Music Therapy in a Private School Setting for Children with Multiple Handicaps who are Visually Impaired or Blind

By Michael D. Bertolami & Lisa A. Martino

In the state of Massachusetts in the US, we are fortunate to be a part of a strong, vibrant music therapy community that continues to grow and thrive despite the current economic challenges in our country. As professionals, we can't help but feel especially privileged to be employed as music therapists by one of the most historical and well-respected private schools in our area. Founded nearly one hundred and seventy years ago, the school has provided educational services to students and clients who are blind, visually impaired, deafblind and multi-impaired blind. At the present time, the school operates four different on-campus programs that provide individualized instruction and support to students age 3-22.

As music therapists, we work in a program which provides educational and therapeutic services to children ages 5-15 who are blind, visually impaired and multi-impaired blind. We work as part of an interdisciplinary team which include teachers, psychologists, speech and language pathologists, occupational therapists, physical therapists, physical education, orientation and mobility instruction, and art. This interdisciplinary team works collaboratively to create individualized educational programs that help each student to maximize his or her abilities and potential. Perhaps the most exciting aspect of this collaborative approach is that it also allows many unique opportunities to provide co-therapy with specialists from other disciplines such as speech and language pathology, physical therapy and occupational therapy. Over the years, our access to these outside specialists have proved invaluable in terms of expanding our approach to our work, and deepening our understanding of the students with whom we work.

In addition to collaborating with other specialists, we are also given opportunities to work with each other within group and individual music therapy sessions. The opportunity to work together as a music therapy team, assessing the needs of our cases and utilizing each other as a resource has become an invaluable part of our service delivery. When a case becomes particularly challenging or confounding, we call on each other for supervision, and when possible, for co-treatment that has opened up and expanded our abilities to provide services. In music therapy, our focus is often to help a child grow developmentally in areas such as language, self-expression and social skills. While the scope of this article will not allow us to describe all of the clinical applications that are utilized in our music therapy program, we will highlight some of the tools that we access to help facilitate therapeutic change with our students.

Along with our commitment to work with the mission of our program and to develop programming that targets the goals and objectives identified by the team, we also have a perspective and philosophy about our work that is unique to the music therapy room. Within our own discipline, we work under the basic premise that every child in our room comes with an innate musicality (Nordoff, & Robbins, 1977). Given the wide levels of skills that we see in our room, the ways in which our students express this musicality can vary greatly. However, it is the musical event, whether a vocalization or a more sophisticated rhythmic exploration that we view as starting points for furthering relationship with the child. While we are held responsible for our work towards goals, and we do take that seriously, we also hold the belief that the experience of making music with others, in and of itself, is meaningful in terms of the quality of the lives of our students. We are fortunate in that many of our colleagues have come to value the music making experience in similar ways, and support our work even when what we do rests outside the confines of goals and objectives.

Within our program, we have access to a wide array of instruments and utilize a variety of techniques to connect with and assist the students through music. What makes the job exciting and deeply meaningful is the level of connection that we get to make, each and every day, with our students. One technique that has drawn our students out as well as drawing groups together has been songwriting. What is most interesting about this technique is that we originally reserved this for verbal groups that had enough cognitive ability to understand the basic task and sequence of the activity. However, over time we discovered that we could modify the basic songwriting approach to engage lower functioning children in what has otherwise been considered a verbal activity. When working with these sorts of groups, we start by helping the group decide upon a basic theme. With non-verbal groups, staff can assist in finding the most meaningful topic to work on. Some examples of these themes can be food preferences at lunchtime, weather and appropriate activities, or favorite classroom tasks. The therapist then takes the theme and creates a simple chorus section that is reviewed so that the children and staff can participate and return to these familiar words throughout the activity. At times, students can participate in actually creating basic melodies that the chorus can rest in. Next, the therapist works from student to student, helping each one develop a simple verse or lyrical phrase that states their preferences or ideas. Again, staff plays a big part in helping develop some verses. For example, if Buddy really loves crackers at lunch but can't tell us this, the staff person can offer this information and the therapist can sing this on behalf of Buddy. There are so many obvious goals that are met in this sort of activity, but what is moving about it is that we see children beginning to notice each other, and acknowledge each other through these individual expressions. What is better than that? Staff members also come to acknowledge the child or perceive the child differently because they are seen as a little more whole, or a little bit richer than assumed.

With some of our older children that present with less significant intellectual impairments, we have also found that songwriting can be valuable for developing areas such as self-esteem, self-expression, self-confidence, and group/social skills. Since many of the children within this part of the schools population are more capable of verbal processing and more advanced instrumental expression, the songwriting process takes on a much different form. Within this more advanced model of songwriting, the students usually create a theme for a song, which then becomes the basis for lyric discussion and construction. The therapist works to facilitate group discussions around lyrical content and helps students to organize their thoughts and lyrics into the context of a musical structure. Musically, the therapist also works with the students to decide on the overall harmonic structure and arrangement of the composition. In some cases, the therapist may create the musical structure based on verbal descriptions provided by students. In other instances, some of the more musically advanced students may actually create the musical structure for the song on an instrument or by using their voice. Obviously, the nature of this process allows students constant opportunities to develop socially and creatively. While it generally takes students anywhere from two weeks to three months to complete an entire song within this model, they are typically highly motivated throughout the songwriting process and are almost always proud of their completed work. In fact, many of these songwriting groups are eager to perform their completed songs in front of an audience and enjoy the praise of their peers and adults. Again, it also provides many staff, parents, and peers with the opportunity to acknowledge a child differently and perhaps see strengths that aren't as readily available or realized in other settings.

While this is only a snapshot of a part of the work we do, we hope it provides a sense of what is so valuable and meaningful about our particular jobs in this field. Of course, there are challenges, difficulties, conflicts and imbalances that impact the system that we work in. However, it is the opportunity to work with and be creative with the children of the school that continue to balance the experience for us and keep us excited and motivated to go to work.

References

Nordoff, P., & Robbins, C. (1977). Creative music therapy. New York: John Day Co.

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Voices: A World Forum for Music Therapy (ISSN 1504-1611)