This Week’s Guest

Coaching parents how to do Floortime through musical interactions is today’s topic with returning guest, Music Therapist, Dr. John Carpente who is a DIR Expert and Training Leader, a Professor of Music Therapy at Molloy University, and founder and executive director of the Rebecca Center for Music Therapy. He is the owner of Developmental Music Health Services, LLC and founding music therapist and creator of the DIR/Floortime-based music therapy program at the Rebecca School in New York City where he participated in weekly supervision and case conferences with Dr. Stanley Greenspan.

John and I recently taught a course for the International Council on Development and Learning (ICDL) called DIR 110: USING MUSIC IN FLOORTIME FOR PARENTS: PROMOTING DEVELOPMENT THROUGH MUSIC which will be offered again in the future. We will also participate in the upcoming October virtual INTERNATIONAL LIVE ONLINE DIRFLOORTIME® CONFERENCE where we will present The Music of Human Interactions: Coaching parents in the use of music in DIRFloortime® to foster interpersonal connections. Please keep your eye on the conference website to register soon!

What is Floortime Music Therapy?

It’s the task of the music therapist to provide music experiences through live, interactive music making, Dr. Carpente tells us. In a Floortime context, this would facilitate self-regulation, engagement and two-way communication through the ‘R’, or the Relationship with the child. Music therapy is not about teaching songs or instruments, but about how we can work within musical dimensions to facilitate back-and-forth circles of communications, he explains. This can be done through instrument play where we make the music relational so the participant is motivated to engage and keep playing, he says.

Dr. Carpente continues that most of the music is improvised where the therapist is following the child’s lead and meeting their affect with the music and the extra things we provide such as body affect, facial expressions, etc., depending on the participant’s needs and individual differences (the ‘I’). How this therapy looks will vary so much from child-to-child depending on the ‘I’ and their ‘D’ (Development), John adds. We want to know if they interactive or do they seem like they’re in their own world, even though they might be engaged where it might seem to us like they’re ignoring us?

Step 1: Assessing the Child

When Dr. Carpente gets a new client, he looks at how the child perceives, understands, and interprets the musical themes presented to them, and then how they make music with us. With the goal being for them to interact with us robustly, we want to understand what’s getting in their way of being able to interact, John explains. What are their biological challenges or what do the musical conditions need to be for them to be able to stay regulated and engaged?

Maybe they only respond to fast and loud music, for instance, or maybe they respond best when the music is really detached due to an auditory processing challenge, Dr. Carpente explains. We want to understand the challenges and the positive things. This informs the music they’ll make with the participant, he says. John wants to understand the ‘I’ so they’re more available for interaction so we can move them up the developmental ladder from regulation to engagement and relating, to back-and-forth communication, etc.

Understanding the Individual Differences

I asked Dr. Carpente what he would do with a child who presents with severe auditory sensitivities, who might wear headphones because they are very sensitive to noise and can hear everything that’s happening even rooms away. A hit on the drum might be so alarming that it sends them into fight or flight, so they are not regulated, which is the first developmental capacity. First, John says, they want to figure out what it is about the auditory information that is overloading, because sometimes kids who have a hard time with sound have a hard time because they’re not controlling the sound and can’t locate where the sound is coming from.

John continues that if the child connects the auditory to the visual, it won’t bother them as much. Then there are other kids who are super sensitive to sound who have perfect pitch and their auditory filters are non existent, he continues. They can hear things in another room that diverts their attention. So John might adjust volume or to use music as an adjunct to interpersonal interaction where music isn’t the main focal point. They might instead put something appealing in the instrument to attract the child’s attention to it.

Other kids are underreactive, which doesn’t mean that they are hard of hearing, but that there is a disconnect between what they are hearing and how the brain is making sense of it, Dr. Carpente explains. There could be an auditory processing delay. John might present music with long phrases with long pauses to wait to see what’s happening. You don’t want to give the child the sense that the music is moving ahead without them, he says. In the pause, you use your body affect to create anticipation, he explains. There’s so many combinations of things that the assessment can take three or more times, but really, each session is an assessment in itself, Dr. Carpente emphasizes.

The Floortime Approach

I pointed out that what Dr. Carpente said about the child who can’t understand where the sound comes from reminded me of Dr. Stanley Greenspan telling us to always let the child have control. I imagined the child getting to hold a stick and hitting a cymbal to hear the sound, which on its own might be startling, but hit by them, might sound pretty cool! I also pointed out that my son is one of the kids with an auditory processing delay and gave an example for parents listening of what he does.

