Have you ever heard the expression, “Music is good for the soul? “Turns out, it’s good for your mental health too! Whether you can carry a tune or not, Music Therapist Nancy Dexter-Schabow says that every one of us has a song in their heart and that everybody, even the hard of hearing, can learn and grow through the benefits of music therapy. That’s why she’s sitting down with host Rick Hoaglund for a two-part conversation on the nature of music in physical and emotional healing, how music therapy is actually a practice dating all the way back to biblical times, and the secret to getting into an industry that’s only growing as people continue to seek out new healing methods.
Whether it’s delivering a high-value employee assistance program, student support, or responding to a crisis in your organization or community, OnTopic with Empathia brings competence, compassion, and commitment to those who need it most. Find out more at https://www.empathia.com.
Click here for the full episode transcription
OT Ep. 22 – Transcription.txt
00;00;09;00 – 00;02;11;11
Rick Hoaglund
Have you heard the expression that music is good for the soul? Come to find out. It’s good for your mental health too! Welcome to OnTopic with Empathia! I’m your host, Rick Hoaglund. When you hear music, maybe you tap your feet, snap your fingers. You can instantly become a rock star with your air guitar or play the drums with imaginary drumsticks. We all know that music can make us feel ways that are hard to describe. Excited, happy, quiet, sad. It’s its own type of language. We may not all speak the same dialect, but we all understand the power of a tune. Author Hans Christian Andersen wrote, “When words fail, music speaks.” Or maybe we should use someone more contemporary. Like actor Johnny Depp, he said, “Music touches us emotionally, where words alone can’t.” This is the heart of a type of clinical treatment that’s being used in many types of circumstances. It’s called music therapy. The idea of using music to make someone feel better or to improve their mental state has been around for hundreds of years. But starting in the 1940s, music became part of clinical treatment and developed into what is now called music therapy. Music therapists use music sort of like traditional doctors use medicine to influence behavior and alleviate pain. But the qualities of music sometimes can do much more than a pill or a tablespoon of medicine can, because it has emotional qualities. Nancy Dexter-Schabow is a music therapist. She uses music to enrich the lives of people who are autistic or have intellectual disabilities. In some cases, it allows those who cannot speak to communicate. Music speaks to all of us. Almost everyone responds to music, no matter what abilities or disabilities we have. Welcome, Nancy!
00;02;11;13 – 00;02;12;25
Nancy Dexter-Schabow
Good to be here, Rick!
00;02;12;27 – 00;02;20;13
Rick Hoaglund
So tell me a little bit about music therapy. Like, how would you describe it to someone that has no idea what music therapy even is?
00;02;20;16 – 00;03;27;01
Nancy Dexter-Schabow
Ah, well music therapy? Very simply put, is the use of music interventions or experiences to address nonmusical goals. So instead of teaching people to play music, which a lot of people assume is what we do, we use music to help people with emotional expression, communication, social skills, academic skills, pain management, anxiety, help them address and decrease anxiety. With a lot of the people I work with, I work primarily with children and adolescents and adults with autism and other developmental disabilities. We work on impulse control. We work on making choices, self-determination. And a lot of those things can be facilitated through music interventions and experiences. A lot of them come up right in the moment, so that they don’t necessarily have to be planned out either!
00;03;27;04 – 00;03;30;26
Rick Hoaglund
I’m going to ask kind of a just a blunt question. Does it work?
00;03;30;29 – 00;04;12;19
Nancy Dexter-Schabow
Yes, it does. It doesn’t work for everyone. There are people who do not prefer music. I remember from from my own personal experience, my grandfather was tone deaf. Music therapy would not have worked for him. He never went to my mom’s band concerts because the sound was meaningless to him. So there are people who do not benefit from that. However, I work with people who are deaf and hard of hearing, and they love music because they can relate to the rhythms and the vibrations and they can really distinguish a lot from that input that is not necessarily auditory because music is a multi sensory stimuli.
00;04;12;22 – 00;04;26;24
Rick Hoaglund
Does it work for people that have no musical talent? I play at the piano, but I’m going to tell you my talent level is minus ten. I like to just pick around at it! But does it work for someone that does not have any talent?
00;04;26;27 – 00;05;28;06
Nancy Dexter-Schabow
Yes. And we have a lot of people who well, people don’t think that they have musical talent. They may not overtly have it, but we all as human beings possess elements of music within our bodies. So our brainwaves, our heartbeat, our respiration rate. We have rhythmic processes going on which can relate directly to what happens in a music therapy session. So if you’re working with someone in a hospital setting and they are experiencing pain, it affects their respiration rate. You match the music to their respiration rate and as they entrain to the music, you can start to bring the tempo of the music down to increase the intake of the inhale and exhale, which helps to decrease the pain. It’s working directly on that diaphragmatic breathing.
