Episode 23: The Unheard Benefits of Music Therapy with Nancy Dexter-Schabow, Part Two

OT Ep. 23 – Transcription.txt

00;00;09;05 – 00;00;44;03
Rick Hoaglund
Studies show that seven out of ten people with autism have mental health conditions such as anxiety, depression or others. One treatment option is music therapy. Nancy Dexter-Schabow is a music therapist who specializes working with clients who have autism and other intellectual difficulties. Because music promotes relatedness, relaxation and self-expression, music therapy can be a tool that works better or in conjunction with group or individual therapy sessions. What happens in a music therapy session? Welcome back, Nancy!

00;00;44;06 – 00;00;45;10
Nancy Dexter-Schabow
Thank you, Rick!

00;00;45;13 – 00;00;59;09
Rick Hoaglund
So we’ve been talking about music therapy and we’ve talked about it being very structured, but music can be used in therapy and not have it be music therapy. Am I correct on that? Can it be used as a tool?

00;00;59;12 – 00;04;15;24
Nancy Dexter-Schabow
That is correct! How about if I lay out the boundaries of what is music therapy and what is the use of therapeutic music? Because that might be- that might be helpful to people to understand what that is. So music therapy, I gave one definition of it, but this one is a bit more structured, but it gives four components that I think do help with understanding, am I getting music therapy or maybe using music therapy or music? Am I getting music therapy or am I using music therapeutically? Or is someone who’s working with me using music therapeutically? Because those are two different things. So music therapy, when someone receives music therapy, the music therapist is a credentialed professional who has completed an approved music therapy program. So- and those are administrated by the certification board for Music Therapists. The approved music therapy program is administrated by the American Music Therapy Association. So this person who is a trained, credentialed music therapist, they are working with clinical and evidence based music experiences and interventions specifically to accomplish individualized goals within a therapeutic relationship. So that therapeutic relationship with a music therapist. That is what makes it music therapy, because the music therapist knows that they are working on individualized goals and they are using clinical and evidence based music interventions and experiences. So the use of music therapeutically is typically what people see and think of out and about, and it frequently gets mislabeled as music therapy. So if there is a person playing harp at bedside in hospice, that’s not necessarily a music therapist, but it is the therapeutic use of music and that’s absolutely fine. So they’re using music therapeutically in this setting where someone needs comfort. Very appropriate. In hospitals, nurses will frequently turn on music, or patients, to help with either distraction, pain relief or anxiety. That’s very common. That is not music therapy, though. That is the therapeutic use of music. So it’s just because there’s no relationship with the music therapist there and there’s no individualized goals. So that’s that’s part of what makes the difference. So a music therapist could go and do the same things, but there would be an assessment and a treatment plan even if it was brief, to address the situation. So- and that’s what I’ve done in the hospital, is I’ve gone in and done a very brief assessment at bedside. I know what my- my goals are for that individual for the time we’re going to spend with them. And then I document on that in their chart after I’m done. So there’s- that’s the difference.

00;04;15;27 – 00;04;43;13
Rick Hoaglund
So what about- and I’ve seen this on TV, and I’m sure people in there listening have seen this too, someone that comes in, brings music, puts it on someone that maybe has Alzheimer’s – a headset with music, and it is comforting, I guess, to the person with Alzheimer’s. Sometimes they react to it. Can that be one of two things? I mean, I guess if it were a music therapist administering that, it could fall under therapy, or no, is this not it? Not therapy?

00;04;43;15 – 00;08;02;28
Nancy Dexter-Schabow
With that one, that’s a really good thing to bring up because there are actual programs for that. There’s music and memory programs, and we’ve actually had them all over Wisconsin as well. Sometimes those programs are set up by the music therapist. Sometimes they are not. And they have a protocol specifically for how to set those up. It- again, I would argue that the actual act of putting headphones on a person with Alzheimer’s is not necessarily music therapy, but the process that might lead to that might be conducted by music therapists so that it’s done as accurately as possible, that- those processes that actually brings in something else are really important that music therapists always do, that other professionals who use music therapeutically do not necessarily do that – particularly music and memory program? Those work really well. If you are using preferred music of that individual, if you are not using their preferred music, you could get an adversive response. May I give an example of a really powerful- Yeah? Okay! So when I was working at the hospital, I was working with a young man who had had a heart transplant and of- following that heart transplant, had a stroke which rendered him unable to communicate verbally, very uncharacteristically. Also, there was a chiropractor working on him when I walked into his hospital room that morning? And I thought, what is the chiropractor doing in the hospital? Because that is something I’d never seen before! And so I engaged with this chiropractor and I noticed he had had like this very soothing music going on in the background. And I’d had enough interaction with this young man who was a teenager to know that that was not his preferred music. And I told them, Hey, dude likes the hard stuff, so take out the Metallica and the AC-DC and because he’s he said that he was literally fighting him to do his job because a lot of times it happens if you music on that you absolutely do not like, your body stiffens! You get some stress response to that! And so I saw the chiropractor a little bit later. He said, Well, yeah, thanks for the advice. I said, I’m a little bit later. He’s like, You were totally right. The ah, the harder rock music, really relaxed him! And I’m like, good, I’m glad that worked because he’s totally into all this, like, really, like, heavy stuff. So, and I only got to know that because I was there with a family member who was able to tell me this is what he likes. And so working off of that, a lot of times, if there are people in a in a hospital setting or nursing home study, they will just assume that because this is music on the relaxation channel, that- that will soothe everyone. It’s not necessarily true. So you need to go with the patient’s preference whenever possible.

