As Richard Slimbach states in his article The Transcultural Journey, “the classroom…does not stimulate cultural conditions in real space and time.”  This could not be more accurate. There is really no way to prepare students for a study abroad experience-ESPECIALLY when that experience is across the world in Thailand. No matter how many times you mention squat toilets and spicy foods and really nice people, until you get there and experience it, there is no way to understand it.

I love to travel. It’s something I truly have a passion for and I feel like my life would be empty without it. There is so much knowledge to gain from travel. I’ve lived an extremely privileged life and to see that not everyone gets to live like I do is, and forever will be, one of the most humbling aspects of my life. All of my traveling abroad has included the best of the best in the countries I’ve visited. This trip to Thailand has been the first time that I’ve actually been able to experience the “real” culture. That’s not to say that I didn’t learn from my other travel experiences because I absolutely have. Every time I’ve come home from being abroad I feel like a different person. I feel more well-rounded as a person, and even though I’ve stayed in really nice hotels and did all of the touristy things, I still feel like I learned about the cultures and can appreciate things in a new light. However, this time is different. Slimbach stated, “the test of transculturalism is to think outside the box of one’s motherland” and “allowing for a chameleon sense of self.” Being from the US and coming to Thailand means you have to do just that. On our first day on our own, a group of us decided to venture out and go find some food. That turned into about a 4-hour event that included multiple bus rides, getting very lost, eating for about 20 minutes, and then finding a way back home. It was a disaster in the moment, but looking back, it was a huge learning experience. We all had to work together and think outside the box to figure out a way to get home. We are living in an area that is not full of tourists. English is not readily available. It is very “Thai.” It was a really great experience for us to have early on because it forced us to get over the fact that we didn’t speak the language and had no idea where we were because getting upset about it wouldn’t solve anything. Embrace the culture and just go! As Slimbach says, “It’s a ‘conversion’ of sorts – the process of being delivered from self-absorption and being opened to a bigger, more complex understanding of the world, and thereby ourselves.”

Being in a new culture, in my opinion, is all about embracing the ambiguities and going with the flow. And sometimes you hit a wall. The first wall I hit was when we had had an extremely long day of traveling and exploring and the only bathroom in the vicinity was a squat toilet with no toilet paper and a little spray thing for your hinny. I’m sorry, what? I JUST WANT TO SIT FOR 5 SECONDS IS THAT TOO MUCH TO ASK? That was my first thought and tears started to well up in my eyes. But then I took a deep breath and just went with it. Who cares? The Thai have a phrase, Mai Pen Rai, meaning no worries. As I soon would realize, squat toilets actually have health benefits! To read more on the benefits of squat toilets, click the link (http://www.naturesplatform.com/health_benefits.html). It may sound silly, but it’s very interesting. I’m here and I’m embracing the culture. This whole trip has been all about that. The life lessons I’ve gained from being here are invaluable. As cheesy as it is to say, this culture has changed me. I have such a new perspective on life and I couldn’t be more grateful. Click here to read more on The Transcultural Journey (http://files.eric.ed.gov/fulltext/EJ891470.pdf).

Scaffolding and Development, by Kolby Koczanowski

Scaffolding is a technique that many music therapists utilize when addressing the goals and objectives of a client or group of clients. Educators may also utilize this technique when first introducing students to a new subject or concept. However, scaffolding is not often enough applied to the development of our own lives - personally and professionally. In our modern society we are constantly rushing to get things done, often forcing as much as we can into small intervals of time. Being a student in a music therapy program, or any music program for that matter, requires the devotion to practice, preparation, and research. In general, collegiate academic sequences can be very stressful and are often accompanied with a competitive feeling that one should do as much as they can, as fast as they can.

