA and CBMT State Recognition Operational Plan has forced a serious review of the language we use to describe music therapy. The process of seeking legislative and regulatory recognition of the profession and national credential provides an exceptional opportunity to finally be specific about who we are and what we do as music therapists.

For far too long we have tried to fit music therapy into a pre-existing description of professions that address similar treatment needs. What we need to do is provide a clear, distinct, and very specific narrative of music therapy so that all stakeholders and decision-makers “get it.” Included below are a few initial examples that support our efforts in defining music therapy separate from our peers that work in other healthcare and education professions.

  • Music therapist’s qualifications are unique due to the requirements to be a professionally trained musician in addition to training and clinical experience in practical applications of biology, anatomy, psychology, and the social and behavioral sciences.
  • Music therapists actively create, apply, and manipulate various music elements through live, improvised, adapted, individualized, or recorded music to address physical, emotional, cognitive, and social needs of individuals of all ages.
  • Music therapists structure the use of both instrumental and vocal music strategies to facilitate change and to assist clients achieve functional outcomes related to health and education needs.
  • In contrast, when OTs, Audiologists, and SLPs report using music as a part of treatment, it involves specific, isolated techniques within a pre-determined protocol, using one pre-arranged aspect of music to address specific and limited issues. This differs from music therapists’ qualifications to provide interventions that utilize all music elements in real-time to address issues across multiple developmental domains concurrently.

As we “celebrate” 2014’s Social Media Advocacy Month, I invite you to join us in the acknowledgement of music therapy as a unique profession. Focused on the ultimate goal of improved state recognition with increased awareness of benefits and increased access to services, we have an exciting adventure ahead of us. Please join us on this advocacy journey as we proudly declare, “We are Music Therapists!”

About the Author: Judy Simpson is the Director of Government Relations for the American Music Therapy Association. She can be reached at simpson@musictherapy.org

How Ice Music Is Like Music Therapy

This morning I heard the most fascinating story on NPR’s Morning Edition, about the annual Ice Music Festival in Norway.

Each year, Norwegian composer Terje Isungset works with his American collaborator Bill Covitz, who makes marimbas, chimes, cellos, and even horns out of ice. In the video below, you can see how these unique instruments are constructed and hear the hauntingly beautiful music created as musicians make the ice sing. (Start at 4:30 to hear the music while they finish constructing the ice cello.)

So how is ice music like music therapy?

I definitely see a parallel between the process of music therapy and the process of creating music from ice.

Think about it:

Ice is beautiful and natural, but it didn’t go to Julliard. Beautiful music doesn’t happen immediately. Rather, it takes a process – and someone dedicated to the ice itself – to make the music come alive.

But that’s not to say that music clients are cold and stiff objects for the music therapist to “work on.” That’s where this metaphor gets really great.

No, the ice isn’t just sitting around waiting for someone to carve it to specifications fit for the ice festival stage. In fact, Isungset and Covitz can’t use man-made ice. They must work with the ice in all of its imperfect, natural iciness to bring out the beauty it has to offer.

This is true for the musicians, too. Says composer Isungset, “you cannot go on stage and expect a certain song. You have to play with the sound that the instrument actually can make, then try to create good music out of this.” In fact, the very instruments change as they perform. As Isungset noted in his interview, the heat generated by holding an instrument or blowing warm air into it changes its tuning. The very act of making music changes the ice instrument, and the instrument itself changes the music.

This is just like music therapy!

Just like the ice instruments, clients come with beauty to discover, despite – or because of? – whatever challenges or “imperfections” they might have.

Just like the ice carver and composer and musicians, music therapists come with plenty of knowledge and skills to offer, but no fail-proof blueprint for therapy success, and plenty of their own challenges and imperfections besides. The therapist must be prepared to work with the client and whatever he or she has to offer.

And the music? Just like the ice music changes as the instruments themselves change through construction and performance, the music in a therapy session changes as the client and music therapist change through making music together.

Then, the beauty that results from the therapeutic process can be just as breathtaking as music made from ice.

