“As a mother of a child with special needs, I found the process of finding help for him and choosing the right help for him to be extremely daunting. With each step through early intervention I felt as though I was left with more questions than questions were answered. “Is this therapy the right fit for my child?” “He tantrumed through the first several weeks so is this working?” After weeks of confusion I asked our music therapist to explain what the assessment process for music therapy would look like for my own comfort. Katy Harmes, Valotta’s lead board-certified music therapist, shared what to expect from the first 5 sessions, plus some insight into what comes next once Katy forms a real relationship with the child. And while it seemed overwhelming, seeing a simple breakdown was extremely comforting.”
The above quote comes from the mother of one of our Valotta Music Therapy clients, and the following excerpts directly from Katy help to explain the structure and purpose of the first two months of music therapy intervention:
First session: Exploration
My first session with a client is huge for my own clinical assessment process, watching how the client interacts with the instruments and materials. It is usually informal with little structure, so that the client can acclimate to the music therapy setting and become comfortable in the environment. I try to make the first session as fun as possible, placing minimal demands on the client so that we can get to know each other! I set out a variety of items from my collection, including instruments and non-musical materials, to see what the client gravitates towards. This gives me an idea what might work as a motivator or reward in future sessions, as well as simply what the client might enjoy using during music therapy. So while the client explores my materials, I can explore them: learn their interests, personality, and the way they use what’s in front of them to play, make music, or engage with me.
– Second session: Build rapport
Once the first session is complete, I really start to focus on building rapport with my client. Rapport is the clinical relationship between therapist and client where the two people are comfortable with each other and have shared trust. Rapport is a crucial piece of the therapist-client dynamic because the stronger the rapport is, the more comfortable the client is in sessions, and the more growth is likely to happen as a result of this trust. Building up this relationship from the very beginning of my music therapy process is a priority for me for many reasons. First, I want my clients to feel safe in my room. It is my goal to make my space as welcoming, warm, and inviting for them as possible. While this certainly means using materials they have displayed a fondness for, it is also important that they feel comfortable with me within the space. I use this time to follow the client’s lead primarily in making music, jumping into whatever they are doing or using to let them know that I’m interested in them and in making music and having fun together. If I can accomplish things as small as smiles and eye contact by the end of the second session, I have done my job well and have built at least the foundation of a rapport.
– Third session: Structure
At about the third session is where I’m really starting to implement a structured layout, moving between interventions and activities that are geared toward that specific client. Each client is different, so the rigidity of the structure fluctuates across a spectrum. The interventions within this structure are crafted to focus on that client’s identified goal areas so that we are working on the highest prioritized needs each week in therapy. Now that, ideally, the client trusts me to a certain degree and I have had two weeks to get to know them, I can tailor my music interventions to their interests and goal areas. During the third session, I introduce my hello and goodbye songs that are meant to bookend the session, giving an opening and closure respectively. In between these, I will offer a variety of short activities to again see what interests and motivates the client. Keeping everything short means I can it a lot into the session and keep track of what I might repeat in the future once there is an established routine.
– Fourth session: Routine
Between the third and fourth session, I work to establish a routine for the client. Typically, this routine consists of singing our greeting song, then 3-4 individualized experiences focused on the client’s goal areas, and concluding with our goodbye song. Again, no two clients are the same; sometimes the sessions are fluid with minimal structure, some sessions have a rigid routine, and sometimes it’s a happy medium! Some clients thrive on a visual schedule on my whiteboard where they can check off each intervention as we do it. Some clients don’t follow a schedule themselves, but I still keep track of a general “order” to things and keep the session flowing with improvised transitions between planned activities. Regardless of how the client reacts in the moment, I still plan ahead of time for all of my sessions based on the individual needs of each client.
– Fifth session: Now, we’re established!
Here we are at the 5th session. Ideally, there now exists the foundation of a rapport, some kind of structure to sessions, and now the client has expectations for what the session will look like when he or she arrives at music. By this time in the process, clients are coming in excited to be there, and little hints of progress start to show themselves. This is the time to start watching for even the smallest changes in other settings, including school, home, or other social situations.
– Adaptations: Improvisation
When clients don’t need as strict of a set routine each week, I’m able to use more improvisational techniques. In these types of sessions, I follow the client’s lead more often and meet him or her with improvised music interventions to fit what he or she is doing. These sessions can be more challenging for me because I don’t know what to expect as much, but the magic I see happening in these sessions warms my heart!
– Adaptations: Challenge
The more time I spend with my clients, the more I see them growing in their targeted goal areas. When this happens, I work to change up my interventions a bit to challenge the client to reach a higher level of proficiency in their goals.
– Adaptations: Consistency
Consistency is SO key to client success in therapy. It takes the average toddler 8 times on 8 different days to truly learn a skill and have it develop some level of permanence. Now add special needs to this equation, which can make these developments more difficult. Next, add the scheduling aspect that I see my clients only once a week. Consistency is a HUGE piece of client success in music therapy! Of course barring sickness and emergency, coming to therapy each week is a crucial part of ensuring the client is learning and progressing in their goal areas, even in their developmental milestones.