How have you used these four music experiences in your practice?

[Julie Palmieri]

How have you used these four music experiences in your practice?

Have you made any changes in these areas since beginning this course?

[Kimberly Werner]

I often structure my more “formal” sessions in similar ways. None of my repertoire is “specific” to drum songs vs movement songs vs shaker songs. Also often create excitement/musical tension through establishing a rhythmic & harmonic pattern, then adding pause to encourage patient response.

I don’t think that my active way of practice has shifted much since beginning this course, but I am definitely more aware of less commonly considered milestones, and how I can support those developments musically.

[Leslie Aldrich]

During my internship, I was responsible for creating music therapy groups for kids on the different hospital units. I would use this type of concept when planning those because we separated them by age groups. What was developmentally appropriate for the older group was not going to work for the youngest group. The musical developmental sequence worksheet was really helpful in breaking this down. I wasn’t previously thinking about it in these exact terms, but I will be using this moving forward with my community group. I think it could also be helpful in assessing your group as well and making sure your interventions are hitting helpful points for all the participants.

[Maggie Johnson]

I feel similarly about the worksheet assignment, and now I want to use it to practice how a single experience or single song can move through the developmental levels (either for like an assessment, or if you are using the same song with clients/participants of different developmental levels.)

[Melissa Neitzel]

I’m appreciative of the way the chapters lay out multiple musical milestones in each experience. It has given me considerations for how I may provide gentle pushes forward when I see a client between two stages. The videos have also provided validation in repetition. Sometimes I feel the pressure to reinvent the wheel every session. I have many new clients who are new to music therapy and the repetition is helpful, predictable. And while I can recognize this and state this, the videos provided validation in my choices.

[Christine Wick]

Yes! I definitely know what you mean by feeling that pressure to reinvent the wheel every session. I’ve been thinking about this a lot lately with one particular client of mine who greatly benefits from repetition for many reasons and I agree that the validation from this material has been helpful. We or parents/caregivers may feel a sense of “ok I’m ready to move on now”, but creating that safe space of predictability and familiarity builds trust engage and explore.

[Erika (TeamRH)]

Thank you all for your insights.

[Katelyn Caruso]

While I am currently working with adults, my sessions have changed for the better since the beginning of this course! It has help me identify the different responses that might be appropriate, and adjust the music to match each clients level of interest and interaction. Understanding these stages and how they progress backwards in dementia has helped me to connect the dots with what clients can tolerate and connect with. I do use these types of experiences in my sessions, although I think in memory care especially it’s important to follow the clients lead in how present they are in a given moment, so sometimes it isn’t structured or we will use a familiar song in a variety of ways.

[Maggie Johnson]

I do a lot of musically matching, reflecting, etc. what clients sing, how they play, and how they move, and then move into them being able to shift in small ways by musically contextualizing so that habitual musical responses become part of intentional musical conversation.

I find assessing client’s listening skills somewhat of a challenge, especially when I don’t know if they are processing the information or not, or rather where the breakdown occurs, like outlined in chapter 12. For e.g. I can tell when a client is discriminating pitch if they positively demonstrate it, however if they don’t demonstrate the ability to reproduce a pitch or otherwise show me that they can discriminate the pitch (e.g. ID-ing the note on a piano), and there is some sort of possible “false negative” in my assessment, I’m curious what is the best approach in describing what stage they are in (particularly in listening)? I think a great treatment approach to this is to keep providing opportunities for them to feel motivated and to demonstrate the skill in different contexts, but I’m curious about those who consistently fail to demonstrate characteristics because of the necessary context or maybe even lack of motivation/comfort. Would you describe their level as “unknown” or the highest level that you are able to assess a response in? To try to answer my own question, I think of Elizabeth’s description of these stages operating like a ladder, where you can kind of be on several rungs moving up and down, depending, makes sense here. But this does signal to me the responsibility that we have to be able to accurately assess in order to provide developmentally appropriate experiences and opportunities for growth/development and sometimes that is a challenge.

I’ll give an example, I had a client who for many years I thought he could not keep a steady beat, but then one day we got an electric kick drum with a small pedal that tracked very subtle foot movements. Suddenly he was keeping a steady beat no problem with his legs and feet. He clearly didn’t gain this skill overnight 🙂 That doesn’t mean that I won’t keep giving him opportunities to gain the skill with his hands, especially because he was very motivated to beat rhythms with his hands, but there was a part of me that had wished I had access to that drum kit much earlier so we could expand upon being in the Responsibility stage of Play!

