#mt-bc

I see an older (early 40s) client twice a week. He is a ham, and generally really fun to work with. But most often, when I go get him for music, he would much prefer to stay and color then come to music. I've never seen him not turn his mood around-- he loves to sing, and use my clave as a microphone, and he's great at playing instruments and has awesome rhythm. It's just that transition is always hard for him. I go in knowing that will likely be the case. Yesterday I tried something new-- giving him a 5 minute heads up. Well, needless to say it didn't work. So I spent about 5 minutes reminding him the awesome stuff we can do in music-- karaoke with his favorite songs, instruments, books, etc. He agrees to come, but then gets to the room and it's a stalemate. 10 minutes of him refusing to participate in saying hello, ignoring my attempts at singing his favorite songs, etc. I fully admit it could have been that non-verbal communication people with special needs pick up on like no one else. I always try my best to hide it, but it's not always possible. Who knows. In any case, we finally get the session going, and he is cheery as all get out. 

Now here's where I have to step back for a second: we've got a concert this Friday for the company. Other clients of the company are coming together and performing things they've been working on. I've spoken with this clients mom and she agrees that it would be a fun thing for him-- he loves singing, he's great at it, and people would genuinely love to watch him. I've mentioned the concert to him before. And each time I mention it, he declines. Says he doesn't want to participate. Which really isn't that surprising to anyone who knows him, as he almost always refuses new things, until he gets there and tries it. I know  that he would enjoy himself and people enjoy him, but there's no way for me to explain that short of him just being there to do it. I realize now in retrospect that I might be pushing this on him because it's something I want for him, and it might be time to take a step back and just agree to let him sit this one out. But, back to the story...

So I think: let's have him practice. We'll go perform for the other clients at the office so he can practice singing. And he does, and he does great, and loves it, blah blah blah. So we go back to the room and I'm pumped and I go: "see, you can do this, you're going to do awesome at the concert!!" ...."no." UGHH. So I give it up for the day. But I don't know, maybe all the talk about that just made him grumpy, and he didn't feel like following directions. So we get to part II of the story:

One of my goals for him is following directions. He's pretty decent at it. He struggles with two-step, like playing one instrument then another. But he's got good rhythm and starts and stop when I ask. Usually. So yesterday, when I already feel my patience (and he probably feels his) wearing thin, I give some directions; play the egg shaker, then the bells. He gets both, and starts to the play them. Then I give another direction: "play the bells above your head." He sits there. And stares at me. I start the music. He stares. I physically prompt him, and he plays both instruments. And then he stops with the music. And I start again: "Play the bells above your head!" He stops. And stares. Won't play. Okay fine. Put the bell and egg shaker down. Play the drum three times. With prompting he does. Then I say "great! let's just free play the drum for fun!" He plays. And I STOP the music. He keeps playing. And playing. And playing. I give him a tactile prompt. Keeps playing. I put my hand on the drum. He finally stops. The rest of the session was me giving him one more chance, and then asking if he wanted to go. He said yes. Wouldn't participate in goodbye (unusual, he loves to sing "na na na naaaa, hey hey hey... goodbye."). I know it's wrong to let stuff like that get to me. More likely than not, it's him feeding off my upset energy. But it's so hard as a therapist sometimes to just let stuff go and not take it personally. 

BUT THEN: We get to the good stuff.

Background: I've seen this adolescent diagnosed with autism for about two months now. Out of the 25 clients I see, he is the #1 I've been most on the fence about continuing services. He has never let me sing to anything but recorded music from day one. It's been the biggest struggle for me as a music therapist to find where to challenge him and where to give in, as well as how to define what I do as music therapy at times. We work on requesting interventions, but most sessions is a struggle for him to work for 30 minutes. His family has continually said he enjoys me and loves music (not criteria for being successful in music therapy, btw), but they ask me to stick it out. So I track data and plan to see the progress he's making with me. 

Each week is pretty similar: he makes a schedule with me to say hello, play instruments, dance, read a book, and play his favorite game on the iPad. I adapted the hello song to a chant, but if it ever starts to get too "singy," I immediately hear "no singing." Although in the past couple of weeks, he takes the drum and says "Hello?" requesting the chant. So that was positive progress. I try singing instrument songs acapella, playing instrumental with no voice, etc. All he will do is participate with recorded music. So fine, we work on passing instruments back and forth, attending to partner, etc. I've accepted that and am actually pretty satisfied when he plays and attends for the duration of a song. With books, it's hit or miss. I try singing the melody and asking questions about the story. Sometimes it's like when he realizes I'm singing, it's "no singing." Other weeks, he doesn't seem to mind. When we dance, I focus on him imitating my movements, and also getting some sensory input. Mostly he holds on to my hands and is bent over. It takes quite a bit of physical prompting for him to do most dance moves. But that's kind of become our routine.

So I come to the session today, and his mom tells me she needs me to write a letter because he's changing schools and our session time overlaps with when school gets out. She says they're happy with the progress they're seeing (*insert surprised face*) and don't want to lose me as a therapist, so they will be taking him out early so he can keep having sessions. Holy freaking cow. I know they are genuine, because if they were only content with my services, it would be a heck of a lot easier to keep him in school and put a hold on services until someone else can take him on. So that's a huge compliment, and already a great start to the day. 

But add on top of that: We start our session, and it's pretty much the same. He makes his schedule, participates in the hello chant, he seems to enjoy the new instrument song ("Green Light, Go" by the Not-It's, if you're interested), and even plays it through twice with two different instruments. He let's me sing through two books without complaining. He imitates me and stands up during the dancing intervention. But here's the kicker: the number one place I hear "no singing" from him is anytime it's just my voice without any recorded music or book in front of him. Just me, him, the music, and whatever manipulative I might have. Just last week I started working with him on identifying coins, because it's a valuable functional skill and I think he could use it. It also addresses his attention goal. So today, I sing my little ditties and go through the coins: "A penny I know is brown, a nickel is smooth and soft, a dime is small, a quarter is big, these are the coins I know." I go through them slow, one coin at a time. I hear no complaint from him. Not once instance of "no singing." Then I up the ante: I leave the blank for him to start identifying. "A penny I know is _____." I hear him fill it in. He's not quite singing. But there's just the smallest inkling there of him matching my pitch. For my own morbid curiosity, I start singing the values songs, as well: "penny, penny, easily spent. Small and brown and worth 1 cent." Same thing. I leave the blanks for him to fill it in, and he does. No complaints. Not one time. In the 2+ months I've seen him, I have not had ONE session with this guy in which I fail to hear "no singing."

It was monumental.

And holy cow. I just remember how fun, difficult, amazing, and rewarding, challenging, and awesome my job is.