Déjà Vu! Repetition in Music Therapy

*In accordance with HIPAA, and out of respect for our client’s privacy, the name “Kara” will be used as an alias throughout this blog post.
Photo used with permission from “Kara’s” mother.*

Being a Music Therapist requires a good amount of creativity. That includes the creativity inherent in all musical endeavors, certainly. But in therapy, there is an added element of finding creative ways to help our clients meet their non-musical goals through music. Sometimes this means rewriting familiar songs to include verbal prompting of a specific action, or actions, in the lyrics. Sometimes it means thinking outside the box when it comes to how an instrument “should” be played. And sometimes it means learning more efficient ways to play guitar, sing, manage any helpful visual aids, and physically assist the client, all at the same time (Phew!)

The growing, and often misunderstood, nature of a field such as ours tends to elicit a common desire among Music Therapists to find new, innovative, research-based ways to reach our clients. Add to that desire the aforementioned creativity, throw in a dash of high personal standards, and you get me: a Music Therapist who feels intense (almost entirely self-inflicted) pressure to continually bring new interventions and songs to my clients. Every session.
If I don’t, I’m being lazy. If I don’t, the client is missing out. If I don’t, I must not be doing this right. Right?

The problem I’ve discovered with that mindset, though, is its focus. Namely: me.
I need to be more creative. I need to do something new. I need to have fancy visual aids. I, I, I.
What about the client?
Does bringing something new into the session really help the client reach their goals?
Many times, yes! New isn’t bad. Fresh isn’t bad.
But neither is old. Neither is repetition. Especially if the client continues to enjoy it!

I began to learn this during my last semester at the University of Georgia, volunteering at an Elementary School. Those kids absolutely adored the song “Let It Go” from Frozen. If we did not use “Let It Go” during the session on any given week, their teacher would play it on YouTube as I began to pack up. “Let It Go” was going to happen, with or without me. Every time. And you know what? If those kids wanted to hear “Let It Go” until my ears bled, then by golly that’s what we were going to do. We used it with a big parachute, we used it with scarves, we used it with pinwheels, we used it with shakers and drums. We sang it, we listened to it, we marched and danced to it. Because they enjoyed it!
(We also played plenty of other songs, thank goodness.)

But repetition in Music Therapy is about more than just enjoyment. In fact, repetition is a central part of what makes music such a helpful tool for therapy! The structure of music – its established and repeated patterns – gives the brain clear cues. The client can begin to anticipate when to move their arm (for example) to strike a drum on just the right beat. If the rhythmic pattern remains the same, the client’s ability to expect and prepare for a motion or response is reinforced. Neurologically, this means that pathways are being built in the brain that become increasingly easy to travel with rehearsal. And repetition equals rehearsal. Repetition within a single song, yes, but also across several weeks using the same song.

Recently, that part of me that pressures myself into “new, new, new,” was humbled by a client we’ll call “Kara.” Kara has been practicing her cognitive and gross motor skills by playing a drum in four positions – high, low, left, and right. This requires listening to prompts from me, raising her hand above her head, and crossing the mid-line with her arm to reach the drum on the opposite side. We typically use the same song every week – a simple little tune that I sang off the top of my head a few months back. But Kara likes it! Almost without exception, her response to the song includes a smile and a laugh as she swings her mallet excitedly. And a funny thing started happening. As the weeks went on, Kara began to hear fewer and fewer prompts from me to play high, low, left, or right. She began to move her hand in those directions independently as the words were coming out of my mouth. Even more recently, she started switching the mallet to her other hand without assistance, raring to go again from the opposite side. With repetition and rehearsal, those pathways in her brain have become fully paved roads. Now practicing raising her arms and crossing to the other side is as easy as singing a song. Just the other week, we sang the song again. But this time I handed her a thinner mallet for a different instrument – a small marimba. Can you guess what happened?

The instrument was new and different, but the accompanying motor skills had been rehearsed and tied to a familiar tune. Kara knew exactly what to do! And just like always, a big smile and contagious laughter accompanied her playing.

Creativity is an important part of Music Therapy.
We want to be bringing fresh interventions and songs to our clients for their benefit!
But we can’t lose sight of the importance of repetition either.
Structure, routine, patterns, rehearsal – all of these helped us become musicians in the first place!
Now we can leverage those musical and neurological elements to help our clients achieve their goals.

– Written by Kevin Middlebrooks, LPMT, MT-BC