The Gift of Intuition

Any clinical professional knows that we study certain rules and guidelines for assessing our patients and clients and then determining appropriate interventions for them.

One such guideline for music therapy for determining appropriate preferred music to use in therapy is that we generally stick to music that was popular when our patients were 15-25 years old. Research shows that this decade of life is when our brains tend to be most susceptible to forming intensely nostalgic, emotional connections with music. The rule tells me I am far more likely to get engagement for therapy when I can find music that likely played on the radio in someone's first car than if I use music their grandparents went out waltzing to.

I have had great clinical success with the process of consciously applying this guideline and sifting through all the available data on each patient to arrive at some great educated guesses to get started. And we know that a responsible MT is going to assess actual responses to music and keep sifting through that data and always take a patient's expressed preferences as the most important information.

And yet...

There are moments when my internal dialogue keeps pestering me with something that falls outside of the rules and guidelines for what "should" be preferred by any given patient. My intuition persistently demands that I ask them, that I offer this music and just see if they even know what I am talking about and if they want to engage with this music. Some of the most powerful clinical responses I have ever gotten have occurred as the result of listening to those intuitive nudges.

And music therapy is not the only area of clinical practice where a departure from the standard procedure occasionally yields a strong result or critical finding. How many physicians can tell stories of that time they ordered a test for a patient for no reason that made logical sense to them, but their gut just insisted? They just "had a feeling" they needed to order the chest x-ray or the bloodwork even though nothing in the presenting symptoms clearly pointed to this?

What exactly is going on with clinical intuition? I want to unpack that a bit. So many of us explicitly trust our logical, linear thinking processes that consciously sift through data and apply theories and guidelines, and thus implicitly remain a little wary of anything intuition tells us.

I recently read The Gift of Fear by Gavin De Becker. This book completely changed the way I view intuition as a subconscious cognitive process (and not as mystical, otherworldly, "hunches.")

Imagine your reflexes for a moment. They operate outside of and faster than conscious awareness. The other morning, I brushed the back of my hand against the slow cooker. My arm flew up and away from it faster than I could realize why. I didn't have to consciously think, "This is hot. I know that this temperature will damage my skin and cause pain. I should move my hand now." It just happens.  Later that morning, I was on a run and happily inside the reverie of my mind, almost in a meditate state. Suddenly, I felt my legs seize up and my body jerk backward, milliseconds before I became aware of my head turning and my eyes and ears consciously registering the oncoming car. My instinctive reflexes operated on behalf of my best interests before my conscious, logical mind had any say whatsoever. And good thing, too.

What does this have to do with intuition as a cognitive process? Imagine it like this: your conscious, logical, linear mind is a bit like a teacher giving a lecture to the rest of your brain. "We are going to take this data today and apply these rules to it and that's how we will know what to do for this patient." Your intuition is all the other unconscious parts of the brain, the room full of students busily gathering sensory and memory data and passing notes to one another in the classroom. By the time these students have generated enough flurry to get your conscious attention and you intercept the note, you can be reasonably sure they have something worth your attention. Yes, intuition is sometimes wrong, but it learns. That error will be stored away for future use and used to inform those busy little students for next time.

This is how the process played out for me in a visit with a patient: By all the "rules," she should like rock and pop music from the 1970s and 1980s, and she does! No problem there. So why, when she mentioned an image from her childhood, did I suddenly feel an overwhelming urge to offer her a cowboy song from 1935? There was no logical reason for my mind to go there, but I had just intercepted a note from my subconscious that said I really must. So, I asked. I said her words had brought some lyrics to mind, and did she know anything about this song? She said it sounded familiar and asked me to please sing it.

She burst into happy, nostalgic tears at hearing this song and told me her grandmother used to walk through the house, singing it all the time, and she had mostly been raised by her grandmother. From there, we discovered many of the other songs she learned at Grandma's piano. The biggest increase in her subjective self-report of her well-being and quality of life happened in that session, using music that I never would have arrived at by only considering the data from my conscious mind.