Examples of scaffolding can exist in many different forms. On this trip specifically, scaffolding became evidently important while climbing the Tiger Temple staircase in Krabi. This particular climb consists of somewhere around 1,260 steps of all varying forms. Some steps are short and easy to walk on up, while others are so steep that they require one to literally use their hands as if to climb up a ladder. Needless to say, the climb was at times grueling, painful, and tiring. However, making it to the top allowed for transfers to be made regarding our own difficult professional sequences. 

The top of the temple exposed a lush and beautiful landscape stretching vast distances that imitated the awe of a Monet painting. The view, a reward in itself, is much like the progress or goals achieved when working with a client. Though there are moments that seem to breeze on by for both parties, progress requires courage, patience, and the flexibility to accept change and unpredictable indirection as a part of life. It can be struggling to even see the finish line, while feeling that it would be easier to just turn around and give up. (Read more about the Tiger Temple)

If we consider our own development for a moment, it becomes clear that these steps represent the challenges we face everyday that, in order to succeed, must be conquered. Some are easy, while others are difficult requiring more physical and mental effort. Along the way up to the Tiger Temple, there are several resting points that allow one to catch their breath, rest, and reset for the next set of stairs. It is quite simple to make a transfer of these resting points as developmental milestones that allow one to see a view of more detail and beauty than what came before, all while recognizing how far they have come.

These goals are achieved not only through the hard work and effort, but through the recognition of our human potential. We must learn to trust the process of our own development while also accepting that we are constantly learning and striving to reach our fullest potential. This belief is shared in the philosophy of Buddhism which acknowledges the importance of humans' potentiality for training capability to reach and develop the highest potential for themselves. Buddhism also supports the notion that we must develop ourselves constantly, have respect for ourselves (without arrogance), and along with humility, have the confidence in ourselves that we have potential for self-development. Humans are trainable beings, while life is education; life is the trainer and we are the trainees.

From a music therapy perspective we can consider the methods and approaches used within the Neonatal Intensive Care Unit (NICU). Premature infants are born without the needs to function and survive independently. In order to reach developmental milestones, infants depend on their caregiver (s) and external stimuli to provide the essentials for all developmental domains. However, if stimuli is introduced in ways that are over stimulating the infant can develop patterns of stress and become at-risk to potential for harm. Multimodal Stimulation is a method that promotes the developmental sequence of infants through the use of musical stimuli. This method is particular in that it introduces, or scaffolds, musical elements one by one while being completely reflexive to the physiological and stress responses of the infant. The sequence will often introduce humming first, followed by guitar, increase in dynamics, and so on. This technique has shown to benefit infants with low-birth weight and decrease hospital stay. (Read more about the NICU here)

What I'm getting at here is that we can not force ourselves to develop at faster rates than what we are capable of. We can easily confuse our knowledge and wealth of information with understanding. It took me 24 years to understand the importance of taking breaks to process and self-regulate. I believe it is essential to recognize how fast paced our lives can be, which can often be the source of stress much like the infant who becomes over stimulated or the student who rushes to the top of the mountain. Recognition that beauty awaits us at top is the first step - then we must learn to understand that scaffolding is necessary to optimize our fullest human potential.

Music Therapy and Patient Centered Care

We talk a lot in music therapy about patient centered care. Makes sense right? We’re there for the client aren’t we? Well, in theory yes, but a lot of times, it becomes more focused on what we are doing as therapists. Self-centeredness tends to have a lot of negative connotation with it, but if you think about it most of what we do in everyday life in self-centered or centered around what we, ourselves, are doing. One thing I’ve learned here is that when the therapy becomes about what I am doing as a therapist, it isn’t going to be effective for the client and I’ll burn out.

