Welcome, Intern Macie!

My name is Macie Skinner and I am so excited to be a part of the Therabeat team as a music therapy intern! I am from Alpharetta, Georgia, and I am so happy to be back home working in a field that I am so passionate about! Growing up, I was on a competition dance team at RISPA, a performing arts studio in Milton, GA. I moved back home at the beginning of the pandemic, and by this past fall I was able to begin teaching classes at my old studio again! I have always loved working with kids and teens, and Therabeat has already proven to be a perfect fit for me in more ways than one!

I began my music therapy journey at Florida State University in 2016, where my primary instrument was voice, but I also spent a ton of time studying instruments like the guitar and piano! I earned a certificate degree in Music in Special Education my senior year, and I was one of a few music students lucky enough to be able to extensively study American Sign Language through a specialization program! ASL quickly became a passion of mine, and I was even able to become a TA for a nonverbal communication class for undergraduate music therapy students! One day, I hope to open my own co-operative private practice that serves individuals with hearing impairments! Outside of the classroom, I served as co-captain of LEVEL Dance Company, a student-run dance team, and performed at various campus events including: Dance Marathon, Relay for Life, FSU’s annual Homecoming Parades, and Pow-Wow Pep Rallies!

I absolutely love all things tie dye, vintage, and anything with sunflowers on it! I am a coffee fanatic, and I’m constantly listening to and learning new music. Some of my biggest musical influences include: Elton John, Jake Scott, Ben Platt, and Sara Bareilles! When I’m not working, I enjoy spending time with my friends and family, and babysitting my sweet nieces and nephew!

My first week as an intern at Therabeat has shown me that this experience is going to be everything I could’ve asked for in an internship and more! The team of therapists have been so welcoming and helpful with any and all questions we’ve had (and there’s been a LOT)! I love coming to work every morning, there’s nothing like walking into such a positive atmosphere full of joy and celebrations for little victories! I’ve already learned so much from everyone here, and I can’t wait to continue learning and growing with such incredible people! 

‘Til next time!

-Macie Skinner, Music Therapy Intern

Welcome, Intern Kennedi!

Hello everyone! My name is Kennedi Walz. I am extremely excited to be doing my internship at Therabeat! I was uncertain of what my internship would look like during these trying times, but I am very thankful I was welcomed at Therabeat. I am originally from Manchester, TN, but have called Chattanooga, TN my home for the past four and a half years. I love to be outside and enjoy warm weather! I love to hike and travel. I am a huge animal lover with a dog named Kupcake and four guinea pigs (that’s a whole other story)! I am a huge Disney fan! Growing up, my family trips would either be to Disney or the beach, probably a huge reason behind what I love now. Family time is always something I have cherished and I believe I always will. They have each made impacts in my life that have molded me into the person that I am today, which has guided me to where I am now. 

I was introduced to music therapy whenever I was a senior in high school. I researched it and instantly knew that it was something I was very interested in. Music therapy combines my two passions: music and helping others. I have always been passionate about the two my whole life. I had many encounters and experiences on my journey on figuring out my life purpose, and quickly realized music therapy was it. I began college at Chattanooga State Community College where I received my Associates of Fine Arts in Music. I then transferred to the University of Tennessee at Chattanooga where I will graduate in Summer 2021! I will be the first student to graduate from the university with a degree in music therapy. I am beyond thankful for my time at UTC and the experience and knowledge I gained from being there. 

My primary instrument is voice, but I also play the guitar, ukulele, and piano. I have had the pleasure of working with older adults with Parkinson’s Disease, children affected by cancer, adolescents with various special needs, and adults with IDD during my time in college. I also found a love of volunteering with the Miracle League of Chattanooga assisting children and adults with various special needs with playing baseball. Miracle League will forever hold a special place in my heart. No matter the day I am having, being able to help someone and “amplify [their] life” will always make my day brighter. 

Starting at Therabeat was life changing for me. Moving somewhere where I know no one is very different for me and transitioning from a student in a classroom to an intern constantly moving has definitely been an adjustment. I have loved every minute of being at Therabeat. The atmosphere is extremely welcoming and it feels like I’ve been there for so much longer than a week. I have already experienced and learned so many new things! I love that I am able to learn from each music therapist, and that they are so helpful. Being adaptable and flexible is something I have been told all throughout my time as a music therapy student and, to all the MT students out there, I lived it my first week! The fast moving pace at the clinic is so much fun though and I love seeing all the smiling faces I pass daily; makes each day brighter. I know I will grow to be the best music therapist I can be here and I am excited for this adventure! Here’s to the next six months! 

