Shoes Off!

•  

If there is only one thing I have learned here it's to be open to new perspectives. This applies to both working and touring. From the moment we stepped foot off the plane it was obvious that we were not in a westernized country anymore. No one spoke the language we were used to, no one looked like we did, and everyone smiled and stared at us.
At first many of the people in our group, including myself, were put off by some of these things- especially the stares. We were all used to blending in to a society with many different skin colors, not a society where we are the obvious minority. This is not where the changes ended.
We quickly learned that one of the main cultural differences is the idea of taking off your shoes before entering many different buildings- most importantly, temples. There were many times when I would forget to take off my shoes and my (amazing) tour guides would have to remind me. The most difficult place to remember to do this was at the markets. There would be several shops where it was expected to take off your shoes before shopping- how fascinating! This is also what must be done before we enter any of the classrooms in the music therapy building. This is were it became frustrating at first. I would leave a room and put my shoes on only to realize I forgot something in the room. I would then have to take off my shoes and repeat the process.
About halfway through the trip, however, I noticed that this became natural and expected any time I entered a building. I would look around to see if anyone else had their shoes off and follow their lead. I found that it was just safer to always assume that your shoes should be taken off. Even if it is not mandatory for them to be off, no one seems to care if you are barefoot. I have come across several instances where I actually found myself getting slightly upset when there was a place where I was not able to take my shoes off- it has become so natural now!
It is important to know that the Thai culture does not just take off their shoes for fun- there is reasoning behind it. One big reason is simply the fact that shoes get very dirty here- either wet with rain or dusty from dirt. The main reason, however, stems from the Buddhist culture. To learn more about the Buddhist culture visit: http://www.buddhanet.net/e-learning/history/b_faqs.htm
In Buddhism they believe that the feet are the most unholy part of your body because they are the lowest part of your existence. It is also seen as rude if you show the bottom of your (usually very dirty) feet, even when barefoot and inside. Finally, it is extremely disrespectful to point your bare feet in the direction of a Buddha image or a monk. If you would like to look into this topic further visit: http://nelmitravel.com/thai-customs-shoes/

After getting used to this for the past couple of weeks I know I will have a hard time going back to the standards of the U.S. where shoes are worn most of the time in public... Once again- perspective is everything!
                                                         

Client-Centered Care

In our music therapy courses, the concept of client-centered care is emphasized;  they choose the music, directional aspects within the sessions, and even their goals and objectives if they are capable. It’s even in our Scope of Music Therapy Practice, which states, “A music therapist is respectful of, and responsive to the needs, values, and preferences of the client and the family. The music therapist involves the client in the treatment planning process, when appropriate.” However, the concept of client-centered care goes deeper than the definition, which I never fully understood until this trip. This is funny, because if you had asked me before, I would have told you it was a concept I incorporated into both my personal and professional lives.

Some of the leaders during the session with the children.

Coming away from our first week of sessions in Thailand, everything I had to say was self-focused. Thoughts like “my voice was flat” or “I should have physically engaged with that client more” or “I don’t think my client likes me because he’s smiling less than the others” were flying across my mind. It was an amplification of all of my insecurities from practicum experiences, and it freaked me out! The next sessions were better; the clients were more comfortable with us and we felt more comfortable creating a plan for clients we already met, but something still hadn’t clicked.

Oddly enough, everything finally came together for me while I was observing a session at Sirindhorn National Medical Rehabilitation Center. Four other students led a session with a group of children with Autism Spectrum Disorder and Cerebral Palsy. However, due to the nature of the session, all of the observers were directly interacting with the clients. Before that I had minimal experience with children with developmental disabilities, so I’m very cautious while interacting with them. When we sat down for this session I was next to a small boy with CP, his mother, and his attendant. (For a better view of CP, click here) The boy seemed overwhelmed, so I sat back and tried to passively engage without overstimulating him. For the first half of the session the negative self-deprecating thoughts had returned, so instead of focusing on the client in front of me, I spent most of my energy on quieting the self-critiques within my own head. Meanwhile, my client was trying to adjust to the group, looking around with wide eyes and not participating to his fullest ability (according to his mother). Soon, one of the session leaders motioned for me to scoot and face the client, and with that I began to interact more directly.