00;05;28;08 – 00;05;43;06
Rick Hoaglund
So I see you’re sitting in a room and you’re trying to explain to our audience, you’re sitting in a room, you’ve got a couple of keyboards behind you, pianos, and so is everyone expected to be doing something with the piano or it- is music therapy, incorporate other types of music?
00;05;43;08 – 00;07;33;16
Nancy Dexter-Schabow
Well, let me spin myself around here, Rick! So I don’t know what you can all see, but I have a whole plethora of drums behind me and there is my guitar. That’s probably the top instrument that music therapists use because it’s portable. So I’ve got all sorts of stuff in my closet and way down at the bottom. I’ve got xylophones down there too. A lot of handheld percussion instruments that anyone can play, regardless of how talented they are or not. And each of the one the rooms in my music therapy clinic has a drum set because it’s better for kids to make loud music here than it is for them to do it at home, you know what I’m saying? And then behind me here, I’ve got one other keyboard. This is actually a keyboard that lights up where the people I work with can follow the lights and actually play a song that sounds like something like even Bach and Chopin and Beethoven. So we got a lot of different things that we do. So now in a music therapy session, we don’t- it’s not always expected that the people who we serve play the instruments! Sometimes they receive the music or they talk about the music. It just depends on what their goals are. A lot of people who I work with, they have a sensory need to touch and handle and even embrace at times. A lot of the the vibratoctile components of our instrument. So one of my guys tomorrow will actually sit with one of the larger bass drums in his lap and literally hang himself over it and get all the vibrations. So and that’s that’s a huge thing for him because it really helps him to relax and de-stress because he carries a lot of anxiety with him.
00;07;33;19 – 00;07;50;28
Rick Hoaglund
So if I were one of your students and I might either be the one playing the instrument or I might be feeling the instrument, I might be listening to the instrument. I guess you’re listening even if you’re playing, but you’re- you’re hearing it. But the object is it to basically have a piano lesson? Or to have-
00;07;50;28 – 00;07;51;14
Nancy Dexter-Schabow
-that is correct!
00;07;51;16 – 00;07;57;14
Rick Hoaglund
-the object is completely different than that. So I guess what is the object of this?
00;07;57;16 – 00;09;42;22
Nancy Dexter-Schabow
The object of this is to address the- what I call the therapeutic priorities for each individual who is in front of me. So some of my folks, we just had a full moon yesterday. A lot of our people are very disregulated. Yesterday and today. So a lot of the work that we do with our folks on the autism spectrum is to help them feel better in their brain, in their body by grounded them and connecting them to like tempo, vibration, melody, singing with breathing. That is like the primary thing. Some of it, during these times of the full moon, just feels like triage where you really work in the moment, you respond to the cues that they’re giving you. You change the music accordingly to help them, you know, be more connected in the moment. And your goal is to send them out better than what they came in. And then on a day where they’re better regulated, then you can work more on like communication and getting them to use their words more accurately or more meaningful way during the session, because that might not be as accessible today on a day when they’re disregulated. You might have them work more on keeping a steady beat and really having that connection with motor planning and that social connection with the therapist who they’re drumming with. So you can you can kind of step up the goals depending on where the person is at on a particular day.
00;09;42;24 – 00;09;48;24
Rick Hoaglund
So you do this one on one or do you do it in small groups, or can it be a mix of- of all?
00;09;48;26 – 00;11;36;12
Nancy Dexter-Schabow
Oh it’s a mix of everything! Here in- here in our clinic, we mainly do one-to-ones. Sometimes we do dyads. Before COVID, we had more small groups. But I also go out into the community. I do a contract at an autism college. I’m at all of the schools in my school district here. So I serve all grade levels from early childhood through high school. And those are groups that are more between, oh like four and seven people per group, and they’re 30 minutes each. So you have to pack a lot into a short period of time, but make it meaningful and purposeful for each person. And so in one of my groups, I have someone who has quadriplegic c.p., I have two or three people have autism. I have people with cognitive disabilities, people with speech impairments. I have people with rare genetic diagnoses. So I have to, in the moment assess what everyone needs like that morning and then with whatever plan I bring in, I have to be able to adjust that on a dime to make it work for every single person in that group. So it has meaning and purpose for every single one of them while preparing their brains and their bodies for learning that day at school. So there’s a lot of- there’s a lot of sensory things that I bring into it. And this is only- this is the part of music therapy that I do with autism and developmental disabilities. So a little bit different when you go out with mental health or when you’re working in hospice or if you’re working in a medical setting. And I’ve- I’ve worked in all of those settings as well as a part of the last 30 years.
00;11;36;14 – 00;11;47;17
Rick Hoaglund
Is this done in conjunction with, say, a person’s physician or maybe their therapist- another type of a cognitive therapist? Or is this sort of- does this sort of sit in a bubble of its own?