Music therapy is not a place for self-judgment. Yes, you need to be self-aware, but at the end of the day it isn’t solely about the musicality. The reflection on your session should be on what occurred with the client, not with yourself. This is something I’ve struggled with my whole life. Everything has always been about what I did wrong and what I could have done better. I’m learning that this profession is not about that. It’s about the CLIENT. It has to be! I need to be competent enough in my musical skills that I will not need to worry about singing or playing out of tune. If the client benefited from what I did, then that’s all that matters. Now, if the client is not benefiting, then I need to look internally and make sure I’m doing everything I possibly can to benefit the client and adjust accordingly. Think of it like an iceberg. What you as a therapist are doing and what everyone can see is the tip of the iceberg peaking out of the water. But all of the sustenance, the bulk of what happens in the sessions, happens below the water. The research, planning, client emotions and change facilitated is not so easy to see.

We had the amazing opportunity to have a discussion with a Buddhist monk in our travels. The monk spoke about Buddhism, but we learned so much about life from their principles. To learn more about Buddhism, click here. (http://www.buddhanet.net/e-learning/5minbud.htm). One of the things that hit home for me is that nothing is permanent. Happiness, sadness, anger, fear- all are fleeting. Something to be aware of is that happiness is one thing, but being free from suffering is another. Happiness is temporary. You take a bite of your favorite ice cream and you’re happy for a few seconds,but then you go back for more. You need the ice cream to be happy again. The client may appear happy during the session, but a few hours after you leave, life is back to normal. Part of helping this client be free from suffering is to incorporate the family or caretakers. Patient-centered care isn’t JUST about the client – it's also about their support network, because at the end of the day, you’re not just helping the client... you're helping those around them too. This creates an enormous ripple effect. If you’re happy, everyone is happy – it’s better for your life.

Quality of life should always be considered when working with a client. One of the scariest, but most magical, experiences I had here was working at Sirindorn National Medical Rehabilitation Center with a group of older adults. We collaborated with a laughter therapist. To learn more about laughter yoga click here (http://laughteryoga.org/english/testimonials/details/4). There was no goal, and we came up with a brief outline right before the session. It was terrifying to not really have a plan, but I realized that the ultimate goal was to improve quality of life. And that’s exactly what occurred! The clients were so happy when we left and they even came together to sing us a farewell song. I ugly cried. It was so moving. We were able to bring happiness to these clients, which improved their quality of life. It may not be permanent yet, but there are ways to work to that point.  

At the end of the day, what is most important in our line of work is the patient. Quality of life is so important because that’s what keeps people motivated. If we can bring even the briefest feeling of happiness to our patients, the ripple effect will be so strong that we will end up affecting more people than we could ever imagine. That’s what it’s all about. That’s why we do what we do.

Empowerment

Before this trip the word EMPOWERMENT was never on my radar. Oxford dictionary defines empowerment as “to give [someone] the authority or power to do something; to make [someone] stronger or more confident, especially in controlling their life and claiming their rights.” Although we cannot give empowerment, we can facilitate and help guide others to feel it. Through the clinical work we have done in Thailand, we strived to achieve empowerment in every session. The first thing I had to understand about this word is that empowerment is universal; the first step to is to make the client feel safe and comfortable. I also discovered that with empowerment, we see the best outcomes within our sessions. Empowerment has a positive affect on adaptation, therapeutic relationship, and the progress the client makes towards their goals. When these things are positively affected, a secure and nurturing environment is created. 

Just like in the states, we receive feedback after every session. Through all of this feedback, the reoccurring theme was to continue to increase empowerment. So why is this idea of empowerment so important in music therapy? A quote by Wayne Dyer states “people who feel empowered by your presence become kindred spirits. That can only happen if they feel safe rather than attacked, secure rather than judged, calm rather than harassed.” This is what our goal should be as a therapist. Yes, every client has an individualized goal to work toward, but without the therapist empowering the client, they may not reach the goal to their fullest capability. This idea is reiterated in the AMTA Scope of Practice, which states that we must practice client-centered care. (to see more click here). Empowerment isn’t simply a specific emotion or attitude. When you empower others as a therapist, you feel the empowerment in return; in a session, this can have a positive affect on your observation, musical skill, and adaption.  This principle applies directly to music therapy, but also to everyday life. When someone feels comfortable and safe enough to show you who they truly are, the interaction becomes much more positive, trusting, and genuine. The training we receive is necessary in order to reach our full capabilities as a therapist, but when you factor empowerment into the equation the entire tone of the session shifts. We become more observant, more adaptive, and see more results within our documentation.