Love the life you live! 

Best wishes, Kennedi Walz, Music Therapy Intern

Music Therapy & Behavioral Disorders

Research has shown that music therapy can be an effective tool for helping patients who have emotional behavioral disorders. Music can be used to help students with social skills, self-esteem, and academic support (Roley, 2017). The IDEA (individuals with disabilities education act) gives five characteristics that describe a child with a severe emotional disturbance:

1. An inability to learn which cannot be explained by intellectual, sensory, and health factors

2. An inability to build or maintain satisfactory relationships with peers and teachers

3. Inappropriate types of behavior or feelings under normal circumstances

4. A general pervasive mood of unhappiness or depression

5. A tendency to develop physical symptoms or fears associated with personal or school problems (6).

This diagnosis makes up only about 1% of student populations due to this population being underidentified, underserved, and there not being a clearer understanding of what a severe emotional disturbance means (6). There are many risk factors that make it more likely that a child will develop this disorder and those include: socioeconomic status or demographics, unsafe home and school environment, environmental or psychosocial events (divorce, death, etc), and psychological make-up (7-8). There are many ways that music therapy can not only help students with behavioral and emotional disturbances but also be a tool for managing inappropriate behavior. 

Music interventions can help students express emotion, create group association, integrate social organization, symbolize representative beliefs and ideas, and support educational purposes (Parker, 2018). Some different music therapy techniques and approaches that could be useful with this population are the Behavioral Music Therapy Theory, The Bonnie Method of Imagery and Music, Nordoff Robbins Music Therapy, Psychodynamic Music Therapy, and Cognitive Behavioral Music Therapy (17-20). 

Specific interventions that could be used to help work on these students' goals could include “playing an instrument for on task behavior, using a small group setting to allow for interpersonal interactions, teaching turn taking, and sharing space while playing instruments to aid in impulse control” (Roley, 2017). One study by Sausser & Waller worked on 8 different goals: create a structured and safe musical experience for students, establish group cohesion, provide planned sessions to focus on group needs and individuals Individualized Education Plans (IEP’s), Music therapy and Emotional behavioral disorders, 13 facilitate group movement to enhance motor coordination and overall physical fitness, and allow for students to explore personal musical interests (12-13). 

Roley states that music therapy can “positively affect social skills in adolescents labeled EBD” (27). The literature showed that group music therapy proved to be most effective as well as improvisational techniques. Roley says that “The final theme re-occurred throughout the literature, which stated the lack of research within the effectiveness of music therapy, within all settings and among all populations. The existing research shows positive effects music therapy can have on patients with mental health needs, especially in children and adolescents with autism” (29). The research points us in the direction of music therapy being an effective tool for the students. However, to continue to advocate for this field and to be able to validate the reasoning behind music therapy with this population, more research needs to be done. 

-Sara Demlow, Music Therapy Intern

Roley, A. (2017). Music Therapy in the Treatment of Adolescents with Emotional and Behavioral Disorder: A Systematic Review. 1-34.

Parker, F., III. (2018). Music Therapy as a Behavior Modification for Students with Severe   Behavior. 1-20.

Music Therapy and Hearing Impairments

The concept of providing music therapy for those who have hearing impairments or use a cochlear implant seems like a far-off and impractical concept to many people. This is a big misconception because most people believe that a large percentage of individuals with hearing impairments can not hear at all, which is not true. Although having a hearing impairment is a far greater communication and sensory handicap that hearing people realize, there are still many challenges that can be overcome. Alice Ann Darrow (1989, p. 61) writes that “blindness” is ‘an environmental handicap’ while deafness is a social disorder that keeps one from people”. This post is going to cue in on how individuals with cochlear implants are able to enjoy music and what methods of music therapy work best when working with these individuals.