Somewhere under the surface, my intuition was sifting through everything I had ever learned about this patient, the CDs I had seen in her apartment in passing, statements she had made, and I don't even know what else. But finally, my intuition had something important enough to bother me with, to interrupt the teacher's lesson and get caught passing me that note.

I'm so curious what other clinicians have experienced with the role of intuition in their practice. Drop me a note in the comments and thank you for reading!

Doing With or Doing To?

Happy Friday to you!

Think with me for a moment about the last time you visited your doctor, or underwent any kind of procedure in the hospital or doctor's office.

For me, that was a fairly painful but brief biopsy. Now, a question: was your perception of that visit or procedure one of having the medical professional do something to you or were you perhaps conscious of a relational element, a sense of doing with?

I think these are very important elements of healthcare and therapy to consider. Chances are, when you undergo "standard" medical care, the dynamic is one of doing to. Think about the language we use: provider and patient, procedure, undergo. As critical thinkers in the helping professions, we know that the perception of care provided is nearly as important as the care itself.

That biopsy I mentioned? The longest. five. minutes. of. my. life. We know that learned helplessness and the feeling of powerlessness is one of the most damaging psychological elements of experiencing trauma. When undergoing a painful procedure, it seems as though there are some traumatic elements "baked in," due to the very nature of needing to allow someone to do something painful to you.

I can't even articulate what a difference it would have made for me to have another music therapist there to engage me in some element of choice and control for that five minutes. I could have chosen my favorite, super intense music to provide a clear signal for my brain to focus elsewhere besides the procedure. One enormous swath of the total experience of that exam room environment would have been under my control, determined entirely by my needs and preferences, and not "standard procedure."

I posit that one of the elements of music therapy intervention and process that sets it apart from other modalities that may address the same or similar goals is the degree to which an MT-BC is focused on doing with.

(Even the cats want in on the instruments for doing with!)

Music is an inherently social process and phenomenon. There are so many ways an individual or group can engage with or in music. You can sing with it, move to it, mouth the words, play an instrument, play what's written or improvise around it, think about the lyrics, analyze and talk about the lyrics, experience and share nostalgic memories in response to it, or just be present and mindfully listen to it. In the presence of live music, some part of you (and many parts of your brain) engages WITH what's happening.

In my work with hospice patients and their families, part of my approach is to include them as co-music-makers to whatever extent is comfortable and desirable for them. And there again, their individual needs and preferences are a driving factor in how our musical interaction takes shape. It's part of my initial clinical assessment: What music does this person prefer and relate to, and how do they relate? Are they a toe-tapper, a crier, a lyric-discusser, a belt-it-out-at-the-top-of-their-lungs-er? Some combination of all of the above?

So when I hand someone with Parkinson's an egg shaker, and they experience tremors, I adjust my tempo to include their tremors. It becomes part of the music. There's relational support. We are doing with, together. Or when someone is more fatigued and they decline to make their own song choices, I don't just decide what music I want to use that visit - I remember and consider what they have responded to and preferred and chosen in the past and keep an eye on their affect, breathing, etc. as I incorporate their previously-expressed preferences and autonomy. And even when someone is only capable of lying still and resting while listening to music, I am carefully watching them for responses - a change in facial expression, breathing rate, motor activity, visible muscle tension - to give me direction. They are still co-creators in this musical experience because what they indicate will determine what we do next.

It's important to remember that I am never providing music "at" someone, but always seeking to engage in music with them. This musing raises the broader question for me of how this unique perspective might translate across the other modalities of healthcare. Could we transform someone's experience of having a procedure "done to them" simply by including MT and the elements of doing with?

Please let me know what you think in the comments and thank you for stopping by!

But Not to be Smaller

Happy Monday, my fellow musers!

Yesterday, I noticed my legs seemed more toned and I was way more comfortable in my favorite pair of jeans. That really has nothing much to do with this post, but more about that in a minute.

