Guest Post - Person-First Terminology

Person-first terminology, also commonly referred to as person-first language, is currently utilized across many professional fields, from special education to health care to therapeutic settings to public school systems. But why is it important? What’s the big deal?

Person-first terminology is not quite how one of my college professors explained it to our Special Education 101 course. Her explanation? Instead of saying, “That Autistic girl’s name is Sally,” her explanation was to say “Sally is Autistic.” Close – oh so close! But still not quite the concept! Person-first terminology does not mean that you call a person by their name.

Thankfully, my music therapy professor explained it with much more accuracy.

Person-first terminology suggests we state phrases stressing the person (name or pronoun) first, followed by their disability or diagnosis.

• “Matthew is a Downs kid” becomes “Matthew has Down Syndrome.”

• “ He is ADHD” becomes “He has ADHD.”

By a simple grammatical change, the focus is shifted from the disability to the person, hence person-first. By utilizing person-first terminology, dehumanization is avoided. The person is not the disability that they might have.

Similarly, this can be compared to the movement to remove outdated words from our vocabulary that have since developed new and often offensive connotations. For example, the words idiot, retarded, imbecile, handicapped, and mongoloid were once more widely accepted. In modern times, these terms are usually considered derogatory. The Education for All Handicapped Children’s Act of 1975 has even been revised and given the name IDEA, or Individuals with Disabilities Education Act.

While this movement in semantics means well, many differing points of view exist on the matter. Some prefer person-first terminology and find it politically correct and a little more dignifying, but some think that this effort takes away from their identity. For example, those involved in Deaf culture (with a capital D) sometimes feel that their deafness is not a disability at all but a mere trait. Many people with blindness and Autism feel the same way and do not mind being called “blind” or “Autistic.”

All in all, it comes down to what your patients / clients and their families prefer. This can become troublesome when switching terminology back and forth so as to earnestly avoid offending someone, but the effort is usually appreciated. Find out what your clients and employers prefer.

Hopefully this short introduction to person-first terminology will not only give the reader insight into a relevant concept, but perhaps it will leave the slightest thought in the back of your mind. As a therapist, educator, health care provider, or paraprofessional, how do you refer to your patients in your daily progress notes? What is your perception of your clients? How do you see them – as people with disabilities, or as disabilities who happen to be people?

Please post your thoughts and discussion questions in the comments section of this blog.

Helpful Links:

• American Psychological Association
• Disability is Natural
• Individuals with Disabilities Education Act
• Why I Dislike Person-First Language
• Wikipedia on Deaf Culture
• Erasing Autism
  

Nikki Belshe, MT-BC, NMT
Music Therapist – Board Certified
Neurologic Music Therapist
Longmont, CO

Guest Post - Self-Care

Anyone who has ever flown on an airplane has heard the pre-flight safety schpeel: this is where the emergency exits are, in case of turbulence return to seats and put on your seat belts, no personal electronic devices until the plane reaches the cruising altitude. We're also told, in the case that the cabin pressure drops, oxygen masks will fall down from the panels above us. The flight staff reminds us that if/when this happens, to place this mask over our own faces before assisting those next to us.

During my final music therapy practicum experience as a student, my supervisor used this example to illustrate the importance of music therapists (as well as others in helping professions) taking care of ourselves in order to provide the best quality services to our clients. We spent some time during each of our supervision sessions discussing self-care and steps we were taking to build healthy mental, physical, and spiritual habits to effectively deal with stress and burnout. Up until this point, none of my supervisors had spent much time emphasizing self-care. Today, I find myself using the same metaphor of the oxygen mask with the students and interns with whom I work as a way to illustrate the importance of self-care in our profession.

