good evening everybody thank you to mary jo and diane and everybody with the sea pack in belmont i am so excited to be here to talk about music therapy at the maracas center for their peta karts we are located in belmont and we've been there for almost two years and we have as mary jo stated we have lots of different services most primarily is music therapy we also offer reiki we offer holistic lifestyle coaching we offer  psychotherapy and she just brand new program we just started as baby massage which is super exciting and we did a childbirth class recently so we're doing a little bit of everything trying to meet the community's needs and the music therapy that we do which i am going to jump into in just a moment is both in house and out in the community and we run individual sessions and we run group sessions so without further ado i am going to jump into who we are and what we do and why we do it so what is music therapy this is a direct definition from the american music therapy association and it says music therapy is the clinical and evidence based use of music interventions to accomplish individual ised goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program and that's something down at the bottom that is extremely important a credentialed a professional who has completed an approved music therapy program so who is that person we're going to talk about miss about music therapy i've been a music therapist for about twenty five years and i have come across so many people who have an interesting idea of what music therapy is when i first started schooling in graduate school i was asked is that just playing records for people and you talk about what that is you know what song is about and honestly i kind of thought that maybe that was it and i thought that the it really great a really great career but turns out that's not like that at all so the first myth is i have to be musical to participate as a client absolutely not you don't have to be musical in any way however i have yet to find someone who's not musical in all of my work second is there's a particular kind of music that i therapeutic you know all music can be therapeutic it really depends on who you are and what you need and where you are in the moment what you need today may be very very different from what you need tomorrow or next week you may absolutely love easy listening music and you put that on the radio if you're in the car have a have a cd that goes in or next week you're going to want some really hard rap who knows you're going to meet yourself in the moment and so it's not one particular kind of music third is i need a particular key or instrument to address my issue i actually strangely enough hear this quite a bit from music therapy students they come in as in turns to my program and they say don't we need to work in a mine or when somebody is sad and i say you can but you don't have to go but i have this client who's autistic and i was told that a flat is really helpful this no such thing as one particular key or instrument to address any particular issue again it's where your client is in the moment and what works for that situation i am a typical you know normal individual neuro typical as we call them music therapy can't help me i disagree i have seen music therapy work with a ton of typically developing individuals we have we'll have a list in just a moment but we have to do less often use a music therapist when they're working on labor and childbirth we have individuals who are working through perhaps some stress or some trauma or some grieving and typically developing but they just need to get through an issue that you can use music because it's non threatening and very different from talk therapy and they can kind of move through to the other side of that issue last is i am musical i play the harp at my grandmother's nursing home i can call myself a music therapist please don't please tell me you're not a music therapist you are a musician who is giving something very special a very special gift to people and it's very it's it's an amazing gift to give of yourself to give of your music but unless you have the education unless you have the training and unless you have the certification you cannot call yourself a music therapist so watch out for that because that does happen a lot ok so who are we a music therapist must have a bachelor's degree or higher in music therapy from one of a m t a's seventy two approved colleges and universities including clinical training we have three colleges and universities in massachusetts leslie university berkeley college of music and in a maria college who all have music therapy programs music therapist must hope the mt be secret entia which is music therapist board certified issued through the certification board for music therapists which protects the public by ensuring competent practice and requiring continuing education some states also require licensure for board certified music therapists massachusetts does not require licensure but licensure is available for certain students  degrees require knowledge in psychology medicine and music we have specialized forms of music therapy nordoff robbins music therapy which is where i train down in new york it's a speech it's a specialized program because it's based on clinical improvisation making music in the moment to meet every need whereas most other music therapists work with pre composed or composed music it's a little bit different neurologic music therapy working on gait training working on how the brain uses music and facilitates the music to develop more brain and neural sorry neurological function and guided imagery and music which is used primarily with adults where it's a visualization process and it's recorded  and working through it's almost like a dream state and all of these programs need extra training so where do we work i'm not going to read the list i'll just pick out a few we have senior centers drug