Dr. Carpente had mentioned singing a phrase and then waiting for the child to process it. It reminded me of how my son will listen to the first verse of a song over and over and over repeatedly until he is able to absorb it because it is going too quickly–just like I need to play guitar really slowly to get my fingers on the correct strings to play a chord when learning. Once he gets the feel for the song and memorizes the lyrics, I hear him creating his own lyrics about Mario Kart. I simply pointed out that this might be a child who fits the category that John mentioned.

The more practice a child gets, John continues, the more opportunity they have to make more connections. Sometimes kids who have a hard time connecting the auditory to the visual and vice versa, there might be an auditory skill that might be lagging in terms of cause-and-effect relationships, he adds. If they don’t have that enough to match what’s happening in different media, they might not realize what they impact and how it’s impacting them, he explains. They’re not sure so it makes them anxious. It’s how they’re managing their world. We can’t even imagine it. It takes a lot of energy emotionally.

We can refocus that energy into interaction, Dr. Carpente suggests, and help them develop the capacities to self-soothe, be able to be comfortable in social situations, and be able to figure things out due to that developmental foundation versus having to memorize what to do.

The Developmental Process

I echoed this important point, which Dr. Gil Tippy brought up in an earlier podcast where he talked about the key shift in Floortime being when a child moves from the concrete world into the abstract, when the child no longer has to operate from their memory every day in every situation, but instead can think abstractly to figure things out and generalize across contexts. This is a main difference between developmental approaches and behavioural approaches that are more memorized and skills-based.

The behavioural approach means you have to teach a skill in every possible context, which is impossible, John affirms, as opposed to the developmental approaches with joint attention and regulation, etc. Once those are created, these are skills of how to be in relationships that cross into new contexts that you can learn about in each new context. It’s bottom heavy and foundational.

Where is the Child Developmentally?

This brings us right into the ‘D’ where we are assessing where the child is developmentally from the first capacity in Dr. Greenspan’s model of being regulated and showing interest in the world to the second capacity of being engaged and relating with someone, to the third capacity of having purposeful, emotional communication with us. 

You can even get into the fourth capacity of complex communication and social problem-solving such as when John showed a video in his courses taught at ICDL where he played the piano faster and faster and the girl picked up the pace and was drumming faster. That’s social problem-solving as she’s figuring it out. Then you get into emotional thinking at the fifth capacity and into logical thinking at the sixth capacity among other things.

The ‘I’ impacts the ‘D’

I asked John how he assesses a child’s development in each moment, since it can change from moment to moment and from session to session. At Rebecca School, he would have the luxury of having input from the Occupational Therapists (OT) about each child’s profile but I wasn’t sure how much information he gets at Molloy University about his clients’ individual profiles. At the Rebecca School, all the disciplines worked in the same way, Dr. Carpente explained. The OTs are experts in understanding the nervous system, so he would want to know what’s going on biologically when kids learn. 

At his present clinic, he asks parents to bring in any information or assessments they have. Those not using the DIR model don’t put a big emphasis on the sensory profile. Sometimes sensory challenges manifest in music. Sometimes the child will play the instrument as if they’re playing through it. They aren’t perceiving how close their hand is to the drum due to depth perception. So the visual system is a big part as well.

In the Floortime Music Session

I gave the example of my son who might have come in and knocked everything down or throw things to watch them move. John says that while many places would use punitive measures, he would wonder where that behaviour is coming from. It could be due to the child being upset because the lights are too bright, the noise is too loud, or there’s too much stuff in the room, John explains, or it could be a learned behaviour where they see that they get a reaction from us. Safety is the first concern, so they don’t want things being thrown. If it’s a visual thing, though, then it’s a motivator, and John will use that in the session.

Maybe John will pause at the end of a phrase he sings and let the child hit a triangle hanging on a string. He won’t make it repetitive. Next time he might slow the melody down, or maybe he won’t put the triangle out at the following session to create a ‘problem’ and see what the child will do from their own resources. They might withdraw, and John would want to know that, too. He wants to get the child at their developmental threshold to see what they can do. 

Once you change it up a bit, the session then becomes adult-led. It has to be adult-led at some point, John asserts. The therapist is not only working on getting engagement and interactions, but also on motor planning, auditory and visual processing, and receptive and expressive language–maybe not through words–all at the same time, in the context of the interaction in a temporal experience.

Everything in Floortime is worked on in the context of interaction, Dr. Carpente continues. Maybe the child is on a swing and with each swing, they hit the cymbal. Visual processing is really important, he explains. Many of our children have challenges in this area. We want to cause problems and playful obstruction in the music to elicit interactions.