When I think about my experiences with stress as a music therapist, I can generally categorize my stress into 2 distinct areas: external and internal. External stressors are those that one has little or no control over (for example: lack of funding/resources at your facility, layoffs/hours being cut, or unrealistic expectations from your supervisor), while internal stressors are generated inside of ourselves (for example: low self-esteem, taking on too much work, or vocal health problems due to lack of proper technique). While some of these stressors are unavoidable, burnout or extreme stress reactions which take a major toll on our health are preventable. The following are some basic wellness tips that I have found to be helpful in my clinical work at as a music therapist no matter which population I am working with:

1. Use common sense: We all know that there are certain habits that are just plain good for everybody, like eating well, exercising, drinking water, and getting adequate sleep. Along with these, there are a number of other "basic" habits that music therapists should strive to develop (many of which I am guilty of neglecting!) -- things like warming up our voices prior to sessions, or taking some sort of break each day eat/recharge our batteries, for example. Even something as simple as deep breathing for a few minutes can dramatically improve acute stress reactions when we are on the job. Sometimes it may seem difficult to make these seemingly little things a part of our daily routines when we're strapped for time between sessions and meetings, but they truly make all the difference when it comes to our wellness as practitioners.

2. Ask for help: Over time, I've learned that a lot of the major stress related to my job could have been prevented if I had asked someone for help. Several years ago, a co-worker accepted a position at another unit at our facility, and I was left to cover both of our caseloads while also supervising 2 interns and preparing for special holiday events. It was important to me that all the clients participating in music therapy prior to my co-workers move continued to receive services, my interns were getting the support that they needed, and that the upcoming events were planned...but I couldn't do it all alone. Luckily, my supervisor sensed that I needed her help to stay afloat until we could hire a new music therapist, and I finally realized that I couldn't do it all by myself.

Whether it is your family, friends, co-workers, supervisor, mentor, personal therapist, or other people in your PLN (see John's posts below for more info), find someone (or several someones) who you can ask for help when you feel the stress creeping on, and call on them when you need them.

3. Get back to your roots: I have a friend who worked for several years as a hospice music therapist and absolutely loved her job. She is an incredibly talented musician, proficient on voice, piano, guitar, and violin, and often performed with different groups or got together to jam with other musicians. After awhile, however, she found that she was no longer making music for herself as a recreational activity or hobby, simply because she was so mentally and physically exhausted from the demands of her job.

Before we were music therapists, we were musicians, and we mustn't lose sight of our deep-seeded passion for our craft. Making music for yourself - whether you're involved with performing ensembles, take lessons, or simply play around for fun at home - is one of the most nuturing and loving things you can do for yourself as a music therapist.

Ultimately, music therapists have the tools to take care of ourselves, but sometimes we can all use a reminder that taking care of ourselves should be a priority -- doing so assists us in continuing to provide excellent services to our clients and ensures a happy, healthy, and long career.

Please, do post your tips and suggestions for wellness and stress management in the comments section!

-- Carolyn Dachinger, MT-BC
Boca Raton, FL

Day 8 - Pondering the future

Lately, the new Star Trek movie has been all over the news. I'm a passive participant in the "Star Trek Fan Club" but all the media hype does have me thinking about a question I ponder from time to time - What is music therapy going to look like in the future?

Music therapy has certainly undergone a revolution conceptually. Initially, it was a restorative medium used to treat the "mental and physical health" of injured soldiers (Davis, Gfeller, & Thaut, 2008, p. 32). Today, it is being used to treat mental and physical health as well as it is being used for social skills training, emotional well-being, hospice and palliative care, neonatal care, spiritual health, and community based/integrated settings.