and alcohol programs rehabilitative facilities schools we have early intervention day care treatment centers i would say out of all of these i've probably worked in about five different kinds of placements myself and the work is all very different depending on who you're working with and what the needs are as i've been saying so i'm often asked how do we fit with related service providers and practitioners in schools and other facilities p t o t and speech and language are often put up way up high in this wonderful pedestal they work awfully hard and music therapists are working so hard to be up there with them because we do put in twelve hundred clinical hours after our training so p t is thirteen hundred hours o t ten ninety five speech and language therapy twelve sixty now that's before they do any specialized training and that's the same for music therapy so before i go into this slide i want to tell you a little bit about why i became a music therapist i was lucky enough to have a younger brother with cerebral palsy hearing impairment and vision impairment quite severely involved and my parents felt that he we were in california at the time and he would be better services in the one nine hundred seventy s at home rather than in a state hospital which is what people were doing at that time there really weren't facilities that my parents felt comfortable with leaving him even though the doctors were saying he'll be a vegetable he'll never do anything just send them away and be done with it so my parents to develop their own home school program and we invited six other special needs children to live with us we had a big old farmhouse in california outside sacramento and as a part of that i was growing up and experiencing these children as my siblings and understanding that and none of them were verbal none of them were ambulatory and yet they were all very vocal and as a teenager young teenager i was forced to play the piano and my mother very lovingly said this is what's happening you're going to be musical and so i have this level e baby grand piano is a bit of a bribe in and practice but what i noticed was that when the children were placed on blankets down on the floor by the piano and i would practice like i had to do every single day they started reacting to the music and i didn't really notice it at first i just kind of noticed out of the corner a foot would maybe move to the tempo that i was playing and then all of a sudden i started paying closer attention and hearing that somebody who was maybe crying was really crying or vocalizing in the key that i was playing it so then as i became much more aware of this i would change my key and they would change their vocalization i would change my tempo and their tapping would change as well so i started understanding how i could communicate with these lovely children who were basically non communicative we thought with music so i took that information and i put it in the back of my head and i went off to college and i really didn't think much about it until i decided on the music program in my in my university schooling and i didn't want to teach and i didn't want to study i didn't want to perform i didn't want to do history i couldn't figure out what to do in my piano teacher said why don't there's this new field called music therapy and so i looked into it and it felt like the most perfect marriage of everything i had done bringing it back from the back of my head oh my goodness i can do what i did at home and i can do it all day long and get paid for this so i decided yeah that's what i'm doing and i went off to new york to do it and i guess you say the rest is history i've been like i said music therapist for twenty five years primarily working with young children early intervention all the way up through about twenty and then within this last year i've added adults to my caseload and it's been so rewarding so that's about my background i want to remind you of this what the m t a had described music therapy as the clinical an evidence based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credential professional who has completed an approved music therapy program music interventions we don't use talk we don't use drawing we don't use music we use i'm sorry we don't use movement we use music so let's go on and see what that means michael is a child i work with his six years old he's on the autism spectrum he can speak but it's echolalic as in he's he spits it right back to me whatever i say comes back if i really want to find out what he's thinking i have to really focus him very very hard and it just isn't fun for him a separates on the alphabet and numbers he draws the alphabet in the rug and numbers and then if i don't buy kind of redirects hands he'll do it in the air and he stimulates systems himself off of that he has difficulty following one step directions and participating in groups and he's easily distracted the first six sessions were very challenging he runs through the room these are individual sessions runs through the room stops themself on windows and glass doors he's running from room a side of the room to side of the room stopping himself like this and as my anxiety level starts to rise he thinks it's funny so my voice is changing please stop michael please stop michael and he's doing it even more so now a lot of music is getting done he has these high  doesn't communicate anything to me i'm trying to get to know him i try to match the music and i feel like we're just we're just not getting there he's interested in the instruments but he's unable to stop moving so that he can involve himself in the music he enjoys familiar songs wills on the bus old macdonald but he's unable to participate for longer than a few moments i'll pull out the guitar i've got the piano always live music that we're using matched the tones that he's that he's and he'll stop and he'll listen and then he'll get up and move around again i develop