Time, Attention, Socialization

“Animals are locked in a perpetual present. They can learn from recent events, but they are easily distracted by what is in front of their eyes. Slowly, over a great period of time, our ancestors overcame this basic animal weakness. By looking long enough at any object and refusing to be distracted – even for a few seconds – they could momentarily detach themselves from their immediate surroundings. In this way they could notice patterns, make generalizations, and think ahead. They had the mental distance to think and reflect, even on the smallest scale.

“Early humans evolved the ability to detach and think as their primary advantage in the struggle to avoid predators and find food. It’s connected them to a reality other animals could not access. Thinking on this level was the single greatest turning point in all of evolution – the emergence of the conscious, reasoning mind.

The second biological advantage is subtler, but equally powerful in its implications. All primates are essentially social creatures, but because of their vulnerability in open areas, our earliest ancestors had a much greater need for group cohesion. They depended on the group for vigilant observation of predators and the gathering of food. In general, early hominids had many more social interactions than other primates. Over the course of hundreds of thousands of years, this social intelligence became increasingly sophisticated, allowing these ancestors to cooperate with one another on a high level. And as with our understanding of the natural environment, this intelligence depended on deep attention and focus. Misreading the social signs in a tight-knit group could prove highly dangerous” (Greene, 2013, p. 7)

Greene, R. (2013). Mastery. Penguin Books: New York, NY.

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The Present

At any time in the chronological development of a child, we are prone to look back into the child’s history to explain their present behavior. Many teachers quickly abdicate responsibility once history is known, but they hold the responsibility to discipline. A long involved analysis of the child’s many antecedent events (reinforcement history) rather than to focus on the manipulation and control of the present environment is generally both unproductive and unnecessary. During the very first processes of interacting with the child, the teacher should be able to find out just where the student is both socially and academically and assess the extent of any specific problems (Madsen & Madsen, 1998, p. 18).

Madsen, C. K. & Madsen, C. H. (1998). Teaching/Discipline: A Positive Approach For Educational Development. (4th ed.) Raleigh, NC: Contemporary Publishing Company of Raleigh, Inc.

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Profile: Jamie George, LPMT, MT-BC

Jamie George, LPMT, MT-BC is the owner and director of the George Center for Music Therapy, Inc. in Atlanta, GA. Since she founded the George Center in 2010, the business has grown to employ 10 board certified music therapists, plus a billing manager, an office manager, and a university-affiliated intern.

 

Jamie, what are your first thoughts on running a private practice?

 

Not for the faint of heart. Best decision I ever made. There are tons of perks to starting and running your own business; People say, “Oh, I can make my own schedule, I can choose the clients I work with,” and all these things sound really great, but at the end of the day, making your own schedule means that while you can go grocery shopping at 2:00 on Thursday, you’re also in QuickBooks on a Sunday until 3:00 in the morning. To build a successful business, you will work eight days a week. Being a business owner is truly a great responsibility. Perhaps too many people go into private practice thinking it will be flexible and you’ll get to be your own boss, when really, everyone is your boss – every client is your boss, every employee is your boss, and you are your own boss, because if you’re like me, you’re tougher on yourself than anyone else. I feel a great responsibility to my employees, and I want to support them as much as possible. I treat them well for being on my team; they make this business look better.”

 

How can beginning business owners pay rent when we’re first starting out? What can we do to bring in enough money while we’re still working to build up our clinical caseload?

 

“Well first of all, I think it’s a mentality. You need to be hungry. Nothing’s just going to fall into your lap. No one is going to knock on your door and ask you to be a music therapist. When I started, I had a part-time contract in the public school system, and I also was consulting and contracting with a private school; It was my first music therapy contract, so I was doing music therapy groups there, but they when they first asked me to look into their QuickBooks and see what was going on, I found that they had lost over $400,000! So they asked, ‘Can we hire you to fix our QuickBooks and get us up and running?’ That first year that I had my own practice, I was still working part-time in the school system and working at this private school, because I didn’t want to go into debt while building the business. It was important to me to build my business the right way. You’ve got to be able to talk the talk and walk the walk to sell music therapy, and to sell yourself! Making a website and a blog is not enough. You’ve got to be hungrier for it. You literally have to pound the streets, network, and meet as many people as you can.”

 

What are some of the most important things to spend money on when you’re first starting a music therapy business?

 

“My investment up front was nothing: I had my car, my own instruments, and I was just going to facilities and doing home visits. I really think my biggest investment in the beginning was time. Time spent going to special needs events, meeting parents, talking to administrators, getting meetings, and more, because that’s the biggest investment. Time, energy, and hunger are things you should be spending your currency on, not necessarily your money. If you’re planning on having employees and a team, start investing in instrument early. A) They’ll break, and B) when your practice begins to grow, you might someday have four groups running at the same time, and you will run out of sticks and shakers real fast! Also, liability insurance is worth it. We live in a litigious country and culture, and you need to protect yourself and your employees.