Another more recent trend has been "increasing awareness of the importance of sensitivity to cultural differences by the helping professions (Davis, Gfeller, & Thaut, 2008, p. 447)." There are a number of reasons why this change is taking place. First, music therapists, who have been trained using traditional "western music (tonally)" are taking their expertise back to their home countries and applying regional and culturally specific variations and/or modifications (Gao, 2009). Judging from the number of news reports/news articles, another hotspot for the development of music therapy appears to be taking place in India (Google search engine, daily, term "music therapy"). Secondly, individuals are much more mobile, physically, than ever before. Consequently, an increasing number of different cultures can be found in particular countries or geographic area. A perfect example can be found in the most recent edition of the Voices e-journal on music therapy that recently featured an article entitled, "Musical Preferences of Argentines Living in Australia: Implications for Music Therapy Clinical Practice". Finally, groups such as Music Therapists for Peace (Edith Boxill) and PlayingforChange have highlighted a social justice/activism role for music therapists and musicians. At the University of Windsor, the university and music therapy program are described as having a international focus and a focus on "social justice".

So how does this impact music therapy? First and foremost, the musical repetoire that music therapy students are exposed to must, by necessity, include culturally specific musical examples. It is no longer sufficient to go with the standard "North American", "Western tonality" based songs such as, "You are my sunshine" and "Home on the Range". In my area of practice (working with geriatric clients) I often see that persons with Alzheimer's will often revert to their "mother tongue" as their dementia progresses, rather than retain English as their primary mode of verbal communication. I also recently completed some training entitled, "Supportive Pathways" where the need to understand culturally specific socialization patterns may impact how you deal with a particular individual. For example, in some cultures, direct eye contact with "an elder" is discouraged and frowned upon. Here in North America, we expect to see a person "look at me[us] when I am talking to you!" This might also be important to consider as part of the training of music therapy students and music therapists.

Speaking strictly as a music therapist working and practiscing in North America, I have also begun to see a generational change in the music. By this I mean that music of the 1920's and 1930's, preferred by many of my clients today, is giving way to music of the 1940's and 1950's. I am personally looking forward to working with the generation that grew up on the music of the 1960's!.

Finally, a lesser obvious impact upon music therapy practice is the proliferation of music, in terms of availability. The early 20th century, at least in North America, saw home based music making, and small publication runs of popular music. Presently, the availability of music from every conceivable genre and/or source is a given and music is becoming increasingly personalized (think iPod versus group singing). This was brought home by an assignment that I had students in my Introduction to Music Therapy course complete recently. Specifically, I had them complete a 20-minute audiobiography of their life. Unlike the previous class of students that had completed the same assignment two years ago, this class presented a more diverse pool of musical examples, including many that could be categorized as "world music" (BTW: The audiobiography assignment is a great assignment that students tend to really enjoy and take pride in, once it is complete). As music sourcing becomes increasingly diverse, and individuals seek out a wider range of music, I believe that improvisation will become an increasingly important part of training. We [music therapists] will no longer be able to learn a narrowly defined set of songs and reproduce them for group or individual consumption. Elements of music such as rhythm and harmony are common to music of a wide variety of cultural groups.

Have I reflected your thoughts about the future of the profession of music therapy or do you have some additional ideas related to "Where are we going as music therapists"?

Bibliography

Davis, W. B., Gfeller, K. E., & Thaut, M. H. (2008). An introduction to music therapy: Theory and practice. Silver Spring, MD: American Music Therapy Association.

Gao, T. (2009, April 30). Music therapy in China. World Federation of Music Therapy/Regional Liasons Blog. Retrieved on May 7, 2009, from, http://www.wfmt.info/WFMT/Regional_Liaisons_Blog/Entries/2009/4/30_Music_Therapy_in_China.html.

Moore, C. C., & Baker, F. A. (2009, March 1). Musical preferences of Argentines living in Australia. Voices, 9(1). Retrieved on May 7, 2009, from, http://www.voices.no/mainissues/mi40009000303.php.

Day 4 - Considering Private Practice?

I've just finished my taxes for another year - Argh! After a late-night trip to the post office to beat the 12 PM deadline, I've got a little time to sit back, check Twitter, Facebook, and Flickr (Can you say information junkie!). My mind is full of deductions, expenses, and income statements and my living room is full of piles of paper (LoL). With that in mind, here are some of my thoughts on running a private practice or being self-employed.