00;11;47;21 – 00;14;28;24
Nancy Dexter-Schabow
Okay, so it depends on where you’re working! So if you’re in like, I’ve done work at a children’s hospital, then you were part of a team. If you are in any sort of facility, then you’re part of a team. For me, as a contract music therapist, I tend to fly a little bit more solo, but I will work with teachers for specific behavioral things that we want to address through music. I will work with teachers for specific- or a speech therapist, actually- with specific communication goals that we would have for one of the little guys in our group. I had this morning, I just sent a teacher an email that says, Here’s our plan for Thursday and here’s two pictures to print off to put on his schedule. So we do- we do some collaboration like that with the individuals who come to the clinic. A lot of times in my practice, it’s the parents who are seeking the service and in- in the state of Wisconsin, where I live, we met a kid waiver services that do cover music therapy, and believe me, we have been through the fire, justifying why we are a valuable service for these kids and families. So our research has been vetted, not my research, but our research as a profession has been vetted by PHD and EDP people at the Department of Health Services, and they do have us approved to be a Medicaid- to be Medicaid waiver providers within the state. So it opens the doors to families who might not have the option to have other services or where other services aren’t a good fit. And we do have- there are some people who are not good fit for music therapy, where music therapy may be too overstimulating regardless of what we do, right? Where it just might not be the right time. So- and for some of those families, we have to say, you know, it’s good that we tried. Now we know there’s some sensitivities that are heightened that we didn’t know about before. So maybe let’s let them get a couple more years on them and then let’s try this again. So we never close the door to it just because someone might have an aversive sensory experience. But we leave the door open because we know that children and adults change and grow as the years go on. So what may not be right at this moment, may be right a couple of years down the line, and actually so much more needed a couple of years down the line.
00;14;28;26 – 00;14;32;02
Rick Hoaglund
So how do you know if you’re making progress?
00;14;32;04 – 00;16;48;22
Nancy Dexter-Schabow
Oh, it is very clear. Sometimes we will get information from parents that tell us that progress is being made, though they will say things like, “They’ve never done that anywhere else before.” “I’ve never heard them say that word.” “I’ve not seen them be able to engage with this kind of sound before.” Parents give us a lot of good information about progress that relates to outside of music therapy. Within music therapy, we follow the standard treatment protocol that all other therapists follow. We do an assessment, we write a treatment plan or we do an assessment. We identify strengths and challenges. We write a treatment plan based on the therapeutic priorities that we see from a music therapy perspective. We collect data through the treatment process. We write progress notes, we revise the treatment plan, and we keep going through it. Music therapy is one of those unique therapies that can stay with a person of their lifetime. We have- I have a person who I have been seeing for almost 30 years, and at this stage is in changes that have happened through his life? His parents pay out of pocket, and they have come to me and said he’s here until he goes or you go, because that’s how important music therapy is in his life. And he’s a- he’s he’s gone through a lot of changes. He’s moved to a residence outside of his parents home because he’s an adult and he wants to do that! And, you know, it brings on some different stress and anxiety. So, you know, he’s had as he’s grown, he’s actually acquired more anxiety issues. He can work on those here safely with someone who understands him. And he appreciates that because he knows. He knows that I’m going to be tough when I need to be, but he also knows he’s going to have choices and that music therapy for him is a collaborative environment where he will be respected because he’s not respected everywhere he lives and goes.
00;16;48;24 – 00;16;52;06
Rick Hoaglund
How did you know that you wanted to be a music therapist?