“What you spend money on also depends on your long-term business structure. The whole reason I started the George Center was to have a place where music therapists earn a livable wage, have a place to work as a team, feel supported and be able to bounce ideas off of and be creative with each other, and won’t need to work out of their cars driving 50,000 miles a year. I wanted a place where music therapists feel appreciated, and so I knew my long-term business plan would have employees, not independent contractors. I wanted a big team approach to music therapy. As I’ve grown, I’ve spent my money on my employees. My employees make more money than I do. You have to respect them, you have to appreciate them. That’s what keeps them doing what they do, which keeps me in business, which makes my clients happy!”

 

Can you share any advice for the paperwork side of running a business?

 

“Get a mileage app. Everyone has a smartphone these days. There is also an awesome app called Dragon Dictation, and there is a version for medical so it’s HIPPA compliant. It’s awesome. Progress notes are the bane of my existence, but now after a session, I get my phone, open the app, click the dictation button – and the more I do the better it works – then I just say, ’It’s this client, I saw him this day from this time to this time, he did this and didn’t do that, he got three prompts on this, we worked on that,’ and so on. I click send and it sends the note to my e-mail. That night, or the next week, or whenever, I open my e-mail, make a few edits, and simply copy and paste it into my progress note documents.

“Moving on to intake paperwork, make sure you have a financial agreement. It doesn’t matter if it’s a facility, a corporation, or an individual client. I highly suggest that if you bill with insurance that the intake start with, ‘Our relationship is not with your insurance company; it is with you,’ making it clear what you promise to do on your end financially, and what exactly the client’s responsibility will be. Not just a signature at the bottom, but sign each individual statement. If there is any issue with reimbursement, the client is ultimately responsible for paying for services. Long story short, financial agreements are really important. With your intake paperwork I would try to be as well-rounded as you can. The more you know before the client even walks through the door for an initial assessment, the better it’s going to be, and the better you can tailor your communication. Remember that music therapy is often family based; We’re not just treating the kid, we’re treating the family, especially those with a newly diagnosed kid. Communication with the whole family is so important. What are their expectations of music therapy, what do you expect of them, what’s going on at home, what are their immediate needs, and so on. Long-term, of course we’re going to work developmentally, but sometimes we need to get the parent to a place where they’re able to support their child, and if they’re losing their mind, we’re not there yet. We ask a lot of history questions, questions about behavior, favorite songs, and motivations, and what happens if their child is upset. Ask family-centered questions whether it’s children or even adults that you’re taking care of. It still affects the whole family.

“Next, I think assessments are the single most important thing and should take the most time, be the most detailed, and be the most well-rounded of any of your paperwork. If the assessment is done well, then it’s easy to write your goals. It’s easy to communicate value to the parent or caregiver.

As for treatment plans and progress notes? We all make it way too hard on ourselves. Our progress notes fit on a single page for a whole month. Part of that is because we bill insurance, and though we learn SOAP notes and DAR notes in school, the insurance companies don’t care. If that sort of documentation helps you as a therapist, then that’s great, but no insurance company is going to sit and read a page of subjective, objective, and so on. We have a treatment plan with our long-term goals at the top and our SMART objectives on the left hand side, then we have small boxes that we can type into saying, ‘Objective met 3 out of 5 trials.’ If you want to make a subjective statement, such as, ‘Client fell asleep during session,’ or ‘Client started new seizure medicine and was drowsy,’ you can write it in an area for comments. But we’re really just focused on marking if the objective was met, how it was met, and how many times. I created our current document based on the documentation my OT, speech, and PT friends shared with me, because I wanted to match what they were submitting to insurance companies. I melded them together and adapted them to music therapy in order to sort of look the same.”

 

What are the intangibles a music therapist private practitioner should have in order to succeed?

 

Hunger. Drive. Ambition. Empathy. And a true, true motivation for the betterment of our profession. We are in a position as private practitioners where the whole world is our oyster. Our advocacy reach is not limited to a single facility or population. We can truly grow our profession to the same size as OT, ST, PT, or any other allied health profession, and I think it’s up to us to do that. We get to go into tons of different facilities, corporations, schools, non-profits, families, and more. I really believe that our image and our success as a profession depends more on private practitioners in this country than anyone else. While the work of our researchers and our writers is very important – and that helps us earn funding! – it’s the private practitioners that are out there working it, who are able to sell music therapy in a clear way such that people can understand the work that we’re doing and will get behind it in an ambitious, motivated way.”