Cochlear implants (CI) focus on transmitting only sounds that are essential to speech recognition. This means that most aspects of music are not transmitted, making it difficult for individuals with CIs to percieve timber and pitch (Hidalgo, Pesnot, Marquis, Roman, & Schön, 2019). The one aspect of music that is transmitted the best is rhythm (Gfeller & Knutson, 2003). Rap music is a common preference of teenagers with implants and line dancing music is a common preference of adults with implants because both rap and line dancing music usually have strong, steady beats (Gfeller & Knutson, 2003). Rap music also typically has rhythmically spoken lyrics over the steady beat. This is important to note because the rhythmicity of the words make the songs more easily recognizable. Individuals with cochlear implants have an easier time identifying songs with lyrics and a harder time identifying instrumental songs.

(http://www.vancouversun.com/health/should+cochlear+implant/7502865/story.html)

Since cochlear implants focus mainly on speech, individuals with cochlear implants can also have a hard time discriminating timber of instruments, tone quality, and pitches. These difficulties can vary based on relative health of the auditory nerve, the cause of deafness, whether a full insert of the implant was possible, whether all the implant channels are active, the age at implantation, cognitive and perceptive abilities, etc. For implant users, it is easier to compare the timbre of instruments to each other rather than listening to an instrument alone. The skill of instrument identification could possibly strengthen after listening practice (Gfeller & Knutson, 2003). Some people with cochlear implants say that the tone quality of most instruments sound “unnatural or tinny” (Gfeller & Knutson, 2003). Differentiating pitches, when listening or singing, is perceived to be one of the most difficult aspects of music listening for implant recipients. Studies show that adults with CIs are more self-conscious than children about singing in public and that they find it very difficult to sing along with an external pitch (Gfeller & Knutson, 2003). 

Listening to music and having repeated exposure to music stimuli can play a major role in how music can affect someone’s life (Gfeller & Knutson, 2003). With repeated exporesure, music would be able to be used in daily life and be more easily enjoyed by individuals with CIs. There is already emerging evidence that specific music training is able to improve music perception for people who use CIs (Jiam, Deroche, Jiradejvong, & Limb, 2019). The existing studies have used in-person training models and have not tapped into online resources yet (Jiam, Deroche, Jiradejvong, & Limb, 2019).

Music therapy can be extremely beneficial for those utilizing cochlear implants. One thing music therapists’ have to be very specific about when doing music therapy with individuals with CIs is the environment. Unlike when recording an acapella piece or singing with a choir, a music therapist would not want a very acoustic room. The room should be filled with many things that will absorb sounds and echoes. Without things like carpets and curtains, the sound will bounce around and cause distortion (Gfeller & Knutson, 2003). It is also important for therapists to dive into their patient musical preference. Just like individuals without CIs, individuals with CIs all like listening to different types of music. Music therapists’ want the patients to enjoy what they are listening to, not be turned away from it.

The four basic types of music therapy interventions used for patients with CIs are listening to music, moving to music, singing, and playing instruments (Gfeller & Knutson, 2003). Listening to music can be functional in many ways, such as providing opportunities for social interaction or even working on speech recognition. Moving to music also is a great avenue for increasing social interaction in a group setting. Singing can target many different essential areas, like socialization, articulation, and exploring one’s voice. Joining a choir can be a very social experience. Singing or saying rhythmic chants like “Going on a Bear Hunt” or “5 Little Ducks” can focus on the range of their speaking voice and articulation of speech. Using vocal exercises or therapeutic singing, music therapists can assess vocal intonation, vocal quality, range, awareness of nasal quality, volume of speech and singing voice, pitch matching, melody imitation, free vocalization, and can also exercise the diaphragm (Darrow, 1989, p. 64). Playing musical instruments is a fun way to work on understanding the sounds you are listening to and specifically focusing on those musical elements like instruments, tone quality, and pitches.

Music therapy can benefit those with hearing impairments in so many ways, especially when it comes to speech, language, and socialization. It is crucial as a music therapist when working with someone with a cochlear implant to understand how the implant works, what other factors in their life could affect therapy, and what objectives are most realistic for the patient to try and achieve.

-Amanda Brennen, MT Intern

References

Darrow, A. A. (1989). Music therapy in the treatment of the hearing-impaired. Music Therapy Perspectives, 6, 61–70.

Gfeller, K., & Knutson, J. F. (2003). Music to the Impaired or Implanted Ear.