Music Therapists Do It Differently: Verbal Interaction

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 eight of a ten-part series. You can find an introduction and links to all ten posts here.

(P.S. Are you loving this series? There’s more where that came from! Jump on our email list for specialized, exclusive content, just for subscribers. Click here to subscribe.)

Music therapists talk a lot.

At least, we don’t spend ALL our time playing music, at least not usually. Verbal interaction is a crucial part of what happens in music therapy sessions. And, music therapists do verbal interaction differently from other professionals.

#8. Verbal Interaction

Consider two of our sister professions:

For performing musicians, the music is the point of their professional work. They may use speech as banter, as a bolster to the entertainment value of their show, but it’s probably considered to be ancillary to the music itself. This is especially clear in a classical concert, where you’ll hear very little speech. The conductor comes out, the orchestra plays, the conductor bows and everyone leaves. No jokes, no history lessons – just music.

"What are they talking about?"

“What are they talking about?”

On the flip side, for therapists who primarily work verbally – psychotherapists, social workers, counselors, and others – the verbal discussion is the point. They may use music as an added element in their sessions, but it is likely that the intention is to have that music start a meaningful discussion. Communicating through the music itself is not the intention.

For music therapists, though, music and verbal interaction are both integral parts of the therapeutic process. In fact, one of the major strengths of our medium of therapeutic interaction is that we can move back and forth between non-verbal (musical) communication and verbal communication as appropriate. And, as usual, these decisions are based on the needs and goals of the clients.

How do music therapists do verbal interaction differently?

Imagine a hospice music therapy session. The music therapist, Karen, is talking with Pat, a woman in her 80s who loves the gospel music of her rural Baptist church. In one session at Pat’s bedside, singing “How Great Thou Art” leads to a conversation about Pat singing in the church choir, which leads to her and Karen singing “Just A Closer Walk With Thee” and “Precious Lord, Take My Hand.” The session flows easily from music to conversation and back.

On another day, though, Pat is not chatty at all. Karen offers to sing “Precious Lord, Take My Hand,” and Pat agrees, but she doesn’t sing along, and her eyes glisten. At the end of the song, Karen pauses, waiting for Pat. After a few moments, Karen prompts Pat gently, saying, “what’s on your mind?” Pat responds that she’s just feeling tired today, that she’s “ready to be with Jesus.” Then, Pat closes her eyes and turns her head away.

What is Karen thinking about during these sessions?

1. Deciding When To Talk

Of course, the first decisions are whether to communicate verbally or musically, and whether to talk or to listen. In Karen’s first session with Pat, the conversation and music were feeding into each other easily. Here, the goals may have been assessment, establishing rapport, or facilitating reminiscence. Karen was likely mindful of gathering information about Pat that could be important in future sessions – her musical background and preferences, her spiritual background – as well as communicating an unconditional positive regard while engaging in music together.

Deciding whether to talk would have been trickier in the second session, when Pat was quieter and the session had more frequent silent moments. At the end of “Precious Lord, Take My Hand,” should Karen have started in on another song? What comes next – music? Silence? Talking? The end of the session? All of these are questions that the music therapist would have to consider in the moment, while thinking about the client’s needs and goals at that time.

2. Choosing What To Say

Beyond deciding whether to talk or not, the music therapist must consider the content of what she says carefully. For instance, after that silent moment with Pat, Karen could have said a number of things. She could have made a cheerful comment about how pretty the song was. She could have chided Pat for not singing that day. She could have suggested another gospel song, to get back into singing as quickly as possible. Or, as she did, she could have given Pat an opening for verbal interaction on another level.

The same choices applied after Pat made her statement about being ready to go to Jesus. Karen could have encouraged more verbal interaction. She could have let the silence stand longer. She could have chosen a song that validated Pat’s statements, to communicate empathy and acknowledge Pat’s spiritual beliefs, like “Peace in the Valley.” Or she might have jumped back into singing something to shift the mood, maybe something more upbeat.