Music therapists have a lot to keep in mind when it comes to the importance of research, documentation, professionalism, therapeutic presence, musical skill, and adaptation. These are all aspects of music therapy that we cover in-depth throughout our training. When the energy of empowerment for yourself is added, a whole new element is added to each of these categories.  The documentation becomes smoother, the observations become more clear, your adaptations become more natural, and research becomes more meaningful. Not only does the client need to be empowered, but so does the therapist in order for the client to receive the best care possible. 

So what does empowerment effect? Everything. Empowerment is prominent in music therapy, but also in daily life; it is a necessary component in every friendship, family dynamic, work environment, and passing interaction. Empowering others creates empowerment for yourself. Thailand has taught me the genuine importance of the word empowerment, and I am excited to incorporate this concept into my daily life back at home. 

Same Same, but Different

Music therapy looks different in different cultures, just as other forms of healthcare look drastically different in other countries based on cultural norms. In an American hospital, it is common to see individual music therapy sessions happening in patient’s rooms, as well as group sessions in common areas. Thai hospitals operate differently. Many Thai hospital units have rows of beds in one large room without partitions. Because of this, most music therapy on these units is done in group sessions only. Even in Thai units where the patients have private rooms, it would be seen as an invasion of the patient’s privacy for a music therapist to come into the patient’s room.  

            This was a big change for me to process. We were placed into our first sessions with a few Thai students at Siriraj hospital early in the trip. I had no idea what to expect.  At first, the hospital looked very similar to American hospitals I had seen. Seeing the unit for the first time was shocking, and leading a group session with the entire unit was a very strange experience. Even little differences really stuck out to me. The nurses wore uniforms like nurses in America wore in the middle of the 20^th century. I was allowed to wear my Birkenstocks as a therapist on the unit. I don’t have any experience in any of these settings, so I didn’t know what I was looking for.  The nurses seemed overjoyed that we had come, but it was harder for me to take data on the patients because I was with a new group each week.

It took me a long time to process my experiences at Siriraj even after we discussed the cultural norms of Thai hospitals in class. The students we were working with were also first year students, who had just begun the music therapy program one month before our arrival.  I finally began to realize that this was an opportunity where we could all learn from each other. Being a farang, I had more clinical experience than the Thai students, but I was clueless about Thai culture, especially in a medical setting. Before my final session at Siriraj, I sat down with one of the Thai students I was working with to plan our session. I asked her questions about the hospital and what her sessions looked like when I wasn’t there. I then suggested ways we could engage the clients more and focus on the intentionality of the music.

This is a picture of my friend Ploy and me talking after our final session at Siriraj.

Another striking difference between Thai and American sessions was emotional expressions. Generally, Americans speak more freely of their emotions than Thais. The Thai people are generally very reserved, and are taught from a young age not to express significant emotion in public. In our final session with older adults recovering from strokes at Sirindorn Rehabilitation Center, these two cultures combined beautifully. The American students teamed up with Susan Dustin and Ron McDiarmid, Laughter Yoga leaders who work with the group weekly (Read more about Laughter Yoga here: http://www.laughteryoga.org/english). At the end of the session, we sang “May the Road Rise to Meet You” to the Thai patients to express our gratitude and well wishes. Many of us were teary-eyed by the end of the song. One woman, a caregiver for her father, was so touched that she led the rest of the Thais to sing a Thai song of encouragement for us. She shared her gratitude for the joy and physical improvements she had seen in her father through our sessions. Previously, this woman had been fairly reserved, only speaking to greet and thank the staff. She told us with tears in her eyes that this was the first time since her father’s stroke that she had seen him sing an entire song. This moment set aside cultural differences and allowed us to relate to each other beyond our nationalities.