When I began my first music therapy job, I didn't have a choice - it was private practice/contract or nothing. Thus began my journey into the world of self-employment and I haven't looked back since. Many people cite the ability to "be your own boss" as a benefit of private practice. What they don't say is - you also need to be the accountant, public relations person, and secretary! I also don't remember a course about "How to run a business" during my training (They should definitely include a "Business 101" course as part of the overall degree requirements).

Being the accountant means that you have to keep track of things like cancelled sessions, damgaged instruments, gas and meal receipts AND come up with a system to invoice and record expenses properly*. Another, less enjoyable, part of being the accountant is following up on deliquent or overdue accounts. Being in private practice means that you can never be sure when you will receive payment for the invoice(s) that you submitted last month. If you have a "need to know" exactly when money is to come in, don't choose private practice. (I've had some invoices that took three months to be processed). And please, if someone has a foolproof way of getting invoices paid on time - PLEASE let me know!

*TIP - find out what tax categories you will be needing and set up your annual spreadsheet accordingly - it will definitely save you a lot of time come tax preparation!! A

Being the person in charge of public relations means that you have to develop your advertising plan/brochure, arrange for pictures (remember what I said in my previous post: no pictures = no interest), and the newer responsibility of ensuring that consents and releases are obtained before you put anything in said brochure or newspaper article! In this position it pays to be an OPTIMIST. You are probably going to have quite a few "no's" before that one "maybe" or one "I think about it". It also helps if you are an "extrovert" rather than an "introvert" (coming from someone who was very shy and had difficulty expressing himself in public). I still get nervous when speaking in front of a large crowd but a measure of comfort can definitely be learned.

Finally, being the secretary means that you get any other job not covered in the previous two roles. Some examples include: writing progress reports and/or letters to funding agencies, answering calls from anxious parents, and, of course, cleaning the bathroom!

Have I made it sound like I hate being in private practice? There are certainly days when I long for a full-time position in a nursing home (my specialty is geriatric clients) and I am an employee, not a contract worker. Overall, however, I do enjoy the freedom, responsibility and challenges that come with being in private practice.

What is your opinion?

Day 2 - Defining music therapy

According to the Facebook site, "Top Ten Things That Music Therapists Love to Hear", the number one answer is, What is music therapy? This is meant sarcastically and not factually. It begs the question, however, of what, when and how is it necessary to define ourselves.

The what?

Bruscia (1998) devotes an entire monograph to the subject of defining music therapy. While there are many music therapy associations, each gives a different definition of music therapy. Davis, Thaut, & Gfeller (2008) clearly articulate that the definition of music therapy has undergone constant revision and evolution (p. 7-8). These are just a few of the difficulties that we, as music therapists, face when asked, "What is music therapy?".

The contextual approach

Music therapist work in a variety of clinical environments. These range from institutional to community based settings, educational to medical settings, individual and group therapy, using improvisational, recreative, and receptive methods. Clients can range in age from pre-term (during pregnancy) to age 100+. They can have physical, psychological, emotional, social, spiritual and medical issues independently or simultaneously. Thus, one approach to answering the question can be - to answer contextually.

For example, if I was answering a potential employer in a long-term care facility, I might answer in the following manner:

Music therapy is a form of therapy employing music and musical activities that encourages individual and group quality of life. Unlike entertainment, that seeks to simply entertain and encourages a passive response, I strive to engage my clients in music making, socialization, and physical activation. I also seek to provide opportunities for clients to develop former musical skills and/or develop new musical skills. My approach is based on scientific research and metholodogy developed over the past 30 years in which music therapy has been an established profession.

Answering a parent of a child with special needs, I might answer this question in this way:

Using music and musical techniques, I will strive to engage your child in a multisensory experience. In part, my approach will be driven by research findings and my training however I will take most of my cues directly from your child and their reaction(s) to the interventions (positive and negative, verbal and non-verbal) that I provide to him/her. I encourage questions and set clear goals and objectives in order to demonstrate my effectiveness.

