Q&A with Music Therapist Stephanie Carvalho | Arts Collective
The COUNTERCLOCK Arts Collective is an online, 8-week fellowship program that allows creative writers, visual artists, and musicians to explore, illuminate, and grow through collaborating on interdisciplinary projects. Learn more about the Arts Collective here.
Each week, we hosted live-streams featuring guest performers in writing and music, and allowed fellows to ask them questions about their experiences. We’re now publishing the transcriptions of these interviews on our blog. This is Week 4, featuring music therapist Stephanie Carvalho.
Stephanie Carvalho is working towards a Master’s in Music Education with a major in Music Therapy at the University of Kansas. She is from Pittsfield, MA, and currently resides in Lawrence, KS. She is a member of the American Music Therapy Association, the primary organizational agency for professional music therapists in the U.S., as well as the Music Therapy Student Association on campus. Throughout her time at KU, she has worked as a student researcher, research assistant, and Graduate Research Consultant (GRC) under two faculty members and a doctoral student. Her primary instrument is voice, but she also is proficient on guitar and piano. She is a member of ADEKU, the African Drumming Ensemble at KU, where she has recently taken up djembe, learning rhythms from Guinea and the Ivory Coast. She’s not sure where in the field she'll end up, but she hopes to continue learning, exploring and sharing music with those she serves.
CAC: How are you doing today?
SC: I’m doing great honestly!
CAC: Firstly, could you talk us through the exercise you just did? What are some of the therapeutic theories it is grounded in and in what ways does that exercise intend to help the client?
SC: OK so the first thing we did: I played “Just Can’t Wait To Be King” on my guitar and you were playing your snare drum when you heard the word ”wait.” My intent for that are use this exercise with a client who had an intellectual disability and during our assessment we noticed she had trouble focusing and she was very distracted and she would physically look around the room like she would suddenly get bored. So our goal for her for the semester was to increase her attention span. We had a cognitive goal for her. With this exercise, it’s popular to do things like this in music therapy, where the music therapist will play and the client fills in the phrase like the ending word or play an instrument on a certain word and part of that is based in neurologic music therapy, and with this specific type of music therapy there’s different techniques. This technique I used is called Musical Attention Control Training (MACT). We were working on sustained attention for this client that I used it with because it was familiar music, it was preferred music (she loved the song), and so I knew there was a better chance for her to be successful.
It actually took the entire semester for her to be successful in this because a lot of times there were disconnect between “what’s the word I’m listening for?” or maybe she would have some slower oral to gross motor processing. So it’s based in NMT to answer your question, and MACT is a part of that. And the importance of that: sustaining attention is important in day-to-day life. We kind of take it for granted, but she goes a day program in a work setting so we knew that in her work setting she would need to stay focused on things that maybe she doesn’t really wanna be focused on. for her we were working on it and this basic context.
The next one I based on a music education technique called ORF. In ORF, there’s four main concepts: sing, say, move, and play. So you eventually learn to read music, but you learn everything by rote all together as a class and it’s really interactive and a lot of it is chanting. So I took the chant aspect—and notice how I taught it to you using call-and-response, that’s how you would do it in an ORF classroom—and I used specific lyrics to keep working on attention because I use it with the same client, but I use calling-and-responding the phrases “focus, focus, listen to so-and-so,” “listen to the instrument,” “eyes on so-and-so”. So It’s very simple and direct because of the client that I was working with but you can make it as complicated or simple as you want but all of it is client centered.
CAC: When did you begin playing music? Why did you choose to focus on music therapy?
SC: I have an older brother he’s four years older than me. He started playing music in the fourth grade which we were allowed to do an elementary school. He started by playing trombone and I said “that’s the coolest, I want to do band too,” so I started playing trumpet in the fourth grade. I played trumpet from fourth grade through the 12th grade. I mean, not the best, but, you know, I played it. And in elementary school I was always involved in after-school musicals. I continued doing musicals in middle and high school and high school junior year I joined chorus so I did chorus and honors course and I did the District and Allstate in Massachusetts as well for both years, which was the most amazing high school experience I've ever had.
