As part of their education and training at Immaculata University, music therapy majors learn how to think about, write, and refine therapeutic session plans for clients. The kinds of plans vary according to whether the orientation is didactic, medical or psychotherapeutic.
Below is an example of the session plan of a student in training. As part of the Music Therapy Principles III: Didactic course, Sally designed a music therapy session for a group of older adult clients in a nursing home. The first stage in designing a session plan is to briefly describe the clients:
Mr. Jones has Huntington’s Disease with a tendency to get up and down out of his seat.
Mrs. Green, the oldest in the group, is very frail, most of the time not oriented, and may talk to people not present in the room.
Mrs. Weiner is in a wheel chair with mild dementia.
Mr. Polsky is in a wheel chair and is on oxygen with chronic pulmonary disease.
Mrs. Brubaker is the youngest with early stages of Alzheimer’s disease.
Mrs. Weinstock is in early-middle stage dementia, fearful, and with intermittent crying fits.
This older adult group age range is between 65-80 years of age. In general, all are experiencing mild to moderate depression due to loss of capacities and independence. All can move their arms and upper bodies; the two in wheel chairs have some issues with walking but are able to move legs, ankles and toes.
They all have had histories of actively participating in music through either singing in church or synagogue choirs, playing musical instruments, or attending musical performances. Their past and current musical appreciation is above average to sophisticated. They also expressed a love for a variety of musical styles. They come from diverse backgrounds such as Jewish, Christian, Russian and African-American.
As part of the assessment, the music therapist interviewed the clients’ families and obtained lists of the clients’ favorite songs as well as a history of their past musical skills so that songs and familiar instruments could be appropriately incorporated into music therapy sessions. Also, the music therapist wanted to offer them opportunities to pick up instruments they played in the past as long as instruments were available and playing was within reasonable limits of their current skill level.
Long-term therapeutic goals
Music therapy for this group will address the following long-term therapeutic goals:
1. Provide opportunities for maintaining cognitive skills. Clients will be able to follow simple instructions and carry them out accurately and independently half of the time during the session.
2. Provide opportunities to maintain physical tone through movement activities. Clients will be able to move limbs to music as modeled by the music therapist for at least half the duration of the movement activity.
3. Provide opportunities for creative self-expression. Clients will be able to perform their favorite songs through either singing or playing, with or without assistance.
The next stage in the design process is to identify goals based upon an assessment of each client. Accordingly, Sally identified the following goals and short-term objectives (STO) for her clients:
1. Clients will be able to independently follow simple instructions to completion half of the time during the session.
STO 1: Clients will follow directions for duration of musical activity with physical and verbal assistance from the music therapist.
STO 2: Clients will follow directions for the duration of the musical activity with four or fewer prompts from the music therapist.
STO 3: Clients will follow directions for the duration of the musical activity with two or fewer prompts from the music therapist.
2. Clients will be able to move limbs with minimal assistance in motion similar to the music therapist for half the duration of the movement activity.
STO 1: Clients will move limbs with full physical assistance throughout the song.
STO 2: Clients will move limbs in similar motion with four light physical prompts and verbal reminders throughout the song.
STO 3: Clients will move limbs in similar motion with two light physical prompts and verbal reminders throughout the song.
3. Clients will be able to sing independently or play through a song of choice.
STO 1: Clients will sing or play through half of a song verse with singing and/or musical assistance from the music therapist throughout.
STO 2: Clients will sing or play through one verse of a song with minimal musical assistance from the music therapist.
STO 3: Clients will be able to hold their own while the therapist and group join in with singing and/or playing.
Once goals are established, the specific plan of the music therapy session is designed. Sally identified the following activities and experiences to meet these clients’ needs:
1. Hello Song. The therapist will begin the session with a favorite song of one of the group members, Mrs. Weinstock: “He Venu Shalom Alechem.” Once everyone is seated, the therapist will begin playing the song on the guitar. She will sing one verse through and those who know it can join in. Then she will start to plug in the names of the group members into verses such as “Ha ve nu Shalom Kim” and finish the verse. The music therapist will do the same with each member of the group, trying to get them engaged by singing their names at the right time.
2. Instrumental exploration and improvisation to a familiar song. Here the long-term goal has to do with following simple instructions and carrying them out accurately and independently. The first part of the activity is to have each client choose and take an instrument from a varied array of instruments. Next the clients are asked to explore the instruments with their hands and fingers to see what the instrument feels like. They can even close their eyes as they do this, feeling the texture, temperature, size, and shape. Next they are asked to play the instruments and explore the sounds they make. Then a familiar song begins, “He’s got the whole world in his hands.” Everyone is asked to find the beat and play with the beat of the song and also sing along. Next, the therapist sings “He’s got [name of client] in his hands," and then everyone sings the name of the client at the appropriate time. Next, everyone sings the name of the client and the client plays an instrument solo, and on through the group to the end of the song.
3. Performance of the day. Each client is asked to choose a song they would like to sing or play for the group and then have the group join in with them. Clients pick the songs and the instruments they’d like to use, if any.
4. Movement to music activity. The music therapist will play a classical theme on the Gam’s horn and the clients will follow the high and low levels of the melody with their hands, as instructed by the music therapist.
5. Goodbye song. The therapist will sing, “Goodbye ladies, goodbye gentlemen,” inserting names as was done in the hello song, and thank the group.
Materials: Guitar, piano, various percussion instruments, wind instruments, xylophone, music stand, music sheets.
Method of Evaluation
Finally, each session is evaluated by the music therapist. Typically, there are two levels to this evaluation. The first level is an evaluation of each client’s responsiveness in a session, a descriptive evaluation of each client describing prompts used, level of participation, verbal or facial responses, level of energy, verbal or non-verbal, tearful, laughing, happy, level of cognition in terms of understanding or not understanding directions, or delusional. In addition, the client response evaluation scale will be filled out so that client responses can be easily compared from week to week. In comparing weekly client response scales, the music therapist will be able to determine whether the client is progressing toward, or maintaining his or her long-term goals, or whether a decline is occurring. If a steady decline is observed over four weeks of successive sessions, a re-evaluation will be made regarding new long-term goals and short-term objectives. A revised therapy plan will be put into place as appropriate.
The second level is an evaluation of the actual session plan and implementation. In this way, the music therapist reviews the effectiveness of the session plan in meeting the client’s needs, and looks specifically at ways he or she interacts with the clients, at the music used in the session, and at other relevant factors.