Hidalgo, C., Pesnot-Lerousseau, J., Marquis, P., Roman, S., & Schön, D. (2019). Rhythmic Training Improves Temporal Anticipation and Adaptation Abilities in Children with Hearing Loss during Verbal Interaction. Journal of Speech, Language, and Hearing Research, 62(9), 3234–3247

Jiam, N. T., Deroche, M. L., Jiradejvong, P., & Limb, C. J. (2019). A Randomized Controlled Crossover Study of the Impact of Online Music Training on Pitch and Timbre Perception in Cochlear Implant Users. Journal of the Association for Research in Otolaryngology : JARO, 20(3), 247–262.

http://www.vancouversun.com/health/should+cochlear+implant/7502865/story.html (image)

Pediatric Music Therapy and Pain Management

One of the big responsibilities of music therapists in pediatric hospitals is to help work on pain management. There are multiple different types of pain that children may experience: procedural and postsurgical pain, pain from sickle cell disease, hemophilia, cystic fibrosis, cancer related pain, and trauma related pain (Bradt, 2013). Music therapy can’t replace the typical pain medications but can be used in conjunction to help manage the pain. Bradt states that a child's understanding of pain depends on the cognitive development of the child. These different stages can affect how you may implement music therapy with a child. Children in the preoperational stage (ages 2-7) have a more passive attitude towards pain. Children in the concrete operational stage (ages 7-12) begin to understand the negative emotions that come with pain. Children in the formal operational stage (above 12 years of age) possess the capability to reflect on pain in a more abstract way (22). Children tend to perceive most of their treatment as out of their control, “three categories of control-enhancing techniques have proven to be effective in the pediatric setting: behavioral, decisional, and cognitive control” (22). The biggest emotional things that children experience related to pain are anxiety/fear and depression.

There are various scales used to rate the amount of pain a child is feeling. Some examples include The Visual Analogue scale (VAS), Graphic rating scales and multidimensional pain scales. The VAS is “a 100-mm line, the length of which represents the continuum of an experience such as pain” (26). Graphic ratings scales involve the use of numeric ratings, word graphics, pain thermometers, and/or facial scales. Multidimensional pain scales are geared at mearing various dimensions of the pain experience. A music therapy assessment of pain will often assess more than the pain itself. It will also assess the patient's emotional state, developmental level, cognitive understanding, musical preferences, etc. “The assessment should also include information about the musical qualities of the pain. Many attributes of pain can be easily translated into musical parameters”  two examples of this would be pulse (how fast is the pain) and timbre (instruments that have a sharp sound/dull sound). 

There are various different types of music therapy methods that are designed to help with pain management. Those methods include Receptive music therapy, improvisational music therapy, Re-creative music therapy, and compositional music therapy. Some examples of interventions within each of these methods are as follows (31):

• Receptive MT

  • Music Guided Imagery: Use of imagery supported by music to help children relax, find refuge from pain, escape hospital environments, and be empowered in the healing process.

  • Vibroacoustic Therapy: Use of sound in the audible range to produce mechanical vibrations that are applied directly to the body, resulting in relaxation and analgesic effects. 

• Improvisational MT

  • Tonal Intervallic Synthesis: The purposeful use of tones and timbres that resolve dissonance into consonance to influence circulation, release, integration, pain, and physical perception.

  • Improvised music for Integration: The use of drumming, toning, and chanting in an improvisatory style to help the child integrate the hurt.

• Re-creative MT

  • Singing songs: Singing favorite songs to shift the child's focus away from the pain, improve perceived level of control, normalize sterile hospital environment and encourage interaction with others. 

• Compositional MT

  • Songwriting: the use of songwriting to give the child the opportunity to articulate their feelings and direct them into a creative form, provide cognitive reframing, and to enhance the child's understanding of pain and/or procedure. 

Bradt states that inadequate treatment of pain in the hospital can have a severely negative impact on a child and create long-term negative effects, “Music therapists play an important role in assuring that children's pain management needs are adequately addressed” (53). Music Therapy can be an amazing tool for children to help contextualize and deal with their pain. 

-Sara Demlow, MT Intern

Sources:

Bradt, J. (2013). Guidelines for music therapy practice in pediatric care. Gilsum, NH: Barcelona.