Friday, July 31, 2015

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. 

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