Wednesday, June 26, 2013

The Fear of Starting Practicum

 Hello readers, Shelby Riley back again!

Coming to Thailand as an incoming junior I began to have a bit of a panic attack thinking of all the reasons that I was not ready to be placed in a practicum setting. First off, I have never done a real session of practicum in my life. Second, I was going to be partnered with someone who had already had practicum experience. Third, that my lack of experience would impact my ability to add input and ideas into the session. Since being in Thailand I realized how much my self doubt was getting in the way and how much I have been preparing for this situation over the past two years at the University of Kansas.

Throughout my two years in the Music Therapy program at KU I have taken a number of music therapy courses. Each of these classes has prepared us to work with different populations and teaching us about potential environments. We have done mock sessions in front of our classmates and teachers in order to prepare us for real sessions. When entering into the program I was knew that I would be taking these classes for the first two years and then starting practicum my third year. What I did not know was that I would have the opportunity to start practicum a semester early by going on this trip. At KU we do individual practicums. We are each assigned a client or a group of clients that we work with on our own once a week. However, here in Thailand we are partnered up and are given two practicum sessions per week. Most pairs had one group of clients as well as one individual client.

Going into my first practicum was nerve wracking to say the very least. I did not want to disappoint my partners, the client, or my teachers/ supervisors. The car ride to the Sirindhorn Rehabilitation Center, took what seemed like two hours.
 Sirindhorn Rehabilitation Center

 When we arrived I began to think about our plan over and over, and then it was time to begin the session. My partners and I were told that we would be working with a group of clients ages 2-7 with Cerebral Palsy. We began the session with 5 clients and more came in and out during. Throughout the session, I looked around to observe how my partners and supervisors were engaging with the clients as well as each other, and how they were approaching music therapy techniques with the children. Each of us were sitting facing our clients meeting them at eye level so they were not distracted by the others. I observed conversations about goals with the Occupational Therapists and also the parents and guardians. Everyone seemed calm and focused, which put me at ease.

As the session progressed I began to realize how prepared I really was to be in this position. The classes, observations, and mock sessions we had done up until this point really gave me all of the tools I needed to be successful during my time here. I was able to focus on the client instead of my fear of messing something up. By the end of what seemed like a 20-minute session (actually 90 minutes), I felt all of the confidence I needed to enter my next session later that day. It was an “ah ha” moment for me, as the youngest member of the group, that even if I had never led my own session I am still capable of trying my best, observing others, and learning from my mistakes. That is the only way to improve and to help me on my journey to becoming the best music therapist I can be. I have learned here that there is not one right way to approach a session. By working with other therapists we have had to improvise on the spot and work with each other on the fly. I have learned a lot from my classmates, supervisors and teacher that I don’t think I could possibly have learned in an individual practicum setting.

I am so thankful for this experience in the practicum setting and for all of the preparation that has been provided to me from KU. This has given a fearful incoming junior the confidence to know that I have been given a great deal of knowledge and skills I will need to begin my individual practicum in the fall. 

Sunday, June 23, 2013

Bring the sunshine in your heart

Sa-waa-dee-ka (Hi), Voonyin Leow is here again. Time flies, Thailand study abroad is almost over. In this trip, learning will never be the end and the outer world you see is a reflection of your inner self.  No matter where you been or even if you have a language barrier or you been in a different country, music speaks a language to connect people heart to heart and make magical things happen. One of the most valuable things that I learned in this trip was “Appreciate what you have because what you have now is one of the things you once prayed for.”

The most unforgettable experience that I had on this trip was we had an opportunity to visit the biggest children with disabilities center in Bangkok (Baan Fuengfah children’s center). We were also giving a chance to have a music therapy session with 55+ children under the age of seven with cerebral palsy. At the first, I thought there would be no differences from other orphanages that had I visited in Malaysia; however, this experience was indeed unique and priceless. The whole experience was so heart-warming, and from that experience I’ve learned a lot. Life in an orphanage can be very lonely. First, you are surrounded by dozens, possibly hundreds of other kids, but that does not always take the loneliness away. I understand that orphans need interaction, attention, love from positive role models… and those can be hard to come by. Baan Fuengfah children’s center was the best facility that I had ever visited. There were a lot of caretakers who are responsible for many children, possible part-time or volunteers who may be a positive presence to take care and gave attention to children with disabilities.

