MT Clinical Skills

Final Exam

Code of Ethics

Summarizes our values as professionals and describes principles and standards for guiding the practice of music therapy in a responsible, fair, and accountable manner

Standards of Clinical Practice

Rules for measuring the quality of services. designed to assist practicing Music
Therapists and their employers in their endeavor to provide quality
services.  These standards are established through the authority of the American Music Therapy Association, Inc. This document first outlines general standards which should apply to all music therapy practice.

Professional Competencies

competency-based standards for ensuring the quality of education and clinical training in the field of music therapy

Goal

broad, long-term desired outcome

Objective

Specific, measurable steps to achieve a goal

SMART objective

A specific, measurable, attainable, relevant, and time-based

Multicultural music therapy

Involves understanding the wide breadth of cultures that exist in the world. It involves understanding how individuals and societies are affected by these cultural systems, and how dominant groups are favored while others are oppressed. It involves undertaking thorough self-examination and awareness of how one fits into these systems and how one can respond to them, while realizing that there will always be more to learn. Becoming a multicultural music therapist is a lifelong journey of continuous self-reflection, cultural learning (musical and non), and adapting to fit the needs of others. 

Privilege

a right or immunity granted as a peculiar benefit, advantage, or
favor : PREROGATIVE especially : such a right or immunity
attached specifically to a position or an office

Intersectionality

The complex, cumulative way in which the effects of multiple
forms of discrimination (such as racism, sexism, and classism)
combine, overlap, or intersect especially in the experiences of
marginalized individuals or groups

Oppression

the state of being subject to unjust treatment or control.

Microaggression

a statement, action, or incident regarded as an instance of indirect, subtle, or unintentional discrimination against members of a marginalized group such as a racial or ethnic minority.

Cultural Appropriation

the unacknowledged or inappropriate adoption of the customs, practices, ideas, etc. of one people or society by members of another and typically more dominant people or society.

Marginalized

having marginal social or political status : relegated to an
unimportant or powerless position within a society or group

RATE

Referral, assessment, treatment, evaluation

Quantitative RATE

MATADOC

Narrative RATE

SEMTAP

Goal areas

Cognitive, motor, communication/language, sensory, socio-emotional, music skills/preferences

TME Foundations

Motivation: What is motivating to the client? How will you engage the
client while holding true to their values?

TME Foundations

Target objective: What is the target objective you are addressing? How
are you going to directly work on the skill you are planning to address?

TME Foundations

Level of Support: What supports will the client/s need in place in order to be
both successful and appropriately challenged?

Success-based learning

Creates intrinsic motivation
• Builds upon the idea that clients are already coming to therapy as
whole people who do not need to be “fixed”
• Allows pathways to working on areas of growth
• Creates opportunities to build frustration tolerance
• Some folks call it “strength-based”

Optimal level of challenge

Not too difficult, not too easy
• Therapist can modulate this and adapt to create supports or remove
supports
• Therapist can build in breaks and cognitive “rest” to manipulate this

Scope-It Model

an occupational therapy framework for children, focusing on motivation of three psychological needs

Autonomy (Scope-It)

“I have choices”
• Motivation leads. To intention
• Intrinsic vs extrinsic motivation
• “The key to fostering self-directed activity engagement is to seek
practical means to support children’s autonomy while also
recognizing current environmental constraints and supports”*

Competence (Scope-It)

“I can do things”
• When children feel competent, they are more likely to be
motivated to do a task
-Success-based learning
• People with high self-perceived competence are more likely to
demonstrate resilience in the face of defeat

Relatedness (Scope-it)

”I am connected to others”
• “underpins exploration nd the ability to engage actively in the
environment”
-trust
-security
-interdependence
-closeness to others

Modeling

This provides an example of success, giving the client a visual and
auditory understanding of what it means to hit the target.
• This demystifies the process-watching someone else do
something first can promote confidence of replication
• This allows a person to visualize and imagine what it would look
like if they were to do the same thing.
• This can promote engagement
-”That looks fun” OR “I want to try” OR “That looks like a good
challenge” OR “I can do that, too”!
• This can be initial, ongoing, as needed, ABA, re-integrated*

Bandura’s social learning theory

explains how people learn new behaviors by observing others.

It emphasizes the role of modeling, imitation, and vicarious reinforcement.

This means we don’t have to experience rewards or punishments ourselves to learn from them. Instead, we watch what happens to others and adjust our behavior accordingly.

The theory also highlights four cognitive mediational processes.

Retention (Bandura)

Bandura highlighted the retention process in imitation, where individuals symbolically store a model’s behavior in their minds.

For successful imitation, observers must save these behaviors in symbolic forms, actively organizing them into easily recalled templates (Bandura, 1972).

