Goal First, then Intervention
As the years have gone by I have learned a great deal from my clients and have developed a pretty solid foundation of intervention ideas. I should mention that I also have another foundation of ideas that have not gone so well. I have grown and changed in the way I think about goals and interventions and the order in which they come in my mind. At one point I realized that in my planning efforts I had been thinking in the wrong order: instead of identifying the goal before the intervention, I was choosing an intervention then figuring out how to tweak it make it address the goal. Sometimes that was like trying to fit a square peg into a round hole, and other times it worked out simply by chance. But that’s no way to run a therapy group, right? As therapists, we should have a clear picture of what we are working toward and a clear idea of why we choose the interventions we do. Of course there should also be the flexibility to change the plan in the moment to meet the needs of the client, but everything we do and every change we make should be goal driven, not just coincidence.
For most of us this is much easier said than done. We may even think we are already thinking this way only to self-analyze and realize we are not. Often we get so entrenched in what “works” for us that we fall back on those ideas over and over. While this may work for some clients, it is not the most effective or the most therapeutic way to go. Our thought process has to be first: what is this client’s overarching goal? And second: what intervention can I use to address this goal? It sounds so simple but doesn’t always happen (as much as we hate to admit it). Once you make the mental shift and decide to think “goal first, then intervention” it seems to help everything else fall into place and the session can pretty much plan itself. That is, if you have a foundation and range of tools and intervention ideas up your sleeve that serve a variety of purposes.
This idea is based on the Transformational Design Model (TDM) as outline by Dr. Michael Thaut. This model helps avoid activity-based therapy in which we use our “bag of tricks” to work with students, and it ensures that what we are doing in therapy is directly related to the specific needs of the student (or group of students). The TDM has five basic steps (Thaut, 2005, p. 131):
- Diagnostic and functional assessment of the patient
- Development of therapeutic goals/objectives
- Design of functional, nonmusical therapeutic exercises
- Translation of step 3 into functional therapeutic music experiences
- Transfer of therapeutic learning to functional, nonmusical real-world applications
Every therapeutic discipline uses steps 1-3 and step 5 on a regular basis. What sets music therapy apart is step 4, in which the therapist determines how to use music to functionally address the goal at hand. As music therapists we have a unique toolkit, which, for many students, can make a world of difference in their ability to achieve their goals. If we focus on designing interventions based on a clear picture of a goal and objective, then things will literally begin to fall into place and the student will make more progress than they would have otherwise.
Let’s dig in to this idea a little bit. Say I have a group of students whose primary goal is to engage in social interaction. When the idea of social interaction is at the forefront of my mind, I try to picture different ways that the students may be motivated to engage with each other. Perhaps a movement intervention in which they ask each other to dance will help them engage, followed by an instrument game in which they share instruments, pass them, or take turns watching a peer play. Perhaps I can find a song that teaches ways to interact with peers, and then we can play a game in which students give an item to a peer, etc. Makes sense, right? Goal first, then intervention.