I have mentioned before how much I loved Brain Rules by John Medina. It's one of those books I keep picking up, and every time I do, it enriches some part of my personal life, my professional life, or the intersection of the two. (Have I mentioned that I am practicing piano better and faster than before with the help these rules?)

Just a few pages into this book and I'd had enough of a nudge to start running regularly again and to recruit my sweetheart to join me. Check this out:

"Just about every mental test possible was tried. No matter how it was measured, the answer was consistently yes: A lifetime of exercise can result in a sometimes astonishing elevation in cognitive performance, compared with those who are sedentary. Exercisers outperform couch potatoes in tests that measure long-term memory, reasoning, attention, problem-solving, even so-called fluid intelligence tasks...Essentially, exercise improves a whole host of abilities prized in the classroom and at work." (Brain Rules, page 14)

An astonishing elevation in cognitive performance? Yes, please! That kind of self-care was the push I needed to start running this time around. I have had an on-again, off-again relationship with running. I think this time it will stick, though. Why? Because this time around, my motives are different.

In the past, running was about being smaller. It was about weight and size and jiggle-reduction and not much else.

My loved ones cannot afford for me to be preoccupied with being smaller. My patients, their families, my co-workers, and everyone else cannot afford for me to bring a version of me that is in any way focused on shrinking. I run for so many reasons now, and a sharper mind is just one of them.

I run to show myself I am fully capable of suiting up and showing up, to get in touch with that inner voice who says, "I can," find her, and turn up her volume, to build my bravery and my self-compassion one step at a time so when I need it, I can confidently call upon that part of myself who must have hard conversations with families facing a death. I run to get bigger in heart, in strength, in confidence, in nurturing self-care, and yes, in improved oxygenation to my brain cells and sharper thinking. But never again simply to be smaller.

So when I glanced in the mirror yesterday and saw some changes, I could think, "Well, cool. But that's not important." How absolutely liberating. I will choose today to grow, but not to be smaller.

PS: If you want to learn some of the best neuroscience out there for taking care of a human brain, you can get a copy of Brain Rules here. I promise this will help you be a better therapist and human being!

The Best Assistant I Ever Bought for Under $20

Do you work in a nursing home? Or ever provide care in any kind of long-term care setting for any reason? Maybe you're another music therapist like me and have a need to sit at the bedside with patients for an extended period, or maybe you're a nurse practitioner or an MSW who is tired of crouching or bending to visit briefly with patients, wishing they weren't so inaccessible over there in the hospital bed.

Maybe, like me, you've noticed something about these facilities, and it probably gives you just as much trouble as it does me.

Where are the chairs for visitors to patient's rooms?

I frequent a large percentage of the nursing facilities in my area as part of my hospice work and I run into the same problem everywhere I go. Those rooms are not designed to accommodate extended visitors because there is nowhere to sit, and not much to sit on.

You've probably found the work-arounds I did, like crouching on the edge of the AC unit, or scaring up one of the heavy chairs from the dining room, which will have arms on it if you can even find one to borrow. Or maybe you scared yourself silly the first time you sat on the edge of a bed that has a bed alarm. I didn't make that mistake more than once!

This problem bugged me for the first nearly two years of field work. I resisted trying to pack anything else along with me because I already carry a guitar, a nursing bag of rhythm instruments, cleaning and sanitizing supplies, and the tablet with the OnSong library. I didn't want one more thing to cart around.

But then, finally, I found something that met my criteria for riding along.  This delightful "assistant" weighs in at just about two pounds, it's self-contained in that it provides its own carrying strap and closure system, and it sets up and down in one step. It's light and small enough I can toss it on my back along with my guitar and not even notice it's there. It's durable and easy to clean. Now I can position myself almost anywhere I need to be relative to my patients, whether they are in a facility or a private home. And my back thanks me at the end of the day of using the iso-principle.

 Travel Chair shown here with large dog and small cats, for scale (and cuteness!)