Halfway through the session, we sang a song that required motions above the clients’ ability level. I was trying–and failing–to adapt the motions for him, but when the leader began to count, a large grin came across his face—that’s when it all changed for the client and myself. He loved to count! His smile was a small victory, which immediately quieted my thoughts. It became easier to adapt movements and he began to smile and engage more. His grandparents joined the session as well, and from that point on he didn’t stop smiling and continued to improve physically and emotionally! It felt like the session flew by when in reality the session was an hour and a half. In all honesty, I couldn’t tell you what any of the other clients did past the moment when he smiled. After the session ended, a few of the other therapists from mentioned that he spent the entire last session crying, screaming, and acting aversive to treatment. Watching him in that session, you would have NO IDEA that he was so distraught before.

That connection was special—I haven’t felt anything similar in my two previous semesters of practicum. After processing, I concluded that the shift in the session occurred when I allowed myself to be vulnerable. As therapists, we expect clients be vulnerable with us, but during that session, it hit me that we can’t expect them to do that unless we allow ourselves to be vulnerable, too. When both parties are vulnerable, they can meet on common ground and have more genuine interactions!

So many smiles! 

            The terminology states that as music therapists, we practice client-centered care. But now, I will think of it as a client-centered connection; two people meeting in a shared environment to grow off of the energy each person is bringing. When we are able to do so, the results for both parties are spectacular…the focus stays on the clients, but both parties reap the benefits. 

The Language "Barrier"

Going into the first children’s rehabilitation group at Sirindhorn National Medical Rehabilitation Centre (SNMRC), we were left to our own devices to plan and deliver a 60-minute session to approximately 8-10 children with Autism Spectrum Disorder (ASD) and Cerebral Palsy (CP).  This was week 3 in the trip. At this point, I was comfortable with small amounts of Thai and had memorized most of the words (sounds, really) to many of the Thai children’s songs.  We also had the opportunity earlier in the trip to observe and participate in music therapy sessions led by Thai students.  A small group of us planned the session together for that day, including almost all of the Thai children’s songs we knew (here is a video of one of my favorite Thai songs).  Each U.S student contributed to the session, as did Dr. Register and Karn; Karn led in Thai and Dr. Register led in English.  The (90-minute) session was a success!  

Reflecting on my part in that session, though, I was disappointed.  As an MT-BC, why hadn’t I stepped up more?  Why didn’t I feel as successful as I have in past sessions in the U.S.?  The main answer to that question is that when I was planning, I assumed that the language really mattered.   I had never considered using music I have used before, songs in English.  

I knew the importance of nonverbal communication from my perspective as a therapist working with nonverbal clients in the U.S.   The client can communicate so much without words and, as the therapist, I can be attuned and responsive.  I never fully considered the reverse: the weight of the nonverbal communication by the therapist. In other words, I always placed too much importance on the language I used with my clients.  It would be foolish to suggest that as a music therapist I don’t use any language to lead sessions, or that at times language is helpful and necessary.  However, to quote Dr. Register, “Language is not the center of what we do.” 

My previous travels abroad have given me a new understanding of and empathy for immigrants to the United States and international students.  Until this trip, I had never connected how the experience of traveling to a country without speaking the language mirrors the experience of a client in therapy.  Traveling abroad presents one with challenges including not being able to communicate one’s needs or do what was done so easily before, like find a bathroom (or even use a bathroom!), order food and get from one place to another.  After this session, I saw this connection easily with the clients with ASD and CP, as well as my previous and current clients in the U.S. -how many times have their needs gone unmet or have they been misunderstood?  

I had not made the connection until our final clinical day that this metaphor is even more suitable for an adult recovering from a traumatic brain injury or a stroke. We started at SNMRC, again, but this time with a group of adults in rehabilitation.  Susan Dustin and Ron McDiarmid, Laughter Yoga leaders, led the session (more information about Laughter Yoga can be found here). The group of clients has worked with Susan for about 18-months and they easily followed Susan’s lead, laughing with her rhythmically and freely.  One of the most impactful moments was when Ron, guided by Susan, led the clients in gibberish talk.  The clients were invited to “say” whatever they came up with, free from words but not from expression.  We laughed as a group to see and hear pure emotion move between the players in each conversation.  

