Thursday, June 30, 2011

More than Just a Term in Our Textbooks

My name is Kim Davidson and I’m going into my senior year at KU. My first semester of practicum, I had sessions with a 17 year old with Autism in his home. His mother and younger siblings were always around but I usually only saw them when I arrived and when I left. In my second semester, I was at the Douglas County Jail so it was all inmates all the time. In every one of my music therapy classes, we’ve talked about family-centered care and I have read about it countless times. However, until I came to Thailand, I had never truly put the concept into practice.

While I like to think that many people in the United States are still very family oriented, an average Thai family system could put the most family-focused of Americans to shame. In each of our practicum sites here in Thailand, every single patient we’ve seen has been accompanied by at least one, and often multiple, family members. This is true of the hospital, of the adult day care center, and of the physical therapy clinics. And it isn’t the “I had to drive them here so I’ll just stay until they’re done” mentality. The family members are in the treatment room or day care room with their loved one, always by their side and assisting in whatever way they can.

This cultural aspect is truly amazing, but for me as a student music therapist, it was rather intimidating at first. In addition to the somewhat improvisational aspect of figuring out how to include the one, two or three family members present into each application, the extra pair(s) of eyes were nerve-racking. Our supervisors, professors, and peers watch us in sessions all the time and we can expect feedback and constructive criticism from them but these new eyes were not professional – they were personal. It was their child, grandchild, sibling, parent, or spouse who I was working with and the desire to meet or surpass goals and to demonstrate the effectiveness of our chosen profession seemed to multiply infinitely. This pressure was self-inflicted (the Thai family members are unbelievably gracious and appreciative), but it was real, and for me at least, it was distracting.

In my first couple sessions with children here, I worried that parents might not be comfortable with me using hand over hand techniques with their children to assist in arm extensions. I found myself wondering if mom and grandma thought what I was doing was working or if they had already pegged me or even worse, my chosen profession, as ineffective. When I observed at the adult day care, I watched the caretakers and wondered similar things. Did they understand the goals and far-reaching benefits of the session or did they see an hour break in the day with some singing and instrument playing? Did they wish that these loud Westerners would get out of their parent’s personal space and take their noisy maracas with them?

It wasn’t until several days in that I realized how self-involved all of my thoughts and concerns were. It wasn’t until several days in that, through baptism by fire, I began to scratch at the surface of an understanding of family-centered care and it’s incredible importance. It had nothing to do with me or my comfort level, for what did my temporary feelings matter in the grand scheme of the treatment of this precious little child with cerebral palsy? I needed to make the caregiver an essential part of the session because it was their comfort with the treatment and their rapport with their loved one that was so important.

Every human has a need to be included and to contribute; when could that need be greater than when someone you love is in pain or needs treatment? They want to contribute to their loved one’s care and we, as music therapists, need to provide that opportunity. Plus, the chance that a family member will replicate techniques used in a music therapy session at home is so much higher if they are actively involved in the applications.

Was there a moment in your work as a MT (or SMT) when the concept of family-centered care became more than a term in your books and lectures? When you really began to grasp the scope and importance of it?

1 comment:

  1. Lots to think about here -- and sounds as if you learned quite a bit from this experience!