As a visitor (also as a student music therapist) on that day of having a music therapy session, it was an exciting day, but the worrying expression was also shown out before the session. It was the most adventured experience that it will never happen in a music therapist life; having a session with 55+ children with cerebral palsy, 19 student music therapists, 2 professors, and few staff in a big room. It was a big challenge for us because we had lack of support from the facilities. However, in music therapists’ perspectives, there is no such thing as a “typical” music therapy session. A music therapy session will look vastly different depending on whom we work with and where we work with them. Thus, this opportunity for all of us was an honor. It was like life: you do not just hand you things. You have to get out there and make things happen. That was the exciting part.  

Even though it was one music therapy session, bonding with children with cerebral palsy helped me to realize the true essence of love and gave me a whole new perspective on what and why we had this music therapy session. From our first intervention, our music successfully bonded 55+ children with cerebral palsy with us; they all showed very high engagement in music therapy. However, we still heard many crying and screaming sounds at the beginning. Those children had dramatic pain while somebody was moving their bodies. Gradually, music successfully distracted their attention to their physical pain. Those children started having more interactions with music therapists by continuing to play the instruments by themselves and increasing their non-verbal communication. They all wanted more music, interactions, and touches. Especially the two children that I interacted with, they were capable to move their hands and legs to play the instruments and respond to the music by their lovely smiling faces and constant eye contact.

Throughout this music therapy session, I could tell that all children with cerebral palsy were not afraid of us “farang,” but excited and happy to be engaged and interacting with us. Their happiness made me feel that these children led me to have a great desire to do something for them. As music therapist who comes with a smile and a hug, and even a music therapy session or a special word to share can be rays of sunshine in an orphan’s dark days.  The memories that can be made and the love that can be shared in that short time can last long beyond the time of departure.

         I cannot proclaim enough how incredible this experience was for me and how much it has changed me. This experience will without a doubt stay close to my heart for my entire life and has made me realize that I like to work as a music therapist.

Reuniting The Spark of Love

Mr. K was my first client in Thailand. I still remember that summer day we met; it was an afternoon filled with sunshine. He came to the session with his wife at the Mahidol University music therapy clinical room. He was sitting in a wheelchair with a clean shirt and his works pants. He greeted my partner Voonyin and I by waving his left hand, but with no facial expression.
 Mahidol University Music Therapy Clinical Room
Mr. K had a traumatic brain injury from a car accident four years ago. Before the accident, he was a successful businessman, who mastered three languages: English, Chinese, and Thai. Mr. K is now wheelchair-dependent with severe impairments in speech, fine and gross motor skills including the use of his hands, and cognitive areas. Emotionally, Mr. K is struggling with adjustment issues relating to his condition, including depression with significant bouts of anger, frustration and sleep difficulty. During the intake interview, his wife indicated that her only expectation of this music therapy treatment is to make her husband happier, and so she can have time for herself while he is in treatment.
In our first session, the first intervention Voonyin and I did was therapeutic singing. This provided an opportunity for Mr. K to practice his articulation. Prior to the intervention, he was unable to roll his tongue but after singing two familiar songs (“Sha La La La” and “Yesterday Once More”), he regained articulation control he once had. His wife was so amazed by his immediate progress that she decided to stay for the remainder of the session.
We continued to play a Chinese song, “Friends”, which is very famous and popular in most Asian countries. The lyrics describe a friendship: You are not alone because friends will always walk through those difficulties together. Mr. K recognized the song by humming the melody with us. His eyes were full of tears. After the song, we asked him if this song reminded him of his friends. He nodded his head and became more emotional. His wife came closer to wipe his tears, and told us they first met at a middle school in Malaysia. She told a couple of stories from their school years. Sometimes Mr. K wept and sometimes he laughed during the stories. He could not say any words to express his feelings, but I saw he was holding his wife’s hand tighter.
The next song we sang was one of Mr. K’s favorites, “The Moon Represents My Heart”. We chose this song because Mr. K was unable to express his love and appreciation for his wife due to his speech impairment. The moon was a symbol of the most beloved one in the world. During the song, we encouraged him to sing some verbs and nouns with us, such as “ask”, “think”, “love”, “moon”, “heart”, etc. His eye contact never left his wife while singing the song. The song triggered memories of love for his wife. He made a connection between the emotion of love in the song and his love for his wife, evident by his replacement of lyrics in the song with his wife’s name. At the end of the song, he wrapped his arm around her, kissing her and saying 我愛你 (I love you). 
This moment was especially meaningful because in the Asian culture it is uncommon for this public display of affection. The lyric analysis encouraged a deeper look at meanings and symbolism in the lyrics, enhancing the emotional and romantic connection between the couple, a connection that has not been present for the past four years due to Mr. K’s injury.
Being a caregiver for your loved one adds an entirely new complexity to a relationship and can be one of the most demanding and exhausting roles one must take on. With this, it is quite understandable that Mr. K’s wife wanted to drop him off and take some time for herself. The emotions and relationship building that resulted from this session are examples of outcomes that are unexpected inmusic therapy treatment (especially to the unfamiliar eye), but some of the most important work we do as music therapists.
When cognitive and communication skills are compromised, music can facilitate a language of love, repairing and fostering feelings and emotions that make some of the most taxing days bearable. While Voonyin and I only met with Mr. K and his wife for two sessions, we are leaving Thailand knowing that their love for each other has a new spark in it. A spark that will remain between them in their journey of life as ONE. 