some goals and objectives for him first is hill expand his communication skills by participating in an active musical relationship using new instruments and voice objective one is michael will participate in a lyric substitution activity by making at least four lyric choices generalized to three or more sessions in a row so substitution activity of be like old macdonald and then you know first old macdonald has the cow and then old macdonald has a and i wait i give him choices and he c objectives because i can't even get him to slow down right he's banging into the windows in the doors being very unsafe lots of loud vocalisations doesn't seem like he's unhappy or uncomfortable he's just not able to come into the musical relationship yet so here's a very simplified line of communication of goal development in music therapy this is not the same for every single person kind of has a lot of give and take here but we're starting with basic imitation beat at this point vocal lyric fill in imitation of rhythmic patterns we're not up there with michael we're down here we're barely here possibly here i haven't been able to to work on an imitation activity with him yet but i'm assuming that he's there making one more lyric choices i think he can do it but he's not showing me yet following one step commands no can even stop his body verbal lyric fillin we're trying but that's in the goals we're not there yet singing whole lines absolutely not talking in three to six words sentences less it's echolalic so i would say in michael's first few sessions we're definitely down in here getting a tiny bit of the call and response we're definitely getting some sounds another goal is michael expand socialization skills by participating in musical activities involving waiting turn taking and keeping his body call me an alert objective one is michael will participate in turn taking activities which call upon him to wait for several moments between turns he's in session with me so we are taking turns together but next is michael participate in passing activities by turning to his neighbor to both receive and pass an item on the  neighbor the last is michael participate in self regulation activities to keep his body call and alert very important that since i was a socialization goal this is extremely simplified but on this end we have know little or inappropriate interactions with peers for him and his peer in the room and on that and we have awareness of an appropriate internet interaction with peers so this side of the development would be assisted and then this side is unassisted so assisted means i'm helping him make a choice i'm helping him with passing games and i'm helping him with turn tak and then as as our sessions progress he's able to make appear choice he's able to pass and he's able to take turns without assistance and love this quote oliver sacks an amazing man and miss him terribly what is beyond dispute is the effect of intensive musical training on the young plastic brain although a teaspoon of mozart may or may not make a child a better mathematician there is little doubt that regular exposure to music and especially active participation in music may stimulate development of many different areas of the brain so we talk about the plastic brain he's talking about the neuro plastic bra very malleable and this is an interview with harper's where he was talking about the mozart effect somebody was asking him is the mozart effect real and that was his answer so we're going to talk a little bit about tiny tiny bit a pet scan positive emission tomography is it measures heat in the brain and this is as it says a resting brain a little bit the green blue little bit of red yellow orange the red and the yellow that's picking up the heat of what's going on in the resting brains pretty evenly dispersed that's just kind of quiet then when you add music it goes like this they used to say scientists used to say that there was a music center in the brain there was one area of the brain that perceived made sense of music because there's actually a speech center in the brain so they thought speech music then there's those centers in the brain well as you can see with the pet scan it's not just one area of the brain that starts to be active it's many areas of the brain and if you think about it and you think about making music or participating in a musical activity or even just listening to the music we often don't just sit still we're often thinking of memories we're often trying to remember the lyrics to that song or where we were when that song came on the last time so it is many parts of the brain that are working so if you know the song think about where you were the next the last time that you sang this song or listen to th of all was a fun ok it's like the key to my work is to make it fun if my clients leave my room my music room having had a good time than i know they've been working but it wasn't just fun because if you think about the pet scan so much of your brain was firing off and i know you're all tired we just had a major storm everybody had to get going today in the ice and yet you were able to produce something somewhat simple but yet we have so many areas of the brain we're just firing off even though you're tired right so i'm not going to go through all of this what i want to demonstrate is that every single area of the brain was just working if your body was moving in any way the as well as this area here if you were watching me watching your friends except at a lobe if you were in touch with feelings of any kind or memories the temp lobe as well as syria and here the hippocampus we have so many opportunities for neural plastic development many of the individuals i work with have some sort of neurological impairment and what we've learned is that by using something like music that incorporates so much of the brain if we have a roadway in the brain that is damaged for whatever reason if we keep if we if we