Finally, answering a group of medical professionals, I might answer in the following manner.

Music therapy is a profession built on a solid base of quantitative and qualitative research. It is multisensory, employing largely non-verbal and musical interventions. Clear goals and objectives are formulated after the music therapist completes an initial assessment, including the medical, social and musical history of the client(s). Validation of clinical outcomes is ongoing and improved quality of life is viewed as a significant aspect of treatment outcomes. Finally, music therapy can serve as an independent treatment or be part of a multidisciplinary approach to treatment.

The simplistic approach

Given the complexity of contextualizing the description of music therapy, another approach can be to simplify the description of music therapy. Davis, Thaut, & Gfeller (2008) describe such an approach in chapter one of their text entitled, Clinical practice in music therapy. They, it can be argued, cite three elements as essential to music therapy - music, therapist, and client. Remove one of these elements and you are left with something that is not music therapy. For example, if you remove the "therapist", you are left with "client and music" and thus, someone who is capable of listening, and making music. The purpose of doing so, however, is not therapeutic and results are likely to be short-term or short-lived (i.e. going to a concert featuring your favorite band or artist). Remove the "client" and you are left with "therapist and music" or a situation in which the therapist is making music for themselves, perhaps for enjoyment purposes. Finally, remove the "music" and you are left with "therapist and client" in a verbal environment.

The "leave it up to public awareness" approach

Music therapy is a relatively new professional discipline, when compared to fields such as law/criminal defense, medical, or education. In the United States, the first music therapy association was formed in June 1950 (Davis, Thaut, & Gfeller, 2008, pg. 33). The Canadian Association for Music (CAMT) was formed in 1974. While the public thinks rightly, or incorrectly, that they understand what it means to be a "doctor", a "lawyer" or "teacher", they do not have the same understanding of what it means to be a "music therapist". Context can again come into play as an individual may answer from the viewpoint of being the parent or friend of a client, being a client themselves, or having no experience with music therapy and choosing to respond or give an answer.

Further complicating is the issue of "title protection". At present, there is no protection for the title of "music therapist" (at least in Canada). Thus, anyone can call themselves a "music therapist" without there being any assurance of their work experience or educational background. This means that public are given various examples of "what it means to be a music therapist" and "how music therapists work" without regulation or accountability to any professional body. In Canada, one can guarantee that a person is a music therapist by ensuring that they use the initials, MTA after their name. This is a credential referring to Music Therapist Accredited that is granted to individuals after they have completed their music therapy training, internship, and have had their work reviewed by a group of music therapy peers. In other countries, check for a professional association of music therapy and inquire of them what, and how, they certify individuals are music therapists.

Finally, there is the media or public organizations who often distort the terms "music therapist" and "music therapy". Frequent are news reports of individuals using music "as their therapy". But is this - "music therapy"? Similarly, if music has brought about a change in an individual, whether long term or short term, the word "therapy" is often applied. Public organizations or individuals can also report to provide recordings of music that are "therapeutic" or "soothing" and/or employ "music therapy techniques". The Mozart effect is one such highly public, and publicized, example. Another is "harp therapy". I am not saying that there are not therapeutic elements or benefits from such music or musical techniques, simply that it confuses the public with regards to the question of "What is music therapy?".

Clearly, there is no easy answer to the question - What is music therapy? Is it any wonder that music therapists shudder slightly when they are asked to explain what they do?

Bruscia, K. E. (1998). Defining music therapy. 2nd ed. Nilsum, NH: Barcelona Press.

Davis, W. B., Gfeller, K. E. and Thaut, M. H. (2008). An introduction to music therapy:
Theory and practice. 3rd ed. Silver Spring, MD: American Music Therapy Association.


Tommorrow...."When" do you explain about music therapy.