I wouldn't recommend this if it hadn't been such a hardworking assistant to me and proved its worth in the field time and time again. It goes for under $20.00 on Amazon and if you're an independent contractor or self-employed music therapist, it's also tax-deductible on your Schedule C. You can get it here.

Please let me know in the comments if you have run into this particular irk and you have found an "assistant" that works for you!

A Very Sleepy 2017

Fun fact: More traffic accidents occur during the 2:00-4:00 PM window than any other time. An even better fun fact is that we actually know why. It's all because of our brains.

For something as important as understanding the workings of the human brain, the findings of much of the field of neuroscience are surprisingly murky. So, when the neuroscience community reaches a strong consensus on an issue, and declares a finding to be strongly supported, I listen. I take it to heart. I recently read "Brain Rules" by John Medina, a highly-respected neuroscientist. In this book, he distills the best of the best of neuro research and translates it into principles or "rules" that guide how to best use a human brain in real life.

So why do we consistently crash our cars more during these hours than any other time and what does it have to do with our brains? It's because our brains really, really, really want a NAP.

And by "want," I mean this is a hard-wired, biological drive. A need, like food or water.

What is our brain doing during this time and why does it need to do it so badly? This is where it gets murky again, but the best research suggests that we are doing intensive offline processing and brain de-cluttering during this time. We take all the information we have encountered during the first half of the day and only during a short sleep cycle can we actually make much use of it.

The science gets pretty clear again on this point: the drive for an afternoon nap occurs universally among humans (without serious sleep disorders) regardless of how much you typically sleep and when, whether you are a night owl or a morning lark. It's so universal and clearly defined that researchers have termed this window the "Nap Zone," and believe it's the other piece of a natural human sleep rhythm. The Nap Zone occurs because you have processes in the brain that fight to keep you continually awake, and ones that fight to keep you continually asleep. The sleep forces win out when you go to bed, but eventually give out when you wake up the next morning. When you enter the Nap Zone, these contesting forces flatline. A cease fire. Nobody is really in the lead, but you definitely feel the possibility for sleep coming on. Thus all the car crashes.

When we attempt to fight through this window, we're pretty miserable. Irritable.  Our thoughts feel s...l...o...w...e...r. We might need to have someone repeat what they just said. Worse yet, we suddenly snap to as we hit the rumble strip on the side of the highway.

What happens when we take this nap instead? Per "Brain Rules," we drastically improve our productivity and our thinking abilities. We become sharper, more creative, faster on our feet, deeper thinkers, and capable of solving the problems that were baffling or stressful before lunch.

I resisted this line of thinking at first - the idea that by taking just 20-30 minutes to sleep once per afternoon, I would actually make up for that lost and time and then some in what I would be able to ask of my brain post-nap. But the science is so, so clear here that I might as well argue that I actually see with my ears instead of my eyes because that "seems" more logical to me.

Resisting the idea that humans need this afternoon nap makes as much sense as arguing that your car runs best without ever putting gas in it, or that a surgeon will perform their best surgery by using the same scalpel over and over until it is so dull it's only good for butter. The nap serves the same purpose as trading out for a sharp instrument.

All of this adds up to the only resolution I have made for 2017 so far. Every single day possible, I will arrange my schedule in such a way that I can nap for 20-30 minutes in the afternoon. I resolve to use the nap zone for what nature intended: revving the brain up to do its very best and brightest work. I encourage you to join me in taking that very needed nap. It's already making an enormous difference for me in terms of clarity of thought, emotional stability, and creative brain power.

On that note, I wish you and yours a very sleepy 2017. Happy napping!

PS: If you want to harness the neuroscience for your own health and better therapy for your clients, you can pick up the book here.

The Archive

Hello, you wonderful people!

One life chapter has ended and another has begun. That means all my music therapy musings will now live here, on this page.

You can still access all the previous posts over here.

I can't wait to share my musings with you in the new year!