increase stimulus like me we create a new pa so especially the earlier we get to this is the better so if i have a young child who's not speaking and there's perhaps some damage in the speech area we can bypass that with music because it fires up so much more the brain is able to take over different parts actually we asked dr sacks dr oliver sacks a question about blind children why are they always so musical i don't know if you know this but they're mainly musical m of them when they have to put a lobe is not working for vision he says it does other things once it's missing or it's considerably damaged it's still there and it's still workable it's going to do other things doesn't need it for vision let's do some other stuff that's the way the whole brain works so if you're firing in with a bunch of music and the brain is just going fireworks in there you're developing new streets new pathways for communication socialization and functioning what better way to do that than music it's fun and it works and it's scientifically  so we go back to michael seven session he responds well the simple requests i have kept everything just the same every single session he were sponsored to me saying use your quiet body you gentle hands your eyes i'm jel but he needs to be constantly reminded meanwhile i'm just continuing to do the same songs with him and calling him into the music he's able to participate musically for up to thirty to forty five seconds now that's not a very long time but considering he's been spending himself through the room and stopping himself on the glass that works for me he's able to make choices for songs and instruments all of a sudden we're shifting and what's happening you may ask we're developing try trust within our therapeutic relationship his trust in the music mistrusting me he continues to stand a bounce needs to move throughout the room every ten minutes or so still with big moving kind of kit but he's not using the glass to stop himself the eight session he participates in a drumming activities into drums bilaterally for up to eight minutes i was blown away what i did was i had to call them paddle drums had two of these and i came up to him and i put one here and i but one here and we went back and forth and all of a sudden all he could see was me and they said and what if you want to do he wanted to touch them  noise and then i had them in all all of his visual areas and he wanted to participate to for eight minutes he looks at me with clarity after the drumming and asks for an animal ok sure participates virtually and musically in the animals on for five minutes making all of the animal choices and all of the animal songs no prompting from me eight session big deal he sits with quiet focus not needing to be reminded to have a calm i created that the trust in the moment and the drumming activity rhythm is incredibly important in our lives we walk we talk we breathe our heart beats we blink our eyes we have the sun in the moon we have the the the tides everything is rhythmical our seasons everything is rhythmical and when we tie into that we're able to have incredible success and for michael it happened on this session so this is an avanti she is eight years old and she is an absolutely lovely child she is bastard quadriplegic she's in a wheelchair and she's missing and i just missed agnes in the in see in video but she clearly loves music loves coming into music we've been seeing her for about three months before we begin we talk to the parents and they wanted to volunteer to attend music therapy sessions to expand her communication skills to increase her hand use and to increase her socialization skills parents know that among his right arm is extremely tight making it almost impossible for her to use it functionally at any time also vocalizes very little to communicate her needs so she comes in to me in the very first session and her arm is way up here she loves the piano and she reaches for it with her left hand in the first session we room wheeler up to the piano she fits right under it and she reaches right out with the left at the right every time i try to repurpose that right hand redirect it  just gets tighter and tighter and tighter she makes a couple random vocalisations possibly from frustration that she cannot access the instruments that the way she wants to quite a bit and so she and i get into a often it's her left hand coming up to her right and then her right gets it into our mouth she accepts redirection to play the instruments more functionally but again like i said it's clearly frustrates her so she and i called the co therapist john is on the piano as the primary therapist creating the music in the in the room and i'm working directly with her to help her use her arms functionally second session she begins to smile when she recognizes her music therapists and realize she's going to piano again she loved it so much she was very happy to come back to it she immediately reaches out with her left hand to play the keys and attempts a few tries to reach with the right hand though her whole arm is extremely tight and i spend most of the session with a hand behind her shoulder trying to relax it and a hand at her elbow  to tap on the drum with very light swipes but no sound is produced and she's really frustrated years old she wants to bang on the drum and she's not making any s become slightly more vocal when the music therapist sings to her with long open tones and you'll see him doing it in the video coming up so we create some goals and objectives and vonte will expand the use her voice to participate in a pretty dialogue communication should participate vocally and call in response musical activities with at least four exchanges within a forty five minute session you remember this so we're working on this where way back here we don't even have this yet so we'll get to this and then go here next is the volunteer will expand the range of motion with her right