00;08;03;00 – 00;08;10;26
Rick Hoaglund
So if I were one of your people that were seeing you for professional services, do you refer to them as patients when you’re a music therapist?

00;08;10;28 – 00;08;43;25
Nancy Dexter-Schabow
If I’m in a hospital setting? Yes! If it’s in my practice, I use client in the economic realm. They use the consumer. If you’re in a school, it’s a student. If you’re in a nursing home, it’s a resident. It just depends on more of what the setting is. I tend to use client if I’m in a day program for adults with developmental disabilities, the word is participant. That’s something that shifts everywhere I go.

00;08;43;27 – 00;08;56;29
Rick Hoaglund
So if I was one of your clients, what would a typical session look like? I you know, I come in, it’s my first time. What information do you need from me? And then how do you proceed going forward?

00;08;57;01 – 00;13;29;15
Nancy Dexter-Schabow
Okay. So the way that I tend to prefer doing my assessments is sometimes I don’t like to have a lot of information? I like to just kind of let it unfold! I will typically start with a hellos son with a guitar, and I’m thinking of like maybe a ten year old with autism here. Just to give some context. I will usually have them strum hello on the guitar, and sometimes people can be very shy. That takes a little bit of time to warm them up. So I might have to demonstrate that first or I might have to try a couple of different songs. But then I usually break the ice by using a gigantic monster pick that anyone can use because it is so ridiculously large. But if people have fine motor problems or motor planning issues, this helps them be able to be successful on the first go. So usually this is enough to get people to try it. So- but we will usually do that. I usually follow that with a sensory experience. Usually I will get on the ground and put the guitar out for them to put their feet on and we will do the Feet song written by one of our Wisconsin people who I greatly admire. And that song has come in handy for 30 years and I will continue to use it and it is much requested, but it gives them a chance to experience the music in their body through the vibrations on the guitar. I usually start slow and then I speed up. A lot of times what I will do after that point is I will give that new client a chance to go around the room and see what they gravitate towards, and we will take out the instruments that they gravitate towards and we will do something with that instrument either very briefly to play it, to see how it sounds. This is when I’m starting to assess for sound sensitivity and interest and preference. Eventually, they usually get on the drum set if they can handle the sound of it, and I will not play it for them, I will let them control the sound because there are a lot of people with a lot of sensitivities, especially those people who live with autism. We usually get to a piano at some point. I will typically improvise something on piano to something they might be playing or just to kind of give them an idea of what it sounds like and provide them with a sense of safety to come over and try it themselves. Sometimes I have picture books that I make using text symbols, which are simple symbols. We’ll use those with familiar songs to help engage communication to see if they can produce words expressively if they haven’t done so already. Also, to look at attention span. Can they sit and pay attention to a whole book? There’s just a number of things that you do right away in that first session to start to get a grasp on, okay, where are my therapeutic priorities trending? And that’s kind of that’s kind of how I do it. I always end with a goodbye song. I will typically also bring in some sensory things. I have some huge xylophone bars called Tone Bars that really help with relaxation because the vibrations go through the entire body like they can be sitting on it, but you can feel the vibration in the top of their head. It’s really cool. So it’s something I wish I could get more input from myself, but they really respond to it well. So it just- I kind of take their cues on it! Because I really think that, you know, when you’re working with someone, it cannot just be my agenda. My agenda can flex and fit with what- wherever their interests take them, I want them. I’m also using that first session to start to cultivate ownership and collaboration with the client, because I do feel that ultimately therapy will not work unless there’s collaboration between therapist and client. And so the more that I can feel out how they can collaborate and how much flexibility they have in that collaboration, the better I can assess what I need to do and how I can write that first treatment plan.

