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Music-therapy during Covid-19 pandemic (Part2): Challenges and Solutions



In my previous post, I began with an introduction to the definition of music therapy and included some information about the how and why it is used in clinical settings.


During the first wave of Covid-19, my day center closed and remained so for 18 months. I, as a music therapist found myself challenged by various obstacles which limited my ability to perform my professional tasks in the manner to which I and my clients, were accustomed to.


Happily discovering the virtual platform (and an application specifically developed for seniors in Spain, and tablets provided by Rogers and Fondation Santé Urbaine) it immediately became evident I was facing a whole lot of atypical frustrations and challenges and no idea how to overcome them. I think I would have found it much more difficult if I did not have nearly 30 years of clinical work and 20 years of live performance in an interactive setting under my belt. I had skills in Ad Lib performance improvisation. The two are not the same but one compliments the other and I swear those skills saved my sanity.


The Most Important Problems During Virtual Music-Therapy Sessions


Frustrated more than I care to admit I found myself in a situation which needed a solution that was in the best interest of my participants, but I knew not how to go about achieving it. As music therapists we come to the table with two professions under our belt, 1: we are trained professional musicians and 2: we are certified therapists with a minimum of a bachelor’s degree which includes intensive studies within the field of psychology and in some instances specializations in particular populations or areas of healthcare. Our professional association demands a high caliber of musical competencies for health care and well-being and one of them is the quality of music production in relationship to the therapeutic process.


Problem 1: Sound Quality:


However, I learned very quickly upon providing virtual music therapy that I could not provide the quality sound experience I was used to giving. I did, I tried my best to make sure my clients still had a positive and healing experience, but I personally felt it was impossible to obtain the level of competency I was accustomed to providing and this greatly disturbed me. Thankfully, the feedback of my clients was positive but to my musical ears and therapists’ soul I cringed painfully and repeatedly throughout the shutdown.


Clinical Improvisation means working to stimulate a Gestalt Therapy experience with live music. Music Therapists acquire many hours of training in clinical improvisational techniques to develop their expertise and very good articles ([1], [2]) explain how clinical improvisation works in the therapeutic setting. You may enjoy exploring this to further understand some of my ‘virtual’ frustrations.


In a music-therapy session you are guaranteed that something will transpire during the clinical improvisation and that is the objective. Because the improvisation is presenting “in real natural time” things spontaneously occur resulting in an authentic and organic experience. In my very first real-time virtual music therapy experience I instantly knew it would be crucial to adapt my clinical intervention approaches and techniques. Suffice it to say it was an eye-opener with pros and cons.


Problem 2: Real Natural Time out of Sync.


From the first resounding note in the ‘real-time’ virtual session I noticed, and was horrified to discover a delay between the sounding of the note and the time it was received by the those listening. We simply could not coordinate the timing and I tried. I tried everything I could think of to sound as though we were together musically, but it wouldn’t or couldn’t come together. There was also an optical delay. I would be watching the screen and see my strumming out of sync with my real time actions and it was quite disconcerting. It was always off by a second, or a second and a half on every single note! It made me want to cry with frustration. The clients noticed it too, but it seemed to bother them less than it did me. They would comment on how hard it was to make it work together and for some it was disturbing but not as much as it was to me. There was always at least one person or another completely out of sync when we attempted to play in tandem. Rhythms were unstable and because the screens on some tablets are small, the client could not actually see to imitate the play if that was the goal, and it usually was in the early attempts. It was an auditory and a visual challenge for all participants.


My years of clinical improvisational experience were being challenged and I felt at a loss to find solutions to technical problems which were foreign to my professional background. My population are the individuals who live at home but are generally advanced in their health care needs and therefore become too easily the forgotten ones within the system with this need being the primary reason for beginning virtual interventions. Understanding this was the only means to assure a constant contact and follow-up we decided together, united in a mutual effort within the early sessions to problem-solve.


This ultimately lead us to decide as a group that instrumental improvisation would have to wait until we returned to on-site in-group music therapy. A huge part of what I love so much about my work had to be shelved.

Problem 3: Lack of Quality Instruments.


In a music therapy session we use high quality instruments for percussion, for melody, to create a sound environment conducive to the theme of the session. It is also rare that my clients have access to the types of instruments you will commonly find in a music therapy session. In our training as music therapists we become very adept at creating instruments out of nothing and learn to use walls, chairs, tables for drumming, or bottles filled with rice or beans to be used as hand-held percussion instruments. It is a bit harder to do this to create melody other than using voice when nothing else is available.


Even under the worst conditions where instruments were not available before working virtually, I was always in direct physical contact with my clients. That was gone and this was a new challenge. Unable to provide my clients with instruments to use in the sessions I asked them or their care-giver, to look in their kitchen, basement, or workshop for something to make music with.