What would have been the “correct” decision? It’s impossible to say, without being in that session at that time. In any case, Karen would decide what to say based on Pat’s needs in that moment.

3. Refining How We Say It

Deciding on verbal interaction vs. music vs. silence, then deciding what words to say – that’s tricky enough. But another level of nuance comes with how we say what we say. Doing music therapy can never be as simple as following a decision tree or a strict protocol, saying, “if Client says x, then MT sings y. Then MT says z with great empathy while patting Client’s left hand.” Rather, all of the music therapist’s experience and training and intuition come into play as he/she decides what to say or sing or do, and how to sing/say/do it.

This is frustratingly difficult to describe. So, here is where I find it especially helpful to think of music therapy sessions as being MUSICAL from start to finish, regardless of the level of silence or verbal interaction involved. As any musician knows, beautiful music is made of more than playing the correct notes and rhythms or singing the correct words. So it goes for music therapy sessions – the value of the whole music therapy session is more than the sum of the words we say and the songs we sing.

Verbal interaction is one important piece of the entire picture of the therapeutic relationship in music therapy.

That’s how music therapists do verbal interaction differently.

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Two Songs for the Holidays: One May Hurt, One May Help

The holidays can be an especially difficult time for those of us who can’t be HOME for Christmas. Sure, home means different things to different people, whether you’re a soldier deployed in Afghanistan, a young worker who can’t afford a plane ticket to mom and dad’s house, or an older woman in assisted living whose home was sold years ago. Wherever home is, though, if you can’t be there for the holidays, it hurts.

Today, I spotlight two songs about being home for the holidays. The lyrics have a similar message – that home is the best place to be for Christmastime – but the emotional underpinnings and context for each song are very different. Let’s compare and contrast these two songs:

320px-Writing_a_letterI’ll Be Home For Christmas

Written in 1943 with lyrics by Kim Gannon and music by Walter Kent, “I’ll Be Home For Christmas” was a top ten hit for Bing Crosby. It’s sung from the point of view of a solider fighting overseas for World War II. The listener imagines this soldier writing a letter home to his family, painting the picture of  a cozy, traditional family celebration complete with snow and mistletoe and presents under the tree. It’s in the very last line that the soldier admits to his reality: “I’ll be home for Christmas/if only in my dreams.”

The tone of this song is melancholy and wistful. Even if the lyrics seem optimistic on their surface, the music acknowledges what was true for the soldier in the original context, and what is true now for anyone else who can’t get home for Christmas: Sometimes all you can do is imagine the beautiful and perfect holiday that’s happening too far away.

(There’s No Place Like) Home For The Holidays

Wreath on fence in snowBy contrast, the 1954 song “Home for the Holidays” is pretty darn chipper. With music by Robert Allen and lyrics by Al Stillman, the song first was a hit for Perry Como. Later, The Carpenters and Barry Manilow recorded popular cover versions of this song.

The lyrics of this song focus on traveling home for a holiday celebration. The singer tells us about people traveling from all corners of the U.S. to get home. The song urges the listener to take a bus, a train, an airplane, or even the family car to get there, saying, “for the pleasure that you bring/when you make that doorbell ring/no trip could be too far.” The musical context is upbeat, too. It starts with a sentimental tone in Bing Crosby’s version, then takes on a jaunty and cheerful spirit. There is no mistaking the message here: Home is the best place to be, and if you want to be happy, you’d better get on your way.

Both songs anticipate a picture-perfect holiday celebration to come, but only one expects you to be there for the experience.

Certainly, there is a place for both songs. When you’re in a cheery, holiday mood, it’s wonderful to have cheery music to play and sing. “Home for the Holidays” is on my playlist for decorating the Christmas tree and driving to relatives’ house for holiday celebrations.

If, however, you’re caring for someone who can’t get home to the holiday celebrations they want, or if you can’t get home yourself, it’s worth considering which of these songs may provide comfort and which may cause heartache this year. Perhaps the message of “I’ll Be Home For Christmas” can provide some solace.

