Creative Arts in Therapy

I have a client with fairly severe developmental disabilities. He is in a wheelchair, has no functional communication skills, and limited functional use of his hands. His cognitive abilities are difficult to determine, due to his inability to communicate. So after completing his assessment for music therapy services, I determined that my primary goals would be providing sensory stimulation that would offer some sort of social interaction and encourage the highest level of functioning he is capable of. I expected that I might be able to shape some behaviors after several months of therapy so that he might keep his hand on a cabasa for 2 minutes while I was singing, for example. Or that he might make eye contact with me or an instrument for a period of time, demonstrating attention to tasks.

My treatment philosophy, though, is to treat every client as though they are cognitively capable of understanding what I am saying and so I explain what I am going to do, what responses I would like my client to have, and for how long we’ll be working on that particular skill. After singing our traditional hello song, I said, “Let’s play the tambourine. I want you to work on holding on to the tambourine as long as you can while I sing ‘Matilda the Gorilla’.” This client grasps and pushes and pulls at items within his reach, but has not demonstrated the ability to hold on to something for any period of time. In previous sessions, he grabbed the tambourine from me, held it up dangling on his thumb, and then tossed to the side.

In this session, though, I sang the song, provided assistance keeping the tambourine in his hand, and verbally encouraged him to work on grasping and holding on to the tambourine between phrases and verses of the song. Again, I expected to use this technique to shape the desired behavior over several months. However, he surprised me by grasping the tambourine and, with assistance, holding on to it for the entire song. He also handed it back to me when I asked for it at the end of the song instead of tossing it to the side!

Now, this client did toss some other instruments to the side and was not able to hold on to things during other parts of this session, but his abilities during this experience surprised me. And reminded me to check my assumptions about his abilities and the goals he might be able to attain. I described more of this session on The Music Therapy Show on January 24, 2010: http://www.blogtalkradio.com/jharrismtbc

Janice M. Harris, MA, MT-BC
Dallas TX
janice@heartbeatmusictherapy.net