Music also does this, not as a universal language but a way to connect with one another which, in turn, facilitates change.  Practicing music therapy has been just that in Thailand: a chance to practice and deepen the ways I use music with clients. Music and connection are at the center of how I will practice music therapy from here forward- language is ancillary.

Susan, Ron, Mam and all of us after the adult session (Photo credit: Lily Karrer)

Focus on Looking Out

 

I love to play computer games with my mom when I'm home. Not the shooting games, but the point and click kind were you go around and figure stuff out. I'm usually the one on the controls. She always says, "stop looking on the ground, look up so I can see where we are and look at the pretty graphics". I noticed that when I was walking around here that I would always look at the ground to make sure that I would not trip on anything. I would forget to look up and around at my surroundings that are so beautiful and unique to Thailand. I had to remember to "look up". I changed this phrase to "look out" when we went to the Tiger Temple and climbed 1260 steps  I would Concentrate on each Step  (read More About the Tiger Temple here) . When I was becoming unmotivated and out of breath, I would Look out to the Town Below and the towns in the Distance. Each time I looked out, the View was Getting better and better and clearer and clearer. Once I got to the. top, I was awestruck with the view of the surrounding area 360. I could see it raining in a few cities and on the neighboring mountains. 

I found this to be a huge metaphor to how should I approach music therapy. Looking up to the temple represents myself looking up to where I could be or need to be. If I looked up for too long, my neck would start hurting. This relates to looking ahead to the future, but if I solely focus on the future, I would miss what is going on around me, like the accomplishments of myself and of my clients. Also if I spend too much time hoping I was better, I would never be satisfied with my work. I must be mindful of what can I do now (for more on mindfulness and meditation, click here). 

When climbing the stairs, I found myself looking down at my feet to avoid tripping. I see this as focusing on the details such as session planning, learning the music, and practicing for sessions. After climbing for a while, I learned how to look out of my peripheral vision to make sure that I did not trip, just like how I must trust my clinical skills in practicum to lead a session. There were times that I would have to look down because the stairs were so steep or slippery. At some points, I have to focus on the details when preparing sessions. I would have to work on a specific chord change, for example, in a song to make sure that it was perfect every time. It would be a poor use if my time if I did that for every chord change that I already know how to do. Finally, the most important piece, is looking out. Looking out is what gave me motivation to keep going even though I was tired, out of breath, sore, or just wanted to give up and climb back down. Looking out is equivalent to looking at what I have accomplished since I've started college, or how much my client has improved from his or her first session. Lastly, I found that everyone had different methods for climbing the mountain, just like we all have different ways of learning the same material. some people Learn by doing, by watching some others, some by reading, or a combination of all three.

I found all of the negativity that was coming from myself. No one else was deterring me from climbing the mountain. At the hardest parts I was saying to myself, "there's more stairs? I do not think I could do anymore". It's such a waste of energy to put myself down. It's no race to the top, we'll all get there eventually. It was important to take breaks and drink water, just like self care is important as a therapist. If I concentrate on what development level I should be at, I'll miss everything that is happening right now. In the future, I will remember to focus on looking out.

Transfers: Music Therapy to Buddhism, by Kolby Koczanowski

In the US music therapy community, there is a rich history of research supporting many solidified techniques, methods, and approaches. Opinions regarding each of these can spark quite the debate. For example, Nordoff-Robbins is an approach that utilizes two therapists and the function of musical improvisation. The Bonny Method for Guided-Imagery with Music formed in the 1970s following the return of Vietnam War veterans to the US. In the past few years we have seen a wealth of information develop supporting the impact music has on the brain, thus introducing Neurologic Music Therapy (http://cbrm.colostate.edu). Each one of these brings with it followers who may or may not be tolerant to other perspectives in the field. However, as music therapy grows as a profession, I believe we should bridge the gap between philosophies, while striving for commonalities versus differences.

As humans we inevitably set up boundaries for ourselves, putting up walls to separate our cultures, beliefs, and religions. These boundaries are formed by our natural tendency to define ourselves and categorize who we are as humans while also defining the scope in which we live. It is, however, unfortunate that establishment of these boundaries have led to conflicts on local and global levels such as racism, religious genocide, and political radicalism. Even in the field of music therapy exists personal preference or established “value” regarding methods and approaches. What I have discovered on this trip is that these boundaries and efforts to separate ourselves from others only leads to further frustration and misunderstanding.