As the seasons of life come and go, each of us will have times to be home, and times when we are very far away. I hope that we all can find peace wherever we are this year.

10 Less-Than-Jolly Songs For Christmas

Stressed young woman in front of christmas treeSometimes the holidays are wonderful and perfect and picturesque.

Sometimes they are heartbreakingly, bone-crushingly painful.

The cultural messages we hear don’t leave much room for sadness or anger or grief. The decorations are relentlessly cheery. (In our neighborhood, there’s an electric Santa waving to cars passing by all night long!) The commercials on TV and radio tell us to buy, buy, buy for the people we love. Even the Hallmark movies always end with a picture-perfect ending.

As my colleague Kimberly Sena Moore wrote, some holiday music can be hurtful. There is this cognitive dissonance there – our minds telling us that we should be cheerful, but our hearts not feeling cheerful at all.

Fortunately, music can contain and express a lot of different emotions, and there are holiday songs that portray all of the complex emotions we may have this time of year. Here are ten of them:

1. I’ll Be Home for Christmas

Bing Crosby made this song a top ten hit in 1943, and on the surface, it seems to paint the picture of an idyllic family Christmas celebration. It’s in the last line that we see the complication here: “I’ll be home for Christmas/If only in my dreams.” This song was meant for military members serving overseas, but it can be just as meaningful for anyone who can’t be home this year.

2. Have Yourself a Merry Little Christmas

Another wartime tune, “Have Yourself A Merry Little Christmas” was sung by Judy Garland in the 1944 film Meet Me In St. Louis, in a rather sad scene where the family is preparing for a move to New York City, away from their beloved St. Louis. Military members, who had the very real understanding that they may or may not see another Christmas, were brought to tears by Judy Garland’s performance of lines like this: “Someday soon we all will be together / If the fates allow / Until then we’ll have to muddle through somehow / So have yourself a merry little Christmas now.” Later on, Frank Sinatra asked the songwriter to “jolly up” that muddling through line. His version, including the line, “hang a shining start upon the highest bough” may be the one you’re more familiar with, but the melancholy roots of this song remain.

3. Christmas Ain’t Like Christmas Anymore

Among the holiday songs about lost relationships is this one by Kitty Wells. The lines, “Holidays are lonely days for me/No, Christmas ain’t like Christmas used to be” and, “This lonely house don’t need no mistletoes/For I’m the only one that comes and goes” surely speak to the loneliness that many feel during this season, in Wells’s poignant country style.

4. Good Morning Blues

Also about lost relationships, this song is a plea for Santa Claus to send her love back home to her. This is a blues song, yes, but it’s hard not to like Ella Fitzgerald’s beautiful, jazzy rendition.

5. Blue Christmas

This Elvis Presley hit may be about a lost romantic relationship, but I hear the words of grief and loneliness in the lines, “Decorations of red on a green christmas tree/Won’t be the same dear, if you’re not here with me.” (I wrote a longer post on this song here.)

6. In the Bleak Midwinter

This song, based on a 19th century poem by Christina Rossetti, paints a starker Christmas picture than we are used to these days. You can almost feel the cold wind blowing in this song, and the lyrics speak to the intimate, very human scene of the Christmas story told in the Bible. Part of the last line strikes me as comforting for someone who wants to be a part of the Christmas celebration but who just can’t be jolly: “What can I give him/Poor as I am…Yet what can I give him?/Give my heart.”

7. Coventry Carol

Dating from the 16th century, the haunting minor melody of this song is from a mystery play once performed in Coventry, England. The lyrics of this carol refers to the Massacre of the Innocents, a dark event in which Herod ordered the killing of all male infants under the age of two in the city of Bethlehem. This beautiful song is, then, the lullaby of a mother for her doomed baby boy. Without delving into Christian history and theology, we can definitely say this: not all Christmas music is cheery.

8. Still, Still, Still

Add to the list of quiet, introspective holiday songs this 19th century Austrian carol. Although it does not speak to the grisly scene depicted in the Coventry Carol, this lullaby paints the picture of the un-self-conscious, quiet intimacy of mother and child, in stark contrast to the holly jolly songs we hear on the radio.