00;13;29;18 – 00;14;00;07
Rick Hoaglund
So what is it about music? I mean, we all have experience with music because, I mean, there are songs that I can think of that I cry to. I’m being honest! I’m just being open here! There are songs- there’s a particular Christmas song. I don’t know why, but it just makes me sob. And so it has- it has something more than just tones and and words. There’s something to it. What is it where, you know, is it stored in our brain somewhere that maybe you don’t know the answer? Maybe nobody knows. I don’t know!

00;14;00;08 – 00;18;10;16
Nancy Dexter-Schabow
Well, I don’t think I know the exact answer for every situation, but I do know the basics. I do continuing on this every time I have to recertify, because there’s always so much new information we use when I’m talking about what I’m having people do in that first session. And I’m really approaching that from a humanistic perspective, what is constantly working in my head in terms of watching their responses is neurologically, where are they at and what can they tolerate. So a lot of music therapists like being educated nowadays have a very strong neurologic basis for how they do music therapy and that music therapy and brain functioning, the- the magic and I’m showing that in air quotes, the magic that people see about music therapy has to do with the fact that music therapy presents multiple stimuli. That requires several separate areas of the brain to work in tandem. So you have the auditory going, you have the visual. So the auditory is going through the temporal lobe, the visual is going through the occipital lobe. You have cognitive functions. do I recognize that song? Where’s my memory? And I can’t tell you how much that happens to me now, where I’m like, What is the name of that song? And who is the artist? So that’s that’s in your frontal lobe. And then all the emotion, the emotion that comes from it, we don’t even think about the emotion. So when you say that makes me cry, it just brings the tears without even thinking about even if you try not to have it happen, it still happens! It’s the same thing that happens when you hear a Sousa march and your foot starts tapping without you even thinking about it. This is the emotion that goes along with it and that is in the center of your brain with your limbic system. And that is the- what happens is that the auditory nerve feeds right into the thalamus and that bypasses all of the need for higher cognition. And you get that emotional response. If you have someone engaging, you’re also- or engaging by playing music, you’re also engaging their cerebellum. So now you have almost full brain involvement with very simply singing a song and having someone play a drum with you. That’s- that’s what’s happening, is you have this full brain involvement. So did I miss any sections of the brain? I don’t think so. Well, you’ve got the- oh yeah, the frontal lobe! The frontal parietal lobe. You’ve got the sensory strip sitting right next to the motor strip. So you’re getting input in. That’s going right to the parietal lobe. And then you’re getting this motor response out. And that’s the cerebellum connecting with the frontal lobe to plan how you’re going to play. It’s just- there’s so much going on. And then I think one of the big things about music therapy is that for some reason, music therapy done properly and I mean in a therapeutic context, we can stimulate the cingulate gyrus which sits right above the limbic system. The cingulate gyrus is responsible for motivation. So even people who are very shut down and maybe resistant to any kind of therapy, this is where I think music therapy can really start to bring down some of those walls and open people up to engage in in some way. It just like if you can crack that door open for some people who are really resistant and I see it with autism a lot, I know it’s something you very commonly find with mental health issues. This is something that music therapy does that’s really special, and it’s all because of neurologically how the brain processes music.

00;18;10;19 – 00;18;33;10
Rick Hoaglund
So we’ve been talking a lot about in therapy sessions, but music can be used privately too. Like I can use music to change my mood! I do that once in a while. What- I mean? I mean, do you have any advice for someone that is sitting at home saying, I really don’t have a need to go to a music therapist, but I love music. How can I use that to my advantage?