The Bridge

Hello friends! Michael Detmer here. Thanks for following our music therapy blog during our study abroad trip to Thailand. Make sure to check out the earlier postings to learn a little more about each one of us and our cultural experience in Thailand thus far.

Long before I applied to graduate school at KU for music therapy, I realized the powerful effects of music as therapy and the way it can empower and strengthen individuals in ways unimagined. Music can be used to treat and improve physical and mental health, as well as aid in social, spiritual, and intellectual development. It wasn't until this trip though, that I found how all of these components fit together in a complex, but beautiful, puzzle when cultural and social considerations are added to the mix.

I have found that music therapy creates bridges. Whether these bridges are to recovery, improved health, stronger relationships with family, or to an unexpected outcome, they form the principles by which music therapist's work. Last week in my session in the pediatric palliative care unit in Siriraj hospital, I worked with a 10-month-old child and her caregiver. While a "normal" music therapy session is very hard to define since interventions are individualized for each client, I can say that from my experience in the US it would be "normal" to have a conversation with the client(s) and/or caregiver in the beginning of the session. I can also say my "normal" usually includes questions, discussion, and some reflection during the session. Facilitating a therapy session abroad, however, is far from my understanding of what a "normal" music therapy session should look like, particularly due to the language barrier.

How do I introduce myself? How do I ask how their day has been? How do I know if the baby has been experiencing pain? Knowing I couldn't find answers to these questions through "normal" discussion, I trusted in the music to be the bridge in building this relationship and facilitating this session, creating a NEW NORMAL for me.

My goals for this client were to help normalize the hospital environemnt and provide stimulating and meaningful interaction between the child and the caregiver. There was success in both areas! So much information and communication was shared only using the music and the silence. During the session, I laughed with the caregiver and the child, we had a "call and response" conversation on a drum, I nonverbally encouraged the caregiver to be a part of the session, I noticed the baby maintained eye contact with me, and I saw the caregiver and the baby smiling and interacting with each other. This all happened only using "Sawasdee Krab" (Hello) and an occasional "Dii Maak" (Very Good) and "Suht Yat" (Awesome), and it was one of the most rewarding sessions I've ever had. Language doesn't have to exist in therapy when music is present because the MUSIC bridges the language barrier. 

After the session, I was organizing and cleaning up the instruments while waiting in the other room. The caregiver and child came walking out of their wing and the child immediately made eye contact with me and, with the help of the caregiver, quickly stumbled over to me. The two, both whom I just met and interacted for a mere 20 minutes using very limited Thai, were already attached to me. Here, is where the music formed a bridge, helping to develop a therapeutic relationship. The caregiver and child proceeded to sit on the floor in the hall with me as we played more on the drum. I couldn't have been happier. The caregiver, child, and I were all smiling in joy. Joy built by a bridge through music.

Saturday, June 22, 2013

Just Jump

Sawasdee ka, readers! Rebecca Townsend again reflecting upon the “study” portion of this study abroad experience. The world is our classroom, and each new experience holds a valuable lesson capable of being transferred and applied to our personal and professional lives. 

