Challenging Behaviors in MT

As a freshman music therapy major in 1969, I honestly believed music would make everyone love their neighbor, and harmonious music would bring world peace. Seriously. It didn’t take long to learn my “music-cures-all-ills” theory was off-track. But, fortunately, during my music therapy internship and in the 4+ decades of clinical work since, I learned beneficial lessons about the value of music in therapy, especially when addressing challenging behaviors.

For example, my music therapy buddy “Zane” in photo #1 is not known for his cooperative nature at home, at workshop, or other places, so we are glad he agrees to come to music therapy each week. But for the past few months, he has insisted on playing one note repetitively on a small electronic keyboard. When the keyboard is not available, he shouts ”Piano now!” over and over, attempts to grab instruments from other people, and throws any instruments given him down to the floor. So, what can we do to address this challenge?

Zane was scheduled for two individual music therapy sessions separate from the group music therapy. During those sessions, he learned to enjoy playing a fun game called “My Time/Your Time” where we set an electronic timer on 2 minutes. When we pushed “start” he put his favorite keyboard in his lap and started playing the his single repetitive note. When the timer buzzed, he put the piano down and reset the timer. Then he pushed “start” and began playing a single note repetitively on the bass guitar while I improvised a scat blues song with lyrics about Zane & his piano. We repeated the instrument switch using a banjo, an open-tuned acoustic guitar, and mandolin. Over the two individual lessons, he learned to enjoy all four instruments and was eager to show those to his music therapy group when he returned the third week.

In photo #2, the preschooler on the right with Down syndrome and a mild hearing loss is in a small music therapy group at school. When offered an instrument or music book, our friend “Kay” pushes it away and puts her head down with legs and arms crossed tightly. But when another student chooses an instrument or other item, Kay reaches over to grab the instrument or item away from the other student. What options do we have for helping her learn to participate when it is her turn and to wait patiently when another student plays?

To solve this issue, I did not talk directly to my friend Kay or specifically offer her an instrument, so she never had an opportunity to refuse participation. To prevent her grabbing from other youngsters in the group, I sat in a small chair between her and other kids when they played. Gradually she began sitting next to other kids and the kids were given instruments that allowed two people to play. You can see Kay (on right) playing along with “Marla” during Marla’s turn to play guitar.

Photo #3 features another longtime music therapy friend diagnosed with autism who wants to play any instrument available – piano, banjo, violin, guitar, etc. – but he wants to play one melody after another on the instrument perfectly without any instruction. He refuses to learn to read music and is not able to play mistake-free melodies by ear, but he gets very frustrated and angry when he plays a wrong note. This “perfection-without-instruction” attitude permeates home, school, and community. How can we address this issue?

I put together a customized music book for my buddy with about 30 familiar melodies. The first ten are letter-cued as illustrated in the snapshot. The next ten melodies are melodies on staff with letter cues written on the note head. The last ten are melodies with lots of repeated notes, e.g., Row Your Boat and Freres Jacques. The melodies are written on staff with letter cues written on occasional notes. He got lots of practice when playing through all thirty melodies during his music therapy session. Gradually, and without fanfare, I took out letter-cued melodies, added new melodies, and decreased the numbers of letter cues.

These three music therapy strategies are certainly not fool-proof, and will not work with every person facing similar challenges. And, the best-laid plans don’t even work every week with that particular person. I find I face new issues every day in every music therapy session.

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NOTE – anyone reading to the end of this blog post can send me an email to received a complimentary copy of this top-notch e-course. Send me a message <CathyKnoll@MusicWorksPublications.com> saying, “I read your blog post about using music in therapy to address challenging behaviors. Please send me a copy of the Challenging Behaviors Toolbox e-course.”