arm to participate musical activities she can do it but whatever it is the excitement of coming into the music room what not she's tightening up the vonte will use her right hand to reach for instruments such as the piano shake a shaker and tap a drum or tambourine for at least two minutes and three out of five opportunity why do we want her to participate in music why why does it matter if she can beat a drum our belief in our reality really because we've seen it so many times is if you can beat here and if you can hold onto a mallet and beat on a drum you can then hold onto a spoon so what we're working on is generalizing so that's quite simplistic but very necessary if you can't beat yourself as you get older there are less and less opportunities for someone to feed you so that's something you really want you to be able to do right social opportunities why does it make sense to take turns doing something because if you can take turns in the music room then you can take turns in school you can take turns on the playground you can take turns work i was thrilled when she did that is so touching to watch somebody all of a sudden be motivated to participate and you're thinking you have this idea in your head you may before use the chimes maybe she'll like that sound she really want to play and then it happens it's like wow to witness somebody coming out like that is really amazing so we develop another goal should participate in musical activities which require her to follow one step directions vonte will participate musically activities which ask her to empty or fill a bucket with fading adult support three out of five opportunities in avante will fill in the beat on any instrument during the rhythmical activities with fading adult support three out of five opportunity like wow how are we going to get there would barely got that arm to reach then we started a new activity get that right i'm trying trying yawning is often a sign of i'm all done with a lot of work so now i'm going to help her out of what i'm in the bucket for you works quite a bit with stroke victims but i would say for me working with stroke if we need to access the language center of the brain because a lot of times languages  is decreased depending on what muscles are controlled and what part of the brain there was the bleed so if i guess it's a complicated answer depending on what area needs support and what  area needs more neural plasticity we're going to work on training we're going to work on reaching and range of motion we're going to work on memory we're going to work on singing songs as a big one especially for like memory units and a where individuals are able to sing whole songs with they can have a cup to sing a different part of the brain and so with music therapy you're trying to access that part that's healthy and get it to generalize to the areas that aren't healthy so that think yes what starts on the telephone with the parent or with the caregiver or with the client themselves to find out why music therapy are you are you familiar with music therapy or is this kind of a stab in the dark and you just want to try everything you heard from your girlfriend that this will work let's try it and then we note down all of the particulars age needs diagnoses if there are any and and then we have at the maracas center we have our clients come in for a free consultation which we call an intake and it lasts about thirty to sixty minutes and if it's a child the parent is welcome to come in the room if it works if it doesn't sometimes children do better without parents but they're always within earshot so they can hear what's going on and we always say it's to see how parents can see how we work and we can see how the child responds to music so because we've been doing this for so long we're usually able to pick up a lot of different things whether they can keep a basic beat have a sense of rhythm whether they can blow a horn whether they can sing a song whether they can have a range of motion you know where where like where her arm is will she let us with to facilitate that arm or will she not will she vocalize if we could do a call in response activity that kind of thing for a higher functioning individual that might be more like socialization strategies can you self regulate lot of our children especially in the school so they are able to regulate their bodies and they're banging into people and their impulse control is really challenging they're jumping out of their c in their needing a lot of feedback in their bodies unable to focus for long periods of time so we notice that we notice how they move around the room we have a trampoline in the room we have a ball in the room we have a few of the things we have big drums in the room how do they hold their bodies how do they interact with us rhythmically sometimes that's going to take another couple of sessions and we'll tell the parent that will say we've got a good glimpse but we'd like to see your child for a couple more sessions to really give you a good idea of what our goals and objectives would be and so we move forward and then we come and we develop a plan that's usually how we do it ok so we're often asked how do you differ from music education and we do and we don't we're all musicians that's one thing that we are we all have in common for music therapy we're process oriented we're goal driven session is finely tuned to the individual even in groups unless the group of twelve to twenty it's difficult to work individually in those groups but if i have a group of say five children or five adults even i'm thinking about what each of those individuals need and how we can meet it musically within the group we support the emotional well being we address needs in a clinical manner scientific manner we have generalization of skills outside of the session to other areas of the client's life life skill building and groups are organized by skill level for music education