How well the behavior is remembered. The behavior may be noticed, but it is not always remembered, which obviously prevents imitation.*

Attention (Bandura)

The model must capture the observer’s interest, and the observer must view the model’s behavior as worth imitating.*

Motor Reproduction (Bandura)

This process involves the ability to perform the behavior that the model has demonstrated.

Motivation (Bandura)

This is the will to perform the behavior. The observer will consider the rewards and punishments that follow a behavior.

If the perceived rewards outweigh the perceived costs (if any), the observer will more likely imitate the behavior.

If the vicarious reinforcement is unimportant to the observer, they will not imitate the behavior.

Communication

Origin of the word communication come from French and Latin words that meant having
something in common, connecting, or sharing
• In its current use, the term is usually equated with speech or written language
-as MT’s we are challenged to think outside of that box
• The above thought is supported by ASHA. “Making effective communication, a human right,
accessible and achievable for all”
• And by AMTA “MT also provides avenues for communication that can be helpful to those who
find it difficult to express themselves in words

Total Communication Approach

a flexible educational philosophy commonly used
in Deaf and special education settings to promote the optimization of language development through the use of multiple means of communication

Alternative and Augmentative Communication

AAC stands for Augmentative and Alternative Communication. It refers to tools and strategies that support or replace speech for people with communication difficulties. AAC can be unaided (like gestures or facial expressions) or aided (like picture boards or speech-generating devices).

Low teach AAC

refers to communication aids that don't use batteries or electricity

High tech AAC

refers to electronic, computer-based systems like tablets or dedicated devices that use advanced software to generate speech and facilitate complex communication

Unaided AAC

refers to AAC devices that do not require additional support for the person to utilize

Aided AAC

refers to AAC devices that do require additional support for the person to utilize

Dedicated AAC

a device or tool used only for the purpose of AAC

Non-dedicated AAC

app on tablet used for AAC as well as other functions

PECS

a visual, low-tech AAC system that involves the exchange of picture communication symbol icons to communicate words, phrases, and sentences. In this six-phase educational program,
specific prompting, reinforcement, and error correction techniques are implemented to help users, typically young children on the autism spectrum, develop spontaneous communication within a child-initiated framework

Sign Language

Signs representing core vocabulary words are often used as a form of unaided AAC in early childhood and educational settings

Feedback

Specific over general (basic context)
• Can support expectations (basic context)
• “Though its pervasiveness in human behavior is noted, feedback in clinical practice is a deliberate
psychological intervention that has two essential functions, information, and influence. Feedback
can be descriptive, emotional, evaluative, and interpretative” (Claiborn & Goodyear, 2005) –
(counseling context)
• Bruscia describes it as: “verbalizing how the client might appear, sound, or feel to another person”
(counseling context)

Descriptive feedback

Focus on observable behavior for the purpose of awareness and reflection

Evaluative feedback

Focus on performance vs standard, for the purpose of reinforcement or correction

Emotional feedback

Focus on therapist’s feeling for the purpose of connection and empathy

Interpretive feedback

Focus on underlying meaning for the purpose of insight and understanding

General verbal skills

Reflect, rephrase, translate

Reflect (verbal skills)

Matching the moods, attitudes, words, and feelings exhibited by the client

Rephrase (verbal skills)

A verbal technique where the MTx takes the meaning of the client’s words as well
as the implied communicative intent and puts it into a summary statement that allows for
greater clarity and intent

Translate (verbal skills)

Providing a summary and then using words to give meaning to client responses,
allowing the opportunity for the client to see their responses in the context of
others/interpersonal communication

Bruscia’s Assessment types

Diagnostic, interpretive, descriptive, prescriptive

Diagnostic (Bruscia assessment)

informs or supports a clinical diagnosis

Interpretive (Bruscia assessment)

explains problems relative to a particular theory or clinical perspective

Descriptive (Bruscia assessment)

attempts to understand clients in reference to themselves

Prescriptive (Bruscia assessment)

determines treatment needs-this would be most common

MT and Mental Health

“Music therapy with clientele who require mental health services is the specialized use of music to restore, maintain, and improve the following areas of functioning: cognitive, psychological, social/emotional, affective, communicative, and physiological functioning” (AMTA)

Three reasons why music therapy is a positive treatment approach in mental health

Non-invasiveness, high compliance, cost-effectiveness

Major depressive disorder

a mood disorder that causes a persistent feeling of sadness and loss of interest. It affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities.

Generalized anxiety disorder

Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or
activities (such as work or school performance).
• The individual finds it difficult to control the worry.
• The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having b een present for
more days than not for the past 6 months):
• Note: Only one item is required in children.
• Restlessness or feeling keyed up or on edge.
• Being easily fatigued.
• Difficulty concentrating or mind going blank.
• Irritability.
• Muscle tension.
• Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
• The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of
functioning.