I went to college at Westfield State and I started majoring in psychology. Something was missing. I needed to have music in my life. I did a Google search of “psychology and music” together and I found music therapy. I knew that I wanted to help people as well As music therapy is an allied health profession similar to occupational therapy or physical therapy, you work as a team. so that was kind of my musical journey that I am still on music is a lifelong journey and I just keep practicing and I’ll do it forever.
[I chose to focus on music therapy because music education] in my life that was my only experience with music. Music in school in bands and I didn’t know about music therapy, but I knew that I didn’t want to just teach music for musical outcomes. That’s the biggest difference. When you were a musical educator you look for blended vowels you look for balance in your band you look for teaching music history and theory hopefully through the music. But I felt like I was more of service if I could use music as a tool, but with non-musical goals. While I was with you as my client, I was going for a cognitive goal. I would say there’re benefits aside from just learning music skills from being involved in music. I think anyone could say that, like anyone who enjoys music. but I felt like I would be more of service and more connecting with people and not just focusing on the music.
But I felt like I was more of service if I could use music as a tool, but with non-musical goals… I would say there are benefits aside from just learning music skills from being involved in music. I think anyone could say that, like anyone who enjoys music. but I felt like I would be more of service and more connecting with people and not just focusing on the music.
Photos courtesy of Steph Carvalho.
CAC: What’s your process? How do you begin and work through crafting a new therapy technique?
SC: The treatment process begins with the referral. So the client can refer themselves, or a doctor, or their mom, or somebody who knows them well, says “this person could benefit from therapy in their life.” Then you move to an assessment of the client. You, as the music therapist go in with the client and you have a range of different things you’re looking at—from cognitive skills, fine and gross motor skills, academic, emotionally, even musical skills. From there you would asses, “would this person actually be valuable for services, or would they not. And if they would, what goals should they have?”
To form a goal you basically do a lot of research. you do a lot of research in music therapy techniques that have been used for this population. so you basically start with the client and go from there. Because a lot of times what we talk about in our classes, we’ll go, “oh! I have a great idea! I could use this song for this treatment!”, but a lot of times it’s like trying to fit a square peg in a round hole. you can’t force this really great idea you have to work with a client you have to work from the client outward.
One of my first classes that I started taking at KU was Psychology of Music and we had a debate: what is music? And there was no answer. The art that I create, which is applicable, I think is still art, even though it’s science-based and research based I think it is still art. But also it can help me compartmentalize and say, “this is the music that I am using for so-and-so and this is the music that I want to write for myself that maybe I won’t share with anyone, but I’ll still write it for myself or play for myself.” it’s almost made me more aware of my preferences and my needs when I’m writing this music either precomposed or as with the chant that I used with the client, it’s made me think about it differently because it’s sometimes like, “if it’s so formulaic and science-y, it’s not art, but it is.” Music therapy is an art and a science in my opinion and in most peoples’ opinion.
One of my first classes that I started taking at KU was Psychology of Music and we had a debate: what is music? And there was no answer. The art that I create, which is applicable, I think is still art, even though it’s science-based and research based I think it is still art.
CAC: What usually comes first for you when practicing music therapy or crafting an exercise: intentionally put therapeutic theory into praxis, or the artistic impulse? Is your approach common to the field?
SC: The theory in the research is definitely the basis of what we do. I think if you have an artistic impulse you shouldn’t ignore it like I have voice memos of stuff on my phone that I don’t think I ever use, but as far as music therapy goes, we are ethically bound to use evidence-based practice. f you feel like doing something it has to be based in research and we are always taught to to start there. This has made me hyper-aware, which is good, and also makes me second-guess everything. It’s funny, we kind of get different feelings from different professors. With some it’s personality and with some it’s style. it’s really important as a music therapist to have your own style. I think it’s really important. but some of my professors are very like by the book you have to have every period and every dot over the I. But I have one professor that says take chances and learn from experience as well.