My music therapy experience in Thailand has once again proven my love for my future profession. The way music transcends the boundaries of language is indescribable. I knew this from observing and leading sessions throughout my past three years at KU, but each new clinical experience confirms this even more. Both of my practicum settings so far have been with children. First semester, I was at the Language Acquisition Preschool on the KU campus. Second semester, I worked with an individual boy with autism. I am very interested in working with children with disabilities, either in a rehabilitation setting or a school setting. I have not yet experienced working with older adults, adults with disabilities, or in a hospital setting, so I want to experience those before I rule them out of my areas of interest.
Seeing the broad grins of those kids is the most beautiful thing. Watching them engage in and recognize the music is fascinating. Getting them to a point where they are willing to participate gives me confidence in my abilities as a therapist and I know without a shadow of a doubt I have chosen the right career path. However, getting to where I am now has not been easy. I have had to overcome many challenges and uncertainties and put faith into the unknown to reach the indescribable emotions that result from using the power of music to touch people’s lives. 

            Zip-lining through the rainforest in Chiang Mai last weekend was one of the most fun things I’ve ever done in my life. Flying from tree to tree was exhilarating, and it offered a view of the spectacular Thailand scenery unlike anything else. I was a little nervous, but snugly strapped into my harness and helmet I knew I was safe. The guides were hilarious! In my opinion, they rival music therapists for having the best job in the world.

Tandem Zip-line with Laura Cribb


I found a lot of parallels to my music therapy career during this experience and it was very enlightening. For both elements, I am aware of how fun and rewarding the process can be. But also for each, there is always that element of fear present. Each session is a little like jumping off that wooden platform. There is that drop in my stomach, and my heart lodges into my throat... the what-ifs cloud my head and there is that split second where I wonder if it is time to turn back and throw in the towel. At each station, after I was hooked up to the zip line, and the guide asked if I was ready, I’d say, “yes” while screaming, “no” inside my head. I’d put my brave face on, take a deep breath, and jump. Only once I was speeding through the jungle, did my fear subside and the fun set in. After the first few times, I knew how incredibly enjoyable it was because I had actually experienced it, and getting myself to leave the platform was no longer a challenge.

I feel my music therapy practicum experience so far is very similar to this. Especially during my very first sessions each semester, I had to use my brave face and jump off the platform without feeling confident or ready to take on the task of effectively using music therapeutically. As I gained experience and learned from my supervisors, my brave face turned into my confident face. I was able to truly immerse myself in the atmosphere my musical interventions were creating for the children. Subsequent sessions came to feel like I was speeding through the jungle. 800 meters is over in a flash. 30 minutes feels like 30 seconds.

Both zip lining and in a music therapy clinical work have both turned out to be exquisite experiences. It is a wild ride, and it is so fun and so beyond worth it. Each session, each time being hooked up to a new zip line, the process gets easier. It becomes second nature. Eventually in my music therapy career, though I can’t say how soon, the stomach drop will be almost non-existent, but the thrill will still be there. I am so grateful I have found a profession I love, and I can’t wait to see where this adventure takes me in the near and distant future. Someday maybe I’ll go bungee jumping (get a master’s degree), go skydiving (present at a conference or give an in-service), or even go scuba diving (conduct a research study). The possibilities end when I stop dreaming, and I don’t see that happening any time soon. My passion for this amazing field is just beginning to bloom. 

Extremes: The New Normal

            Sawadee ka readers!  Morgan Skillett again, a recent graduate of KU, coming up on the start of my six month internship in Hayward, California.  It's hard to believe our time here is almost complete.  I will miss so many things about Thailand, that I can't even begin to count them all.  But for now, time to talk about the main reason I traveled half-way across the therapy!!