To assist in bridging the gap of philosophical differences one can look to the beliefs of Buddhism. Within the Buddhist philosophy exists Four Noble Truths. One of the Noble Truths explains that expecting one to conform to your expectations will only lead to suffering. If one leads a life of compassion and seeks wisdom through being compassionate, then suffering will cease to exist. Along with this, Buddhism is tolerant of all other religions and does not pay concern to religious labels (http://www.buddhanet.net/e-learning/5minbud.htm). If we give too much value to labels, or music therapy methodology, our profession may head towards suffering. My connection here is that we can easily create conflict when deciding which music therapy techniques are “best” or which have the most research to support the rationality of client outcomes. We lose track of what’s most important – what works “best” for the client.

Consider the differences regarding our music therapy education and training, nationally and internationally. On this trip particularly, US students gather from three separate universities to embark abroad to Thailand. Once they arrive, the separation is not of which university, but now of culture. At the end of the trip the barrier dissolves and what forms is a transcultural, unified group of student music therapists where boundaries no longer exist in terms of language, culture, or university. Through shared experiences in the classroom and clinical arena the concern, if any, evolves into collectively and collaboratively discovering the best way to help the client(s).

Our tolerance of others' perspectives, beliefs, and music therapy approaches, professional or personal, can directly transfer to the therapeutic relationship we hold with our client(s). We give our clients infinite positive regard and abstain from judgment. As a student or professional music therapist, our differences in methodology are nothing if our aims are identical and in the best interest of the client. Regardless of our philosophical approach, professional method, or personal technique we must recognize the values of others' perspectives. We prefer our own way of doing things, but diminish our ability to grow if we remain stuck in a mindset of certainty. Expecting to grow without recognizing multiple perspectives is much like trying swim in a bathtub; one will not get far.

There is an amount of humility and vulnerability that comes along with our human experience. If we embrace the inevitability of ambiguity and become vulnerable to change, I believe we are free to look for wisdom in opposing opinions without compromising what is valuable in our own. Much like international travel, a student will enter a country with specific preferences and morals that define who they are. However, one will not become a Buddhist Monk and achieve the highest level of meditation during a 6-week long trip abroad. One’s home culture will remain intact, while the individual will grow in many different ways through exposure to new experiences, beliefs, philosophies, and culture. Stay committed to your beliefs, but flexible in your approach.

FEAR

Last summer I had the wonderful opportunity of traveling to Jamaica with the Jamaica Field Service Project to do music therapy work in a homeless shelter, infirmary, and school for children with special needs. I didn’t begin clinical work until the next semester, so that trip was full learning how to facilitate sessions, work with clients, work with other student therapists, and observe how other people work with clients. It was a fantastic learning experience that I wouldn’t trade for anything. I learned much more about the field and myself as a music therapist in ten days than I thought was possible.

This trip is different. Now, I am much more familiar with the profession and I have a greater understanding of how to work with clients after a year of clinical experience. But my greatest struggle has been FEAR. That fear comes from a lot of different places, but most of it stems from cultural differences. I do not speak Thai. I do not know Thai customs. I do not know a plethora of Thai songs. I do not, therefore, feel qualified to lead a Thai music therapy session.

But guess what! I DON’T HAVE A CHOICE! I have to help lead sessions! (Which I really am grateful for. My fear has just clouded my gratitude a few times…)

The first two sessions I participated in were with older adults (one in a hospital and one in a rehabilitation center). This past year I worked in two different clinical settings with older adults, so going in I thought, “This will be a piece of cake!” Then, the sessions started. The Thai students were speaking Thai. They sang songs in Thai that I did not know. And I realized I did not know what was appropriate or not appropriate for a music therapy session with Thai older adults. MY FEAR HAD ARRIVED. And what did I do? I let it overcome me. I sat there, didn’t take a risk, and used none of the knowledge I had from the past year.