product oriented often working toward a performance curriculum driven individual or group doesn't matter class organized by overall agenda this is what we're doing today we're working on this we have the holiday concert coming at cetera does not address emotional well being that that is it depends i'm also piano teacher and i know that i address emotional well being of all my my students because that's how i work it's very hard to turn the therapist off in me and i think a lot of our really good music teachers have to really tune into this doesn't address the needs in a music class we're really thinking about getting to the end and having everybody be a cohesive group and these are all i'm certainly not against music education like i said i'm a i'm a piano teacher myself so it's just different expectation of practicing outside of lesson whereas in music therapy there's no expectation that you're going to practice anything outside of the lesson or the session talent building and classes organized by age typically ok so to wrap up the power point i have this great quote by michael toat and gerald mackintosh where music therapists music can drive general reeducation of cognitive motor and speech and language functions via shared brain systems and plasticity once used only as a supplementary stimulation to fiddle facilitate treatment music now be investigated as a potential element of active learning and training so once they learned that there w just one music center of the brain they realised we can do so much with music because the brain is so trainable and malleable so that's the end of that part the part that i wanted to go back over for the baraki center is that i'm not just a piano teacher i'm a therapeutic piano teacher in our field of music education slash music therapy in this area of massachusetts there are very few teachers who actually teach an instrument to a therapeutic crowd i have met many many parents who have children who want to learn music and yet they send them off to a music teacher a drum teacher a piano teacher a voice teacher and because of their child's particular needs or learning style they failed the whole system failed and the child ended up being discouraged which is a real shame so we developed both john and i teach ther to individuals any age who are interested in doing lessons and there's only one of the teachers that i know does this and he's and said barry so that's one of the thing that we do along with all the other music and the work with the whole spectrum we work with the the early intervention baby who is not making any sounds and has perhaps a genetic issue and we work all the way out one of my more recent clients was ninety years a sorry seventy years old with a brain tumor and you don't normally developing woman who developed unfortunately brain cancer and then we started working musically with her to work on some getting back some of her skills so we all may have we all meaning music therapist may have our own preference of who we want to work with but generally in terms of like  range or ability slash disability but typically music therapy can really span the entire gamut at the maracas center we never turn anybody away if we feel that it's not a good  fit we would talk to the parent we would try to find another therapist for them it may take a couple of sessions in order to really discern what we can do like i was describing earlier you know it it it does to it's very important to take the time to develop a gear for you we do get referrals from other practitioners we get them from doctors neurologists we get them from schools we get them from other parents word of mouth weekly it's all right i can answer all of it and it's usually about forty five minutes and often what our first question is individual or group and to be in a group you have to have some pretty good socialization skills usually to go into a group that's what you're working on or socialization skills but you have to have a certain level in order to be in the group we can't be managing a ton of behaviors if you're going to be in a group because then we don't get anything done and  so then when we set a plan we talk to the parents and or to the client and we say we'd like to start initially for a three to six month period and its ties into the payment situation music therapy in massachusetts alone is not reimbursable by insurance directly meaning that i cannot become the provider however some music therapists are licensed mental health counselors they can be providers and they can be reimbursed directly by the insurance company if the individual has mental health benefits coverage so if you come to the maracas center at this time we do not have l m h c s so if you come to the maracas center and you're interested in insurance coverage what we do is we start with the primary doctor and we ask you to go get a prescription for six months of one hour a week music therapy and that includes forty five minutes of the session and fifteen minutes consultation time and when they come back with the prescription then we're able to work with the doctor for that with the proper medical forms and the letter medical necessity and then the parent or the individual can then submit that with our bill to their insurance company and depending on who they're covered by they could possibly get coverage we have had some  some of our clients are covered and some of them are  not well right now we've had really good success with and we know that individuals on the spectrum the autism spectrum are often covered for many different services and then there are the different programs that work with recreational funds that some parents are a part of with their children and they will pay for music therapy we are at four thirty one road so we're between the belmont studio cinema and star market on the same side of the road a star market crazy thank you so much i'm so glad you are here thank you for braving the ice in the cold