            When first starting my music therapy practicum in Thailand, I had no idea what I was in for.  There are multiple challenges one might face in a session, including language barriers, familiarity with Thai music that would be appropriate for each age group and that we were told that some clients may be timid or shy around us because we are "farang," or a Westerner.  Thai people are unbelievably forgiving and kind, which is probably the reason most of us did not burst into tears of fear before walking into our first session.
Thai Music Lesson
            During my trip, my practicum placements were at Sirindhorn Adult Day Center and at Siriraj Hospital in the Pediatric Palliative Care Unit.  Both of these placements are broadening my knowledge of music therapy and are shaping me into not only a better therapist but a better person.  These two sessions are vastly different and require multiple techniques and strategies to find ways to ensure we are providing the clients with the best music therapy session possible.
            Over the course of my sessions,  I have noticed that the Thai's prefer to the extremes.  This can be illustrated in the enormous response level we get to singing or playing very slow music and very fast music.  The songs in the middle have a significant drop in participation, which is much different than back at home.  Generally in the US, most of our songs fall into the middle range of fast/slow tempos.  If the song is too slow, we run the chance of having all of our clients fall into a deep sleep.  If songs are too fast, it can sometimes overstimulate the clients, running the risk of increasing their arousal level too much.
Melissa, me, Taylor, clients and Laura after our last session at Sirindhorn
            At Sirindhorn, the clients are thrilled to dance, play their instruments to upbeat classics such as Hound Dog or Can't Buy Me Love.  Slow songs such as Can't Help Falling in Love, Edelweiss and Somewhere Over the Rainbow are also very popular with this group of adults.  Over the past few weeks, we have found what works best for our clients with the help of the other music therapy staff.  The extreme fast and slow tempo songs are the most beneficial for the clients and helps sustain their attention.    To ensure that we're accommodating to their preferences, it requires us to make specific decisions about which songs we will sing/play in our session and what strumming pattern or style we will use.
Taylor, me, Melissa and Laura with our beautiful lei's that were given to us 
            Extreme is such a beautiful and unique word that describes Thailand.  Extreme food, music, beauty, people and culture.  Shouldn't we all be a little more extreme in our lives?  The possibilities are endless.  It is truly an honor to have the opportunity to do music therapy in Thailand.   

Share Wisdom

            Music therapy is a complex profession. Those who practice and those who receive music therapy intricately know the benefits of music as therapy. However, many people that I personally encounter on a daily basis regard music therapy as illegitimate, either as a result of a lack of knowledge about the profession or a different perception of valuable therapeutic treatments. I expected to find this outlook from those unfamiliar with what we label as music therapy during my time in Thailand. Like so many other encounters I have had during this trip, my expectations did not meet reality.
            During a weekend trip to Chiang Mai we visited the Rajanagarindra Institute of Child Development.
Rajanagarindra Institute of Child Development
This center provides care for children from all parts of Thailand with developmental disabilities and behavioral problems. Some treatments at RICD include physical, occupational, and music therapy. However, the “music therapist” at this institute is not trained in music therapy. She went to school for music education and implements music activities at RICD with the children. In America, we stress advocacy of music therapy and require board certification. We often look down upon those who practice music therapy without the proper qualifications. In Thailand, my views about music therapy had to change to meet the culture’s views about music therapy.
                        Piano keys above the entrance to the new hospital.           
            While RICD may not implement what those trained in the United States call music therapy, their openness to the use of music as therapy left me astonished. The institute is in the process of building a new hospital in the shape of a grand piano with a giant violin-playing panda featured in the lobby.

Musical panda located in the lobby of the new hospital.
The new center contains three group and ten individual music therapy rooms. The creation of such a space for music therapy shows dedication and immense support for the career, even though their current definition of music therapy does not exactly meet my own definition.
            I am an active supporter of research-based music therapy. I believe that music can be used in many different ways to reach non-musical therapeutic goals that have been tested in various circumstances. In the American culture this outlook of music therapy is extremely important. Music therapists are constantly advocating for their career as a legitimate healthcare profession. However, roadblocks are created as a result of the society we are a part of. Some people view music therapy as an illegitimate medical practice and collecting research that shows its benefits is important to furthering the progress of music therapy. In Thailand, the culture as a whole is more open to alternative medical practices. Acupuncture and types of ambient music listening are often implemented in medical institutions or hospitals. As a result, the Thai people in the medical field have a desire to execute music therapy but many do not have access to the resources needed to create a comprehensive music therapy program. The differences in the appreciation of music as therapy in correlation to access to the product between the United States and Thailand strikes me as unfortunate.
New group music therapy room.
            Although America and Thailand view music therapy in different ways, I believe that both countries can learn from the philosophies of the other. Where the United States is abundant in standards for music therapy practice, Thailand is abundant in openness to the practice of music therapy. Instead of focusing on the differences I hope that music therapists and non-music therapists alike can broaden their worldview and seek improvements in working with others who may not have the same outlook, in any situation. Viewing a comfortable situation in another light provides insight to untapped wisdom, in music therapy or any other profession. 
Learning how to play a Thai traditional instrument.

