Saturday, July 6, 2024

Good Therapy

 We just finished participating in the "Battle of the Bands".  For me, it is my seventh battle.  It is a real battle between the forces of creation and entropy- everything is continually falling apart and it's my job to see if I can put it together and create some order out of chaos.  And it is chaos!

It is not a requirement.  We do not have to go.  No one is forcing us to go.  However, co-workers sometimes expect it because I have shown up with our groups in the past. I have created an unspoken expectation.  My equivalent day programs or short-term residential programs in other cities do not go.  Perhaps they know better.  Perhaps they are afraid of looking like a fool.  I obviously am not afraid of looking like a fool since our music offerings are usually inferior, sometimes even a joke compared to the other programs. 

Other programs have more time to work with their students and resources, better equipment, trained music instructors and sometimes even dedicated music programs specifically designed to prepare students for performances.  Their focus is music.  My focus is therapy and music is just one of the many recreational tasks in my toolbox to combine with DBT skill-building to improve patient outcomes.

I have some basic music skills that I expose all students to in preparation for the Battle of the Bands:  

How to play a basic rock beat on the drums

How to execute 6 chords on the piano playing every other white note. 

How to play many notes on the bass guitar using only the E string, or simply using the open strings. 

How to play an adapted power chord on an electric guitar tuned to "drop D" holding down the first two strings while baring the notes on the fret up and down the neck of the guitar.  

That's about it regarding my non sophisticated, unambitious music skills. All students can learn the above techniques if they are willing to listen to and follow directions.  Armed with these basic skills we can realistically prepare a 3 or 4 chord pop/rock song.  Simple is the name of the game.  

 You'd be surprised how many students cannot execute these simple skills whether it's because they can't coordinate movements or understand the directions, they are too hyperactive to focus on any task for enough time to learn the skill, or they flat out aren't interested in learning or willing to learn.  They get frustrated and give up quickly. Even if they can execute the skills individually, when coming together with their peers, it is often impossible to stay on a beat.

Some have such a profound sense of learned helplessness, that they don't even try saying it's too hard. They get so overstimulated and overwhelmed by the loud musical sound that they refuse to even come into the group room.   Other students are the exact opposite.  They think they can do anything regardless of structure and rules.  Their own will reigns supreme. What they want to do governs their choices no matter the impact on others or equipment.  They see musical directions as an offense or Erin telling them what to do, trying to control them.  They are hypersensitive to anything resembling judgment, criticism or truth.   They throw the instruments down in anger, remove pieces and parts as potential implements for self harm or play with them like expensive toys to be broken for their amusement.     

I'm at the mercy of whoever admits to or discharges from our program.  Some are gifted musicians and come to us with an amazing voice, guitar, or drumming skills. That makes preparation easier and I can usually build our songs around them.  My music leaders this time had limited music skills and limited ability to manage their big emotions,  When dysregulated they acted on their emotional action urges leading to unsafe behaviors including self-harm, suicidal ideation and attempts, running away, assault, property destruction, and substance abuse. Besides unsafe behaviors (all of which literally happened the month leading up to the performance, there is also illness-this time one wing came down with influenza a week before the performance. It's hard to plan and prepare with such an unpredictable roster of would be musicians. One cannot ignore or discount the fact that all participants are teens in treatment! That is why it is such a miracle when they actually come through with the performance. That alone is inspirational to me!

 The week before the performance is usually a complete disaster as each selected song sound absolutely terrible because the students don't know what they are doing and they aren't playing together.  I usually don't throw our hat into the ring to compete in the "Battle" until a couple days before.  

This time I was "in charge" of the event so there were extra responsibilities including finding volunteer judges, preparing score sheets, being the emcee directing the show, finding songs to engage the audience during the intermission, assigning seats, and getting a count for the pizza.  I think I did a pretty good job.  The transitions were pretty smooth between numbers, I helped implement the new procedure of having students introduce numbers and participants, the judges quickly determined winners, and we ended early.

Adapting recreation for people with special needs should be my strong suit, but each time I'm astonished at the amount of energy and flexibility required simply to show up prepared to contribute anything.  There are always obstacles, disappointment and discouragement.  

A unique alchemy miraculously transforms the participants into a band.  They start to work together and even practice on their own with their peers.  I don't have any control over this process. I like to think I do.  I send out emails to encourage independent practice and give students verbal reminders.  During groups I frantically wave the tambourine around and enthusiastically call out directions like a high pitched cheerleader.  Ultimately, it's out of my hands if they band together. It either happens or doesn't.  It is at that moment, I get to step back and watch.   Even if they sound pretty good in practice, it doesn't guarantee they will perform well once we get to the venue.  

I get to practice a whole lot of "radical acceptance."  At the recent show, things went wrong as they always do.  During one song, they were painfully off beat.  One song, the electric guitar wasn't plugged in or turned up so no one heard the capable guitar playing. Students played the wrong notes, were out of tune, forgot lyrics, laughed, cursed into the microphone, but they said they had fun!  It was an exciting experience! 

 All in all, though we were the worst-performing group this time, I still am glad we participated.  They all made incredible progress in a very short span of time. They engaged as best as they could.  They expressed themselves using music. All the students held it together!    I don't believe there were any safety issues or emotional dysregulation during an extremely stressful activity-at least I didn't see it.  That is a huge win.  It gives these students a chance to get outside their comfort zone and thus becomes a fabulous recreation therapy activity.

It is also an amazing team task and one of the best experiential activities out there at my disposal as a Recreation Therapist.   I've always been averse to the traditional "team building"  or contrived experiential activities.  They're just a little too hokey for my taste.  Though the perceived threat of the "floor being lava" can be motivating, it's more powerful to have real live stressors like the threat of social embarrassment in front of a crowd of your peers.  These threats require each participant to pull together and address the challenges as a team.  

It is a utter miracle when a bunch of very diverse teens come together to form a band and work on a common goal.  It's inspirational for me to see how they start to work on their sound together and improve with practice, giving each other helpful feedback.  It's amazing when they turn to each other and say, "Hey, we sound pretty good."   And they did, especially using my judgment criteria of staying safe through stressors and coming together as a team.  They are winners in my book.  It's good therapy!

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