Tabletops, wooden spoons, metal spoons, magazines as drum skins, and in some instances maracas or small hand drums were found and brought to the sessions.
I can say I saw a lot of spatulas of different shapes and sizes bobbing in the air upon my screen over the months that followed. It is a sight I shall remember forever.

We may not have made the beautiful and harmonious sounds such as one finds in an orchestra like the OSM but we sure as heck were creative and laughter became our melody of choice. You might even say it became our COVID Anthem.


Problem 4: Sound Production


The hardest obstacle to overcome and one that never has been resolved was, and continues to be the lack of good sound quality. If there is one thing I definitely learned it is that a tablet is not the tool for providing a quality recording during a virtual experience. They are good one on one, but in a group setting be prepared for disappointment. Even playing client with therapist (solo/duo) the problem persisted albeit somewhat easier to cope with especially where my ears where concerned. In group music playing we could not hear each others instrument effectively.


Having no control of the volume on the various (at home) tablets, I never knew who could hear what, or even what they were hearing from me. Also, any background noise such as a CD player or Bluetooth needed to on a very low setting otherwise it tended to bother the listeners in their homes as too loud, or distorted. The opposite was true using the piano and/or guitar where the complaint was they could not be heard loudly enough. So much time was spent just trying to find the volume balance I still find myself cringing just thinking about it.


Truly, in our continued virtual session happening right up to today I have never found a solution because in my workspace we still do not have the proper recording equipment that would, maybe, make the virtual sound experience a positive one . Again, to my musical ears chaos reigned and on more than one occasion and I would sit back during the session and just wait until the participants all came to a natural unsynchronized finish because we were always, and I do mean always, out of sync with each other. Ironically that did not impede the positivity of the experience for the participants. The laughter, chatter , or dialogue that manifested in the session juxtaposed the lack of beautiful sounds and made the experience a positive one in spite of the obstacles.


Personally I still find it very unnerving to listen to our posted videos because of the terrible sound quality. I must remember to overlook that negative element and notice the connection that was created, the realization of breaking the Isolation and Solitude of the participants. After all, that was the objective and it worked but each time I recall my years of training and how it was pounded into my head that music therapists must always assure the music is as perfect as it can be, at all times.


The music created can be chaotic or harmonic. As long as it is part of the therapeutic experience it is acceptable.

In this instance, poor sound quality production was an unwanted participant who entered into the group and never left. To not have been able to provide even mediocre sound quality in my sessions challenged me to the depth of my professional soul but there was nothing, absolutely nothing I could do to fix the problem. No money for improved equipment was or is available so we made due as best we could. As my Daughter in Law says all the time "it is what it is" and that was the reality of what it was, and yes, still is as we come out of this 5th wave and second shutdown. I crave getting back into on-site sessions and begin to resonate my "quality" instruments again.


Now, in spite of the difficulties, the virtual music therapy sessions provided positives and a big one was in providing access to self expression and social interactions. I watched bodies , heads and legs on my screen swaying to music with arms and spatulas moving in the air to whatever the sound of the time signature they were experiencing happened to be at their end and upon their tablet.


In those weekly 60 minute sessions fun and pleasure for my population reigned. They were no longer the forgotten ones and COVID took a place on a back burner for an hour. This was good!

I am aware the virtual experience sounds like it was largely a negative experience for me and at times for my groups, but the truth is I never ceased to be amazed by their comments of how much they loved our time together. We we able to laugh at the some of the rather ‘out of the ordinary’ sound experiences and it definitely inspired reminiscing about a whole lot of other things. I missed terribly the magic of improvisation but they were replaced by Question and Answer Musical Games or Name that Tune, or Fill in the Blank with the right word.


These are the activities that we use with my senior population as part of the therapeutic process, but not as the principal intervention because it limits or even blocks the possibility for insightfulness to develop within the therapy session. Having to abandon clinical improvisation confirmed my previously held belief that in the profession of music therapy the process must take place in a face to face setting and not screen to screen. During our problem solving discussions I, and my peers in music therapy shared the same consensus which is ours is not a profession which transfers easily to virtual interventions but without a doubt virtual interventions can augment or supplement the music therapy process in ways yet unexplored, and we look forward to doing that.


References:

  1. MacDonald, R.A., Wilson, G.B. Musical improvisation and health: a review. Psych Well-Being4, 20 (2014). https://doi.org/10.1186/s13612-014-0020-9

  2. Erkkilä J, Gold C, Fachner J, Ala-Ruona E, Punkanen M, Vanhala M. The effect of improvisational music therapy on the treatment of depression: protocol for a randomised controlled trial. BMC Psychiatry. 2008;8:50. Published 2008 Jun 28. doi:10.1186/1471-244X-8-50


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