What do you think music therapists in America can learn from music therapists in Thailand and vice versa? What types of cultural differences have you experienced within your own profession? Please answer in the comment section below.

Friday, June 21, 2013

The Impact of Music

When it comes to music, there are no boundaries to the impact it  may have on people. To me, music can break through the strongest barriers and connect people of different cultures; although their understanding and their perception may be different, the presentation of music is the same. As a student music therapist, this has been my foundation while facilitating sessions here in Thailand. I have had to communicate  through music and let it be the common denominator. 

Because I cannot speak or understand the language it limits the therapeutic effect of verbal communication with my clients. Therefore I depend solely on non-verbal communication and musical elements to promote success in my sessions. I have discovered that these strategies can carry you a long way.

My first individual session that occurred on the Pediatric Palliative Care Unit at Siriraj Hospital, a two wing, 20+ bed unit of fragile children age 0-18 with a terminal illness. In our sessions here, there are four student music therapist on the unit to facilitate group sessions, and two to facilitate individual sessions. After co-facilitating three group sessions my first day; a seven year old girl came to her bed weeping. She had just been released from surgery, and as you could imagine, she was in a tremendous amount of pain. The child’s mother contacted the music therapy supervisor to request services and the supervisor happily agreed to see her. 

I volunteered to facilitate the session because I wanted to try some of the different techniques that I learned in my pediatric class last semester as it related to pain with children. I had not planned for this session and was unprepared, but I knew I could be effective if I followed the energy my client was giving me. There was no formal introduction needed; I said hello and started singing and playing very softly by her bedside. During the first few minutes she was still crying and seemed apprehensive to participate. I continued to sing softly as I reached in the bag to bring out a few puppets and instruments. I set them in front of her, giving her an opportunity to choose. As I watched her response to the options I provided, I realized that this stopped her from crying. 

At that moment, I knew it was time to sing a song that she was familiar with, since she was making eye contact with me and seemed receptive to interaction. I decided to sing “Chang Chang Chang”, a traditional Thai children’s song about the parts of the elephant/chang. I used a chang puppet to motivate her and help her participate in the session. I asked the music therapist supervisor, who speaks Thai, to help me say “chang, take the pain away in Thai.” I then moved the chang over her left arm where the procedure took place as the mother helped us say “take the pain away”.  Once the child noticed her mother’s engagement in the session, her affect changed tremendously. She began to release the tension in her body and her grimaces turned to a pleasant smile. Not once did I have to depend on language as a mean for communication, I used non-verbal communication and music elements to enhance and carry-out this session.

We continued singing together and I incorporated instruments into the session. With the few Thai words I know, I was able to give her directives to extend her arm over her head, to the left and right, and below her waist. This was beneficial for the child because it allowed her to use her arm and hand muscles, improving blood-flow, preventing potential pain. The most important application used in this session were interventions to distract the child from the pain she was experiencing.

This short, 45 minute session, impacted me in so many ways. It was challenging, but it helped me work through my insecurities about facilitating a session with fragile children as a music therapist, which is much different than my experience with this age group when working as a music educator. As a music therapist, we see clients of all ages and of varying illnesses. When it comes to working with infants, toddlers, school age, and adolescents with IV’s, bruises, and scars from operations, it is hard to maintain a poker face. Although it is very sad and difficult to see, I knew that it was my duty to try and bring a positive and professional attitude to my these kiddos. Therefore, I set my emotions aside and worked to be the best for this patient. 

The techniques I learned in class were successful because I followed my client’s lead by adjusting to what she needed, used non-verbal communication, and used strategies that were conducive to children. For instance, using a stuff puppet, implementing rhythm sticks and eggs shakers as instrument play, and using music elements such as dynamics and tempo changes to the calm her down were strategies and techniques I learned from my pediatric class. The techniques used were not hindered because of our cultural differences. In fact, our therapeutic relationship was initiated and successful because of the music. The outcomes of this session demonstrates that music can impact anyone no matter what the barriers may be. How does music impact your life?

Music can connect us and affect us in different ways!!!