9. Mary, Did You Know?

For Christians, this season is a time for remembering the birth of a savior, so several Christmas songs hint at the ministry, death and resurrection of the man that little baby grew up to become. If Christian faith is important to you, reflecting on this part of the Christ story may bring the meaning you are searching for in this season. This song speaks especially to mothers and the uncertainty and pain that can come with that role.

10. I Wonder As I Wander

This folk song was collected in the 1930s, and it too speaks to the larger theological implications of the Christmas story as understood by Christians, that God came to earth in human form to suffer and die just as any human does. For people who are wondering about suffering and pain this time of year, this song may provide comfort, at least from knowing that others have wondered about this topic, too.

No matter what kind of Christmas you expect to have this year, I am wishing you peace for this season and the year to come.

Music Therapists Do It Differently: Sound and Silence

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 seven of a ten-part series. You can find an introduction and links to all ten posts here.

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In a music therapy session, you should not expect to hear a wall of sound from start to finish. In fact, you may be surprised at how much “non-music” time happens during the session.

Contrast a typical entertainment event at a nursing home with a music therapy session.

"Why did she stop playing? Isn't she still on the clock?"

“Why did she stop playing? Isn’t she still on the clock?”

Say you hire a pianist for your nursing home’s holiday party. You likely expect that person to show up early enough to start playing at the 2:00 party time and to continue playing until the party ends at 4:00. Yes, it’d be nice to see the performer tell jokes or share fun facts from the stage, but you probably don’t expect them to chat with the residents individually, and you might be a little irked if they stepped away from the piano for more than a couple of minutes. The entertainer is there to provide music, and that’s what you want to see. Plus, you probably expect the audience members to chat with each other as they enjoy their hot toddies.

Music therapists work differently. Sure, we provide music, but our main concern is developing the therapeutic relationship through music. And, as anyone knows, a one-way conversation does not a relationship make. Plus, music therapists are conscious of working with folks who might get over-stimulated by music more easily than the general population. Thus, another way that music therapists do live music differently:

#7. Sound and Silence

Music therapists make judicious use of sound and silence in their work. These are two reasons why:

1. Music therapists focus on building an interactive relationship in the music.

Silence becomes an important tool in this effort. Here are just some of the ways we can use silence in our music-making with clients:

  • Stopping a musical phrase early to cue participants to “fill in the blank”
  • Waiting for silence before beginning a song so that everyone starts together
  • Silencing the therapist’s voice or instrument to allow a client plenty of room to lead the music
  • Leaving silence at the end of a song rather than jumping into a conversation or verbal discussion
  • Allowing quiet moments between chords or musical passages to leave room to breathe in music for relaxation

Using these tweaks and techniques can help to cultivate an interactive client-therapist relationship in the music itself, even without considering verbal interaction. (More on that one in the next post.) Breaking that wall of sound and allowing silence can become an essential part of the music therapist’s work.

2. Music therapists aim to avoid over-stimulation.

There are times when our planned music experiences are too much for a given session. That is when in-the-moment adaptations come into play, and the music therapist dials down the planned experiences to be less overwhelming, either by thinning the texture or stopping the music altogether. In fact, sometimes sitting in silence together is the best – and most musical – gift a music therapist can give a client. Insisting on filling our whole hour with songs can sometimes be counterproductive.

Music is made of sound and silence.

All musicians must be aware of how these pieces fit together to make a beautiful musical whole. For music therapists, though, sound and silence are first of all considerations in building the therapeutic relationship and meeting clients’ needs.

That’s another way we do live music differently.

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Music Therapists Do It Differently: Rhythm

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 six of a ten-part series. You can find an introduction and links to all ten posts here.

(P.S. Are you loving this series? There’s more where that came from! Jump on our email list for specialized, exclusive content, just for subscribers. Click here to subscribe.)