So it’s maybe more hyper aware, but it’s also given me more of a concrete way to create art. Because I think for so long I was like, “I can’t write songs. I’m not an artist. I can play music and I can sing, but I’m not a composer or a creator.” And then diving into music therapy where a lot of the answers aren’t out there in composing this one song that has everything I need in it but I have to compose the song myself. So I think having a drive and having guidelines—maybe it’s just my brain—but it’s actually made it easier and given me more confidence to have those guidelines there and then I can sort of write my own music that more reflects me.
Because I think for so long I was like, “I can’t write songs. I’m not an artist. I can play music and I can sing, but I’m not a composer or a creator.” And then diving into music therapy where a lot of the answers aren’t out there in composing this one song that has everything I need in it but I have to compose the song myself. So I think having a drive and having guidelines—maybe it’s just my brain—but it’s actually made it easier and given me more confidence to have those guidelines there and then I can sort of write my own music that more reflects me.
CAC: Perhaps because music therapy is such a young field of study there seem to be many misconceptions of what music therapy actually is and how it is practiced. For instance, one of the FAQ’s on the American Association of Music Therapists is “what’s the difference between music therapy and listening to an iPod with headphones?”. So let’s just take that question seriously (because I am a fraud and I steal questions): what’s the difference between music therapy and listening to an iPod with headphones? And can you go into a little of the theory that music therapy is based in?
SC: The difference: yes, there’s still music out there, but what is crucial to music therapy is the therapeutic alliance and the relationship, just like if you go to therapy or if you have a physical therapist. In class we say the most important thing is the relationship, the therapeutic relationship. like if you don’t trust someone when you’re not feeling welcome with someone then you’re not really going to do what they ask you to do especially if they’re asking you to play this weird instrument you’ve never seen before. Music is a very personal thing. So that’s the main difference between just an iPod and a music therapist. Mainstream music therapy is seen by many as a hippie-dippy thing or like, “aren’t you just listening to an iPod,” but there’s so much work happening behind the scenes, and it requires a board-certified music therapist who is knowledgeable and has practiced these things. To be a music therapist you have to go through a six month internship anywhere in the country that’s certified by the AMTA (American Music Therapist Association), clock in at least 1200 hours, and then you sit down and take a board certification exam that is held by the formal organization who certifies music therapists. And only then can you go out and practice.
There’s a big difference but a lot of people don’t realize it until they’re explained to. I think it’s like what you’re saying with the newness of the field. it’s really only been around since the 1950’s, post World War II. And the AMTA, it was actually two separate groups before and was merged in 1998. So that’s how recent we’re talking about. And yes, the field needs more work. We need more work as a whole, and the way to get there is through more research which we really need because a lot of the research that we have is case studies which is harder to generalize to large groups. also part of what’s so difficult is that each client is so unique. For example, say you have a client Who has had a stroke and is doing gait training. That client is still going to be different from another client who is doing gait training. So I think that’s part of the art that goes into it to: the individualization. So yes the field needs more work, but it is being more legitimized with each year as more and more research comes out.
Photo courtesy of Steph Carvalho.
CAC: In an article from the World Journal of Psychiatry, “Effects of music and music therapy on mood in neurological patients”, by Alfredo Raglio, Lapo Attardo, [...], and Enrico Granieri, the authors conducted a meta-analysis of “the large amount of regarding the effects of music therapy” and found that out of the 25 studies included “most of the studies support the efficacy of MT and other musical interventions on mood, depressive syndromes, and quality of life on neurological patients”. Music therapy seems to be a rapidly growing field and has a lot of contemporary support based on the literature even in its relative infancy. Do you feel that the science field is opening up to using music and art as a legitimate health practice, or do you feel there is still some resistance from the old guard when it comes to treatment practice?