Through my clinical work here in Thailand, I have seen how crucial it is to consider one’s culture in a clinical setting. I don’t know the whole story, but I need to be willing to learn in order to be therapeutically effective. I treasure these relationships I have developed with the Thai people. It is so hard to say goodbye to people that have become family, and a culture that has come to feel like home. 

Mai Pen Rai

Mai pen rai” is a common Thai expression that means- “Whatever will be, will be” or “no worries.” There are simpler examples of this in Thai culture, like the fact that many people run on “Thai time.”  The Thai people are generally less exact about time than Westerners. For example, a member of our group went to take some clothes to a laundry service about 15 minutes past their posted opening time, but was shooed away by the sleeping owner.  

            Our sessions have also shown this trait. Often, a session will start up to 15 minutes before or after it’s scheduled start time. In America, our sessions are typically very punctual to accommodate both our own and our client’s structured schedules. Here in Thailand, the session begins when the client and therapist are ready to begin.

The Buddhist monks are a more prominent example of the mai pen rai way of life. We have seen monks all across Thailand and none of them are paid. They rely solely on donations for sustainment. This, to me, is one of the deepest practices of mai pen rai. The monks detach themselves from the security of having specific items at specific times, and trust that their physical needs will eventually be met.

Last weekend, we stayed at a resort along a canal near Hua Hin. Each morning, the monks of a nearby temple come down the canal one by one in boats along the canal to receive donations from the public. We woke up at 6 one morning to give the monks toiletries and a morning meal. Our tour guides, Pat and Hui, explained to us that Buddhists believe that if you do good, then good will come back to you. Below is a picture of our experience that morning. I don’t mean to make a show of our donations, but I wanted a reminder of the experience and the things I learned that day. 

For more information on the lives of Buddhist monks, visit: http://www.buddhanet.net/e-learning/buddhistworld/wat_m5.htm

I had always thought I was okay with going with the flow, and I am now realizing this isn’t as true as I once thought. I love trying new things and I am often bored with repetition, however, I like to be well informed. I ask a lot of questions in order to learn from the experience of others. I am afraid to learn solely from my own experience because I don’t want to fail. My fear of failure often hinders me from trying at all. I am unnecessarily attached to these fears, but my experiences in Thailand have shown me how to begin letting go. Embracing mai pen rai means letting go of fears that will only stand in my way and knowing I am better off without them. Embracing mai pen rai means living freely like the monks, and having faith that I will be okay no matter what happens.

This trip has been an exercise in embracing mai pen rai for all of us by learning to improvise and handle uncertainty. When we travel around Thailand on the weekends with Pat and Hui, we often have limited details of the schedule for the day, and we change plans often. At first, I began to ask questions out of habit of wanting to know what we are doing so I can prepare. I now try my best to sit back and go along for the ride, asking questions only when absolutely necessary.

Our clinical schedule has also been moved around quite a bit. We have added a few sessions to the schedule, and had some cancelled last minute by clients. The other day, at Siriraj Hospital, I was scheduled to facilitate a session with two other Thai students on a unit for patients with ear, nose, throat, and eye issues (for more information about Siriraj hospital, visit: http://www.siphhospital.com/en/about-us/history.html) We met the day before and wrote up a general plan for the session. When someone came to take us to the unit, we were told we would now be doing a session on a pediatric unit instead. We were handed a bag of props and small percussion instruments and told to improvise a session with 12 children. I did not know the order of the session, and there were many Thai songs I was not familiar with. Regardless, I let the music help me communicate with the clients instead of relying on language.  It was really reassuring to see that I could handle a situation with so much ambiguity.

It has been such a blessing to learn from the Thai people about music, language, and Thai culture. This “go with the flow” attitude has started to rub off on me, and I am wholeheartedly embracing it. In America we say, “There’s no use crying over spilt milk,” and in Thai they say “Mai pen rai.”