I think the biggest changes I am making since the beginning of the course is listening with more intention of identifying characteristics of the 5 developmental levels, starting out with a focus on listening to singing responses as they relate to the levels. I think I also am beginning to formulate more ways to assess and guide or deepen experience within the different areas.

[Erika (TeamRH)]

Hi Maggie,

Thank you so much for thoughtful and insightful response.

I wanted to respond to your question about assessing listening skills and assessment. I am apologizing ahead of time that this will be a bit long.

Assessment, from a traditional therapeutic lens, looks at skill ability and acquirement from a very concrete and fixed lens. Meaning, once you have a skill it is mastered, then you have all the skills mastered for that developmental level you are now at that level (and it’s a “fixed” position). However, the neurodiversity movement and emerging research is showing how this view of development does not match what it actually looks like in all people. In fact, with neurodiversity we know that neurotypical development “can” have some areas of fixed skill mastery, but overall, it is rather fluid, and we are never firmly planted within the levels. It also acknowledges that people who are neurodivergent are even more interesting in that they have asynchronous development which does not match the standard levels created for the neurotypical population. A second consideration is that someone’s “skill ability” actually fluctuates from day to day, week to week, and year to year. Also, as one skill may be the central focus of the body or the individual, other skill areas can regress in order to compensate for the centrally focused skill. So, it may look like other skill areas are no longer developed or not developed and then suddenly they re-appear (or appear out of nowhere).

Taking all of this into consideration when we assess, for individuals that appear to be on a neurotypical scale it seems more useful to look at global development and thinking about “moving” or “being” within a level as opposed to a fixed idea like “the child is at this developmental level.” For me, when I assess using Elizabeth’s scale, I find I get an overall picture of working within a specific developmental level based on the number of items that are present and then I use that as a baseline for monitoring how those skills move. When they show a general movement vertically these are signs skill acquisition is happening. Then when a more global movement has occurred within the next level from there, I know there is a moving or being within the next level happening.

Relating this directly to someone demonstrating listening skill, we do not have the capability to formally determine if pitch discrimination is always happening because it’s not always something that can be demonstrated. Certainly, when someone can match pitch, move a pitch with the change of pitch, or verbally identify the pitch these can be signs that pitch discrimination is happening. But there are many people who can audiate (hear in their mind) pitch discrimination but not demonstrate they are doing that. This is especially true for children. So, I try to really look at what is globally happening with listening to guide me, as opposed looking for a specific mastered skill.

I did want to share one last thought about neurodivergence. With neurodivergent individuals it is a bit more challenging and unhelpful to look for all the areas of development to be happening within one stage. This is because of the asynchronous skill acquisition that happens. Therefore, I find it really important to break down and look at each skill area separately, while also looking at how those effects the outward look of global development. For example, I may have an individual who shows that they are generally in the awareness stage of pitch due to apraxia, but rhythmically they are at a trust level. Apraxia effects the motor coordination for all the motor areas involved in speech and singing. So, discrimination may very well be happening but do due motor coordination challenges the individual will not be able to demonstrate what’s happening within their auditory system. At the same time, they could also be showing skill mastery of all the rhythmic skills in the Control phase. In some cases, you can find children who demonstrate rhythmic skills at the Trust stage and then pitch skills at the responsibility phase. This makes it virtually impossible to give a global level of development because they are not really moving within one stage or phase, rather they are within multiple areas of development unique to their body. This, in turn, informs me how I can accommodate the areas that are in drastically different places so that the individual can continue to have experiences that supports all areas of development. I also try to move away from the idea that all these areas of development have to eventually be at the same level as that is not likely to ever happen for a person with a disability.

I think Elizabeth’s assessment is unique in that it really lends itself nicely to the idea of fluidity of development and can be easily adapted to the unique and asynchronous development that happens within neurodivergence.

I apologize for a long response and hope this is helpful.

[Christine Wick]

I work in early intervention and also with older children with developmental differences and disabilities.
It was nice to see each musical experience broken down into the different sequences according to developmental milestones. It helps focus attention to be as intentional with musical choice making as the facilitator as possible. I’d say I use my voice the most within sessions, being very mindful of rhythmic cues it can provide or tonal shifts to support arousal levels. I loved when “music is movement and movement is music” was said because I think this is absolutely true. We’re all born to move and music provides such organization and structure to explore, whether it’s just listening, singing, or playing an instrument. There can be movement in all of these and within sessions I’m watching where this is happening and how I can validate, support, and help grow from.

[Katelyn Caruso]

Great point about music and movement! I love how music can support movement, and vice versa.

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