00;16;52;09 – 00;20;45;00
Nancy Dexter-Schabow
I didn’t! When I was in high school and I knew I wanted to go to college. There were no music therapists in my community at that point. I didn’t know any music therapists, and I went to my guidance counselor and I said, I want to major in music and psychology because I knew how music had been so beneficial for me throughout my life. And I’d played piano since I was eight years old. I’d always sung in church and choirs and grade school and everything like that, and I knew how music was so beneficial for me. And I’ll be I’ll be very transparent here. I lived with a form of obsessive compulsive disorder since I was ten years old, so music probably had a greater meaning for me than I realized until I actually started studying music therapy. So I, as a 17 year old, having been told by my guidance counselor, You’ll never make a living majoring in music and psychology, it was very discouraging! And he should have known this field existed because he had all the files in his office. I got a mailing from a college down here in the Milwaukee area that listed music therapy as one of their majors, and I was like, That’s it! I need to major in music therapy! And that was it for me. I was one of those rare people who, when I saw the words put together, I knew that was what I was going to do. I didn’t know what it was. They didn’t know anything. But I know that that’s music and psychology together. That’s that’s what I want to do. And so I knew from the minute I saw those words together that was what I was going to do. And I, it- it was a fight to get through college financially. But my family and I did it and it was a fantastic course of study for me. I actually got to study with one of the original pioneers who founded music therapy because music therapy as a profession was organized in 1950. So it’s still relatively young profession, even though if we look back in history, we can all go all the way back to biblical times and see examples of music therapy way back, like David playing the harp for Saul. That’s the example that people go to. So we know that music has been used therapy therapeutically for millennia, but I had the privilege of studying with someone who was there at the beginning of the organization of this profession, and she was absolutely wonderful in helping- helping me understand the fact that basically this profession rose out of nothing. And now it’s something that I can actually do with my life. And I thought that was amazing. And then I had a- she retired and then I got another professor from another college who came into mine and she like opened the door even wider to a lot of these- a lot of these opportunities that really pushed us to like really shoot beyond what we had ever thought we could do before. And I ended up being the first person in Wisconsin to have a private practice. So- and subsequently a music therapy, a community music therapy agency. So, yeah, I’ve been mentored by some phenomenal women who one of whom I still keep in touch with to this very day. So I’m I’m very blessed to have those people in my life who pushed and said, you know, we’re still at the beginning of this. This can basically be whatever you feel it can be. And that’s what I never thought I’d do it, but that’s kind of where my path was leading me! So…
00;20;45;03 – 00;20;53;24
Rick Hoaglund
So if I today wanted to be a music therapist, what do I have to do to become one? You mentioned college. I’m guessing you have to have a college education.
00;20;53;26 – 00;25;52;03
Nancy Dexter-Schabow
Yes. So usually music therapy, typically for most people starts prior to even knowing that you want to be a music therapist. But there’s so many more music therapists out here that people are understanding what they need to do to follow that. So like participating in solo ensemble competitions, just to really up your musicianship because the musicianship is a core part of music therapy. I always tell people learn piano, so not just play at the piano, but learn it. And you know, you don’t necessarily need to learn it by reading all the notes and everything. You can learn by ear, too, and that can be very valuable! Most of the work I do on piano today and I am a pianist, that’s what I played all almost all my life. I do most of my work by ear today, so my skill set has really shifted! Encourag people to sing! I encourage people to take music theory, understand the components of music theory, understand why the chords that your favorite artist uses in a certain way in a song understand why that works. That’s music theory. Volunteer with people who have challenges in hospitals, in cancer, people with special needs, Special Olympics, nursing homes. There’s a whole lot of places where you can interact with people who have- who are living their lives with challenges, and that can help make you more comfortable with those populations because if you choose a career in music therapy, you will eventually be doing that. Oh, and I almost forgot – Learn guitar! I said guitar was one of our main instruments that we use the music therapy. Learn guitar, learn how to do chords! It’s all good if you’re still in school. Take psych, take anatomy and physiology, take anything you can to help you out that way. When you do get into a college program and there’s a lot of people come back as equivalency people or as second degree students. So their path is not nearly as long, but the requirements are the same as a four year degree. It’s just if you get to transfer in a boatload of stuff, it cuts down how much time you have to do it. So the four year degree requires that you are a part of an approved music therapy program, and those are approved by the American Music Therapy Association. And if you go on to the website, www.musictherapy.org and go under education, you will find all of the universities and colleges in the country that are accredited by AMTA. They are the ones that are the gatekeepers of the educational standards and they’re very, very good about it. Once you complete that program which consists of music performance, music theory, music history, anatomy and physiology, music therapy classes, psychology and there’s, there’s a few others in there. I have taught in a college program for 22 years previously part time. So I know these, I just have been away from it for a couple of years. So it’s not as on top of my head anymore. But all of those all of those courses help the music therapists help make you into music therapist who is very flexible with music. And that’s what you have to be. You have to be able to- you have to not be married to a page of music. You have to be able to turn on a dime and you have to be able to improvise music in order to address the needs of the people in front of you. So once you go through all of that, you complete a six month internship, specifically as a music therapist, mentored by or supervised by board, certified music therapists. Once you complete that internship, you take the board certification exam through the certification board, through music for music therapists, and then you can work. So now, depending on which state you’re in, you might need to get an additional registration, certification or licensure to practice in that state. So in the state of Wisconsin, we currently have registration. And so to be like a Medicaid waiver provider, you need to have that registration. You need to have the state recognition in order to provide Medicaid waiver funded services. Some states have licensure. We’re currently working on that. Wisconsin as well, because there’s been some safety issues that have come up with people who have claimed to be doing music therapy but are actually not music therapists. So people need to like check out the credentials of the people who are providing services for them. But that’s basically it! Degree in music therapy, six month internship board certification exam, and then whatever your state requires!
00;25;52;06 – 00;26;22;23
Rick Hoaglund
We will continue our conversation in the next episode. We’ll explore what happens in a typical music therapy session and what is it about music that makes it a valuable tool. To hear that episode and other 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 to OnTopic with Empathia!