SC: I think from the field of science I think it is getting traction and people are taking it seriously, especially if you’re in neuroscience which is where a lot of music therapy research comes from. I think in regards to the mainstream, you can sort of say it’s both not taken seriously and is. It depends on how much you know about it. If you know somebody who has received services or maybe you’re a nurse in a hospital and you have seen a music therapist at work, then you sort of see it firsthand or you know from other people’s experiences what it is. If you don’t qualify for services or you haven’t had someone explain to you what it is it can be really confusing.
I had one guy tell me after I had said, “ I want to study music therapy,” and he said, “oh, my wife’s into aromatherapy.” I was like, what are you talking about? Then there’s people like the politician Gabrielle Giffords, when she was shot she received music therapy services after, and it was on the news and some people kind of gained more awareness through that.
One of my GTAs interned at a hospital in Texas and even at that hospital some of the doctors and nurses didn’t really know much about music therapy. But she springboarded a program there as part of her internship project. The doctors would present her with different hypothetical situations or clients, and she noted that she could use different techniques. Within the field of medicine or science, there is still some skepticism, but I think it is gaining traction. But maybe it’s more compelling if you know somebody who has seen it or does it or if you’ve seen it done.
CAC: Looking back at your journey, and where you are now, there must be many moments where you felt pushed toward where you are now. When you were young, what kind of guidance did you see yourself wanting and what did you receive? Additionally, many of our fellows are interested in intersectionality and bringing art into the world. What advice do you give to our fellows on how to weave art into their daily working lives? Can you offer any resources?
SC: I always had supportive music educators and teachers in my life who had guidance for me and support for me in that visceral I’m-teaching-you-how-to-play-trumpet-I’m-literally-here-next-to-you kind of support. And also my parents have always been supportive of me.
I was lucky to have that support. and I think that at this point in my life. And now my professors for sure. When I was in undergrad, I knew zero music therapists. I observed one music therapist, but then even as I was doing my senior honors project, my mentor didn’t actually know a lot about the field, so it was difficult to ask for advice or ask for anything because I knew that this wasn’t their expertise. And I tried to get music therapists that were local involved in my project, but it didn’t really work out. Now I feel like I have professors who are mentors to me who I have a professional relationship with.
Along the way, I always had people who were supporting the art that I was doing even though I was five or 10. It just helps to have people who support what you do in whatever way possible. Coming here to KU was life-affirming. Even though I am 1000 miles away from home, I’m surrounded by people who I now have a common language with, whereas before, at Westfield, I was trying to pave my own way and sort of make something happen that wasn’t actually there. Now Westfield actually is hoping to start a music therapy program! I don’t have any recent details on it because my old professor told me last year, but I’m happy that I could’ve left something that could have inspired the program.
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Woody Woodger lives in Lenox, Massachusetts. Her first chapbook, “postcards from glasshouse drive” (Finishing Line Press) has been nominated for the 2018 Massachusetts Book Awards and her work has appeared, or is forthcoming, from DIAGRAM, Drunk Monkeys, RFD, Exposition Review, peculiar, Prairie Margins, Rock and Sling, and Mass Poetry Festival, among others. Her poetry has been nominated for Best of the Net. In addition, she has a regular column with COUNTERCLOCK Literary Magazine.
Sarah Feng is a writer from the San Francisco Bay Area. She was a 2018 Foyle Commended Young Poet of the Year and the runner-up for the Adroit Prize for Prose. Other organizations which have recognized her work include Teen Vogue, the New York Times, the Critical Pass Junior Poet Prize, the National Council of Teachers of English, the American Scholastic Press Association, and more. She was Kenyon Young Writer's Workshop '18 and the Adroit Journal Summer Mentorship '17. She plays piano and dabbles in charcoals, and she thinks rhythm and light and lyric pulse in every field of the creative arts – if you can call them distinct fields at all. In other words, she has faith in the power of the interdisciplinary arts and their persistence in our memories and minds. She is the founder and program director of the COUNTERCLOCK Arts Collective. You can find her here.