00;18;33;13 – 00;22;48;01
Nancy Dexter-Schabow
There are several ways in which people can use music and several ways which people probably do use music already, but they don’t even really recognize that they’re doing it. So music can be used as an organizer. So think of everyone who’s listening. How did you learn your ABC’s? You sang it to Mozart! A, B, C, D, E, F, G! That’s what you did! How did you lear your 50 states? There is probably some snazzy 50 state song that you learned, most likely the one by Ray Charles. So if you don’t remember it, look it up because it’s a great blast from the past when you hear it. And I think it’s on YouTube. Using music as a reinforcer. Okay, if you have kids who just need some motivation to get through something, say- you can say, you know what? If you can get dressed and do this, I will play your favorite song on the way to school. So you got to listen to Baby Shark like for the 500,000,000th time. But it will be worth it if your kid gets dressed by themselves and gets in the car, right? So that’s it! That’s very similar to using music as a motivator. Music as a motivator, though. Like imagine if you want to get something done. So I was here in my clinic assembling a new electric piano on Sunday. I played Handel’s Messiah in the background because there’s something about baro- about Baroque music that helps me just like get the work done. So you might be cleaning your house and you might need that high energy music from your teenage years to get you through it so you can sing through it at the top of your lungs and just have a good time doing something that is not fun at all. Music As an Energizer! If you are feeling really dragged down, start to incorporate music that gradually brings you up to the speed you want to work at. Another way is to use music as a sedative. I’m sure a lot of people listening use music to go to sleep at night. They have music playing in the background or white noise, which is another way that people use to change their brainwaves. Music can also be used for pain management. A lot of times I realized this in the hospital. I’d heard a lot of people like downgrade music, as you know, using music or music therapy as a distraction, But music is a powerful distraction that can be used to offset pain perception. So in a- in a medical, medical students are taught that there’s a pain gate theory where basically all the pain comes up through the gate and you’re- you’re your brain only sees, hears and smells pain. When you put music into the mix? And I’m not going to say any music when you put your preferred music into the mix, that music can get through the gate and supersede a lot of that pain perception. It might not take all of it away, but it can make an impact, which can help you better relax and possibly even sleep if you need that. Same thing with anxiety, music can help bring down your anxiety simply because it can be a good distraction from anxious thoughts and feelings. So- but it’s got to be your music that drives you. Music as communication and expression. Think about what people do at end of life when they do like some sort of legacy. A lot of times they will have their favorite music played at an event following their passing. That’s music as expression and music as communication, and that can be very powerful. But you don’t- it’s not even just for those occasions. It’s- that can be an expression. If your husband comes home and you want him to know it’s not the time to hit me with anything difficult, you could put on music that puts that communication out there! And see if he picks it up!

00;22;48;04 – 00;23;02;04
Rick Hoaglund
Let’s face it, the movie industry does that all the time. Every soundtrack is meant to trigger us in some way. Scary music. Romantic music, you know? Yeah!

00;23;02;07 – 00;23;47;03
Nancy Dexter-Schabow
Yeah, that’s right! And you every individual can have a soundtrack of their life through music. So you can, if you think about it, you can think about what your soundtrack is. You can go through your whole life or you can go through your day or something specific in your life that you want to frame. A lot of people do that will do that for childbirth! They’ll put together their own playlist for childbirth. And it’s- I know I did for mine, from the pperspective of a music therapist, but it can really help you have the energy and whatever you need that soundtrack for what you need to get through really tough stuff and it’s very much like a soundtrack for a movie, but it’s so much more personal.

00;23;47;05 – 00;24;13;02
Rick Hoaglund
So it- it’s funny. I have a really good friend that always asks me, how much of our minds do you think is taken up by music, lyrics, and songs? Songs that we haven’t heard in 20 years and suddenly we know every word when it comes on the radio? So that just tells you that there’s something innate in humans where we’re not only loving music, but we retain something about that music.

00;24;13;04 – 00;24;51;02
Nancy Dexter-Schabow
And I think that one of the- one of the pop culture things recently that drives that point home is all of us, people who grew up in the eighties? Watching Stranger Things brought every song lyric back from Casey Kasem’s Top 40! So, my goodness! Yeah, that is the exact response. And all of a sudden it’s like, you remember exactly where you were and who you were with when you first heard that song or when something really important happened with that song in your life or something really sad and oh my goodness, yeah, it really hits.

00;24;51;04 – 00;24;55;00
Rick Hoaglund
Well, thank you very much! Is there anything you’d like to add that I haven’t asked?

00;24;55;02 – 00;25;29;18
Nancy Dexter-Schabow
I would just encourage people that, you know, if if you know someone who is struggling and may be resistant, see if there’s a pathway to get them into music therapy and have them try something different! Music therapy does not have the invasive quality that talk therapy has. So for someone who’s really resistant but really needs some support, it may be a way to really reach someone who may really be struggling.

00;25;29;21 – 00;25;40;05
Rick Hoaglund
Well, thank you very much, Nancy! It’s been my pleasure talking to you! You you’ve informed me a lot about music therapy. And I really appreciate you taking the time to speak with us today!

00;25;40;07 – 00;25;43;18
Nancy Dexter-Schabow
Thanks, Rick! It’s been a great pleasure to do so!

00;25;43;21 – 00;26;26;20
Rick Hoaglund
Music therapy is not just used for those with autism or intellectual difficulties, but for people suffering from anxiety, learning disabilities, Parkinson’s disease, mood disorders, strokes, chronic and acute pain, substance abuse and much more. If you feel that music therapy may be the answer for you or someone you know, there are specialized search engines online to help you find a music therapist near you. To hear all episodes of OnTopic with Empathia, visit our website, www.empathia.com. Follow us on social media @Empathia and subscribe to OnTopic with Empathia to hear new episodes as soon as they go live. I’m Rick Hoaglund – Thanks for listening!