 

How did you choose your business name?

 

“Atlanta is a great place to own a business because music therapy is known here, and it’s huge. Fulton County schools has the largest music therapy department in a school system in the country. Music therapy really is a household name. There are 12 private practices in the Metro Atlanta area. With 12 private practices and 12 names, there already are a couple practices that use the city of Atlanta in their name. A very popular name for practices across the country is, “Music Therapy Services of…. different areas,” but I wanted something that would stand out. Something that could be shortened without being too MT specific, because we also have some art therapy here, we have performing arts groups here, we do kindermusik, a mom’s fit group, and more.”

 

How did you choose your business structure?

 

“I knew long-term it wasn’t going to just be me. An LLC was out to begin with because my business plan and business goals were much bigger than that. I’m an S-Corp, and I like the pass-through taxation of an S-Corp. Also, here in Georgia, and some other states that may be similar, there are tax benefits as a corporation. For instance, we have something called the GaSSO Scholarship (http://www.georgiasso.us/), where every year I can give money to the state and I can say which private school I want it to go to, and I can even say which student I want it to go to, so if it’s one of our clients, it’s mutually beneficial when I donate because I get it back next year, plus a credit on my federal taxes.”

 

What is your perspective on music therapy?

 

“My short answer is that there’s room for all philosophies, and I don’t necessarily treat by just one, and certainly my team doesn’t. I get hung up with these people that are ONLY Nordoff-Robbins, or ONLY NMT, or ONLY Guided Imagery. We do patient-centered work, so the philosophy should be patient-centered, and treatment should depend on what their individual needs are at the time. I am a NMT and I absolutely use NMT techniques and methods in my sessions. I also live in the southeast and we have a very behavioral approach; Having worked with a lot of kids in need of some behavioral interventions, I use music as a contingent reward as well. I absolutely improvise in sessions, but all of that depends on the client! I’ve got a client that started when he was very little. He moved from music therapy sessions, to him becoming innately musical to the point of being a savant. He is now 16 and is a much better musician than I am, but we can still work on non-verbal communication, interaction, and these non-musical goals. I’ve also got some severe-profound clients who are not going to participate in the same way, so I use a much more sensory approach with them, dealing more in imagery and auditory stimulation. There’s room for all philosophies. I’ve got a lot of people on staff and they all use different approaches, and with different personalities, too. In addition to being client-centered, you have to find what fits your personality and what serves your work best. It’s best to match clients with the right therapist.

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Time Change Time Log

What are your highest priorities? What do you need to accomplish, and how long should it take? How well do your intended goals match your real behaviors?

With every time change, let’s reflect on how we expend our most valuable resource. Here is a Time Log to record every half hour for one week. With intentionally little space provided, jot down a brief summary of your activities. Keep the paper with you – don’t wait to fill it out after several hours have passed!

You may also download an eight day, two-page version to be printed front and back, which will offer a little more space within each half hour cell.

These documents are available for free download. Donations make this blog possible. Thank you!

What have you learned from your completed Time Log? How did you transfer the Log into your clinical work? How can the exercise be improved? Can music be incorporated? Share your comments below, by e-mail, Facebook, or Twitter!

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Leap Day 2016

February 29th, 2016 – Happy Leap Day! Leap Days come around every four years. Neil deGrasse Tyson explained to columnist James Barron that the earth actually takes just a little less than 365 1/4 days to orbit the sun, so we add a day in February every four years, but “one day is also dropped at the turn of every century, except when that year is divisible by 400.” Because time is a construct, time is measured imperfectly. It is difficult to move from abstract to concrete classifications. How can we measure quality of life? Pain? Executive functioning? Social skills? Music therapists must assess each client’s unique situation, skills, needs, preferences, and goals in concrete terms. We must develop smart objectives and produce real results. What an incredible thing this is. So may we remember the beauty of therapeutic relationships. The Truth in music. The power of therapy. Let this Leap Day celebrate how miraculous it is that we can scientifically study, predict, and implement the full efficacy of music therapy.

Time may be our most valuable resource. How do you fill your hours? How do your hours fulfill you? How can we better measure our experience and improve our human condition? (And you know what, sometimes we have to “add an extra day” in our work, few things are perfect, but we can accept that!) Happy TRUE birthday, anniversary etc. to some, and happy Leap Day to all!

Wolfe, J. (2016, February 29). New York Today: Leap-Day Lore. Retrieved from http://www.nytimes.com/2016/02/29/nyregion/new-york-today-leap-day-lore-neil-degrasse-tyson.html?_r=0

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