#6. Rhythm

Rhythm is perhaps the most basic building block of music.

Rhythm alone can make music, but you can’t have a melody without rhythm. You can’t add harmony to a melody without rhythm either.

Obviously, rhythm is important to every musician, whether they are performers, composers, conductors, or dancers. Music therapists do have some unique considerations when it comes to rhythm, though.

Because rhythm is such a huge concept in music, it’s helpful to talk about some of the smaller components that make up rhythm. Tempo is one that we already discussed. Two more are meter and accent.

Meter Matters.

Rhythmic meter involves the relationships between strong beats and weaker beats within a musical phrase. Those of us used to listening to Western music are probably most familiar with the difference in feeling between duple meter (2/4 or 4/4 time – like a march) and triple meter (3/4 time – like a waltz), and between simple meter (with beats having an even number of subdivisions – like “Yankee Doodle”) and compound meter (with beats divided in three – like “Hickory Dickory Dock”).

"That lullaby sound is nice! Makes me want to take a nap…"

“That lullaby sound is nice! Maybe I should take a nap…”

Music therapists choose to improvise in a particular meter or may choose a song based on its meter. For example, we know that music in triple meter tends to have a rocking feeling. (This makes sense when you think of the connection to waltz music.) So, when I want to support a husband swaying to the music with his wife, I would probably choose “Let Me Call You Sweetheart” over “You Are My Sunshine.” On the other hand, when I want to support someone in marching in time to the music or playing a drum with a steady beat, I would choose something in duple meter.

Accent Matters, Too.

You can say that the strong beats in a particular meter are accented (i.e. beat one in 3/4 time, or beats 1 and 3 in 4/4 time). When the accents do not match up with the naturally-expected strong beats in a particular meter, you get syncopation.

Syncopation was the defining feature of jazz and other popular styles to emerge in the 20th century. Although it has been around long enough to be very familiar to our Western ears, adding syncopation in melodies and accompaniment can still sound contemporary and fresh. In fact, one study suggested that syncopated patterns were more enjoyed and viewed as happier and more complex than unsyncopated patterns. So, music therapists may add syncopation to make a musical experience more emotionally rewarding and attention-grabbing.

On the other hand, from a neurological perspective, it is easier for us to find and match the strong beats in a meter than to track syncopated rhythms. Simpler, more predictable accents work better for clients who are trying to match a movement to rhythm, whether that is playing a drum on the beat or walking in time to the music. In helping clients with gait training using rhythmic auditory stimulation (RAS) following a stroke, for example, music therapists prioritize simpler rhythms that encourage rhythmic entrainment over the enjoyment or emotional reward of the music. So, music therapists choose simpler or more complex syncopation based on the needs and goals of their clients.

What do these choices look like in a music therapy session?

Imagine Lynn working with an 77-year-old resident, Larry, who is in the early stage of Parkinson’s Disease and is recovering from a hip fracture in a nursing home. Larry is working with a physical therapist to rebuild his strength and endurance for walking, and Lynn is providing music therapy co-treatment. To support Larry’s gait training, Lynn sings and plays “Yankee Doodle.” While this isn’t Larry’s favorite song at all, it does give the strong beat to help him march down the hallway. The priority is regaining the functional skill of walking.

Contrast that with Lynn’s session with Rhonda, a 69-year-old woman on hospice care for end-stage breast cancer. Rhonda loves classic Motown hits, especially Martha and the Vandellas singing “Dancing in the Street.” Lynn often offers to play this song, and on “a good day,” Rhonda invariably shimmies and shakes to Lynn’s version of the song. Lynn uses syncopation and other musical surprises heavily, to add interest to the song and encourage Rhonda’s musical engagement. It doesn’t matter whether or not Rhonda is dancing in rhythm, as the goal isn’t to regain functional movement. A positive emotional experience is the priority.   

Rhythmic choices – tempo, meter, and accent/syncopation – matter for all musicians, but for music therapists, these choices are made with the clients’ goals in mind.

That’s how music therapists do rhythm differently.

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