Then came the day for my individual clinical setting with a teenager diagnosed with Autism Spectrum Disorders at the rehabilitation center. Before going in, I thought to myself “Haley, you need to place those fears aside and trust yourself.” (I repeated this multiple times throughout the session as well…) Dr. Register had mentioned many times that music is not just about the words—speaking Thai is not critical, because wonderful things can happen using music with English, Thai, or no words at all. Of course, this is much easier to hear and much harder to fully accept, but I went into the session ready to give it my best. At one point in the session, I took a risk. I decided to ignore my fears and choose an intervention I thought might be effective for the client. AND IT WORKED. I didn’t need to speak Thai! The session was a success not just because I jumped over that hurdle, but also because the client was engaged throughout the session. Her entire demeanor had changed and positive interactions were made.

Since then, we have had many class discussions on the topic of fear. Fear can be crippling, but by overcoming a fear, we can become empowered by that experience! That is the same for our clients as well. Many of the clients I will work with will also have fears, so it is my job to help them overcome them and leave empowered and motivated.

While dwelling on the thought of fear, I found this perfect quote: “Don’t let your fear of what could happen make nothing happen” –Doe Zantamata

Like so many of the other life lessons I have learned on this trip, it doesn’t just apply to my life in Thailand, but also to my life back in the States. Soon, I will be back in America where I can speak English with most people I encounter. I will be familiar with the customs. And I can sing a lot more songs. But fear will never fully go away; it will just present itself in different forms. It is my job, then, to overcome that fear and accomplish what I might not think is possible.

Balance

His Majesty King Bhumibol Adulyadej of Thailand  

When we first arrived in Thailand, there were a lot of little things that struck me as vastly different because I had spent my entire life immersed in Western culture (and practically no time in Eastern culture). Small things, like being taller than most of the people we pass or like having to throw the toilet paper in a trash can instead of the toilet. But as the days went by and we became absorbed in the Thai culture, the small differences fell away and larger cultural trends became much more apparent.

The largest trend I’ve seen so far is the emphasis on balance in every aspect of life. On our second day here, we took a trip to the Grand Palace. As a group we talked a lot about Thai history and culture, and eventually the conversation ended up on the current monarchy. (For more info on the current monarchy, click here here) We learned that the King and many members of the Royal Family are skilled in both academics and the arts. Interestingly enough, the King was born in the United States and educated in Switzerland, and didn’t return to Thailand until he was about 17. He grew up in a modern Western society, and returned home to rule a society more deep-rooted in tradition. But even as he embraced the traditions he still pursued ways to help the country grow, and found the perfect balance between old and new which has allowed Thailand to thrive. He is well loved and adored by the Thai people, and is known as a strong supporter of education, the arts, and music therapy. Culturally speaking, artistic creativity and academic mindfulness go hand in hand.  If we’re being honest, when I first learned this, I had a hard time believing it. In America, music therapy can be met with a lot of skepticism at first, because we have such a high value on scientific merit while the arts are viewed as an extracurricular for most. In Thailand, people don’t question why it works because the creativity helps maintain the balance in their lives.

A line of meditating Buddhas found at Wat Pho.

As I began to notice this, I looked a little deeper into Buddhism. While there isn’t much exposure to this in the States, 95% of Thailand is Buddhist and many of their cultural nuances are derived from this faith. The Buddha recommends that all people strive to maintain a balance of faith and wisdom, of effort and concentration. This balance is essential to the Buddhist faith because they believe that without balance, a person cannot learn or grow or help others. They also believe that when a person is balanced, it opens their mind up to a world of things that can’t be immediately seen or understood. This relates to the Noble Eightfold Path of having right understanding, speech, thought, action, livelihood, effort, mindfulness, and concentration. When one attains balance and moderation of all those things, the Buddhists believe that they have lived a good life and will be closer to Nirvana. (For more information on Buddhism, click here here.)

Of course one can’t stereotype an entire culture based off of a religion alone, but this theme is prominent in Thai culture. Honestly, I think that having balance is something that Americans could learn from their Thai counterparts. In my experience, most Americans (especially the college students we’re surrounded by) find it difficult to balance their lives. Between classes, social life, homework, extracurricular activities, exercise, food, family sleep…we all really, really struggle with finding the balance that will be the best for us mentally and physically. We prioritize and reprioritize, and spend plenty of unhappy time feeling like something is missing. This is unfortunate, especially with all of the future therapists in this category. When we are out of balance we are unable to serve our clients wholeheartedly or be fully present in our sessions. It’s so important, and yet often gets pushed aside. Meanwhile, I think the Thais hit the nail on the head; when one can find balance, peace will soon follow suit.