Bipolar 1

a severe mental health condition defined by at least one full manic episode, which involves intense euphoria, high energy, impulsivity, and potentially psychosis, often followed by major depressive episodes, causing significant disruption to life, work, and relationships, with causes linked to genetics, brain biology, and environment, managed through lifelong treatment like mood stabilizers and therapy

Bipolar 2

a mental health condition defined by recurring episodes of major depression and hypomania, a less severe form of mania, without ever experiencing full manic episodes, causing significant mood swings between depressive lows and elevated (but not fully manic) highs, often leading to underdiagnosis because depressive episodes are prominent, but treatment involves mood stabilizers, psychotherapy (like CBT), and lifestyle changes

MT in psychiatric populations

Relevance?

Problems with contact and communication (psychiatric)

music therapy allows for switching between closeness and distance through music

Problems with becoming aware of and expressing feelings (psychiatric)

MT gives the opportunity of relieving one’s feelings in a safe setting with
a person who can contain, process, and reflect the expression

Problems with identity (psychiatric)

MT givens possibility for clients to rediscover playful and creative sides. The focus of musical
interaction can be on potential rather than a one-sided focus on weakness

Problems with feelings of distorted reality

The musical relationship can reflect oceanic experiences-The MT can consciously change between uniting and separating elements in the music, change between symbiosis and separation

Wheeler’s Psychotherapeutic classification of music therapy practices

This three-level approach to music therapy provided an early path to understanding the use of words and verbalization in music therapy

Wheeler’s three levels

Activity therapy, insight with re-educative, insight with reconstructive (extra training)

Bruscia’s MT Levels

Four levels

Auxiliary (Bruscia levels)

Not health-related goals, but still beneficial; words direct and inform, not treat

Augmentative (Bruscia levels)

MT is used to enhance efforts of other treatment modalities/supportive; verbal skills draw attention to music experiences

Intensive (Bruscia levels)

MT takes a significant role in addressing priority health needs; the words connect feelings and thought to music making

Primary (Bruscia levels)

MT takes the lead/singular role in meeting needs; advanced training, music therapist helps the client to confront deep issues

Integral Thinking

Here Bruscia discusses how there are so many different ways to
think about and practice MT.
• He says the differences of opinion in theory, practice, and opinion
are necessary to promote the profession
• He challenges folks to ”integrate new and old, see differences as
opinions, respect the ideas of others, be reflexive, change locus
and focus, and consider micro and macro perspectives

Agents of change in MT

Anticipating music, musicking, processing the music

Verbal framing

direct, guide, inform

Verbal exchanges

reciprocal verb., immediate circum

Verbal interactions

recip for meaningful content

Verbal interventions

primary agent of change

Verbalizations in sessions can…

Increase client awareness towards the music, increase client awareness towards client’s musical behavior, increase client awareness toward the interpersonal process in the music, increase client awareness toward the client’s internal experience

MT supporting SUD

“Music Therapy is part of an integrated approach to treatment for
addiction. Music therapy for substance abuse recovery is the use of
music and the therapeutic relationship to promote connection to
self and motivation to change while learning to navigate life in
sobriety. Active music-making, as well as music listening, has been
shown to activate the dopaminergic pathways in a similar manner
as many illicit substances. This response may reduce cravings and
improve mood. Music listening also calms the parasympathetic
nervous system which facilitates relaxation and decreases anxiety.”

Contraindications for music to treat SUD?

Could trigger trauma, could increase cravings via music
associations, completing full music history is best practice

Music IN therapy vs Music AS therapy

know the difference

Isoprinciple

Technique that was developed by Altshuler where the therapist musically engages the client based on their current/initial levels of mood and tempo. The music would then be systematically modified to bring about a corresponding change for the client/s.*

3 requirements for verbal interventions

 Advanced Education and training, Client consent, Adherence to ethical practice

Probing

asking q’s to elicit information sharing

Clarifying

or getting a clearer picture

Interpreting

or offering potential explanations

Disclosing

controversial, but the therapist reveals something about themselves here

Confronting

or challenging the client by pointing out contradictions/discrepancies in client responses

Summarizing

recapitulation, like Haydn.

Common goals of pediatric care

Decreased pain perception
• Developmental support
• Reduction of anxiety
• Emotional expression/ processing
• Development of positive coping skills
• Increased opportunities for social interaction
• Increased sensory stimulation
• Procedural support
• Bereavement support
• Legacy building
• Normalization of the hospital environment

Common TMEs of pediatric care

Active music engagement (AME)
• Music-assisted relaxation
• Music-alternate engagement
• Music listening
• Music-facilitated dramatic play
• Therapeutic singing
• Therapeutic music instruction
• Songwriting
• Recording projects

Psychoeducation

a therapeutic approach that provides clients and their families with knowledge about mental health conditions, treatment options, and coping strategies

Reflexive practice

Reflective practice is the ability to reflect on one's actions so as to engage in a process of continuous learning.*