Getting Parents Involved

If parents want to do this kind of play with music, we can show them how, Dr. Carpente says, but just as the child has individual differences, so do the parents. We all do. Music can be really intimidating because people get performance anxiety trying to sing around a therapist whom they know can and could judge their singing. He needs to establish a rapport with the parents first to get out these emotional differences first.

It’s not about the performance, John offers. It’s about providing a musical experience in a way that helps a child move up the developmental capacities. You can do it with voice, or a drum, or a shaker, or whatever. You can create a rhythm. The first building block is building that trust with the parents. The parents aren’t sure what to expect. It’s not about teaching. It’s about providing an experience to help the interaction sustain itself in a continuous and robust manner, John explains.

We want to empower parents in music to be able to work in the same way with their children with the music therapist’s support, Dr. Carpente explains. He has worked in person and remotely for families who live far away. He also teaches music therapy too to budding music therapists. They talk about the aesthetic of music. It’s a subjective experience. It’s not about the beauty of the music. The beauty is only as beautiful as the robustness of the relationship. That’s what it’s about.

Relationships are Dynamic

Dr. Carpente gives a great example of this. He says that if he worked with my child for a month and have this great interaction and come up with themes they use each week and stretch them out. If we then went to another music therapist, it’s not like he can take those themes and use them in the same way. It just doesn’t work that way. You can’t remove the person from what you’re doing. They have to come up with their own themes with the new client. The source of inspiration is different from clinician to clinican and from child to child. 

You want to create different experiences every time so the child learns to be interactive in different environments and situations, with different people, etc. The more practice they get at this, the more they can move up the developmental ladder. We want spontaneous interactions over rote responses. John says that Dr. Greenspan used to say that to keep it robust and in the moment, and always adaptive to the child, if you know what’s going to happen next, you’re doing it wrong. 

A Virtual Example

I gave a preview of our upcoming ICDL conference presentation where Dr. Carpente will be coaching me to do musical Floortime with my son. I suggested we might make fun sounds that he likes such as, “Bloop boop beep bloop boop… Uncle Nanny!” and have him yell a funny name, which is what he’s been on the kick of doing lately. John says that he’ll have this in his mind as he forms a rapport with my son, and then he will want to make sure my son just doesn’t have this library of scripts in his head, so he might slow it down.

If my son slows down with him, then John will know that my son is listening. Next, John would speed up and see if my son’s timbre is matching his. After a few spontaneous trials, John would have determined that my son is responsive, so the next thing to try would be to stretch it out more where he circles it around to see if my son is initiating. John might sing, “Doo doo doo doo doo… Sha-nay-nay! (pause) Doo doo doo doo doo…” then wait.

My son might say, “Ja-na-na“. John would respond with, “Wait! I’m not Ja-na-na!” with a lot of affect and wait. He wants to see what my son would do. That was drastic, but John could vary the response. If my son responded with, “Yes, you are!” and did it with a smile, John would see that he’s using humour, which is abstract, versus a memory thing. John could even start crying and say, “No! I don’t want to be called that!” and see if my son understands that it’s pretend. This is getting into emotions.

The Tough Moments

Dr. Carpente gave an example of working with a child and his para (helper). The child would hit her and she would firmly say, “No hitting!” John suggested she instead pretend to cry when he hits her. She sang in music therapy while crying after he hit her and pointed where it hurt and the child had a tear come out and he rubbed her arm better where he hit her. He expressed empathy in that moment as he hadn’t before. If he could follow the instruction, “Don’t hit!” he wouldn’t need therapy, John suggests.

When the child’s para joined in the play, it’s not as abstract. It became abstract when he started crying which showed empathy and theory of mind. It’s the aesthetic of the relationship. Sometimes when we know something will set the child off, we won’t go there, Dr. Carpente suggests. When we make it happy all the time, though, it’s always going to be that way. It’s hard for parents, John empathizes.

How do you work through not getting that cookie when you really want it so you can move up those developmental capacities where you develop flexibility, collaboration, and being in tune with the world versus always getting your way? It’s a hard time, but let’s join in, join the affect, and meet them emotionally, which helps them manage their ability to self-regulate. It takes a long, long time, John adds.

Putting it in a music context covers the whole spectrum of emotion. We all have a relationship with music. We take our love of music and provide an experience to go through the range of emotions. I added that we can’t assume they don’t have empathy, because some adult self-advocates have said that they knew hitting was wrong, but couldn’t control their body movements.

We talked about my son kicking water from a puddle on to a classmate and laughing. John said that’s a tricky one because in some contexts that’s ok, such as at the beach, and also kids play like that in general. The child has to have the experience of feeling bad, John asserts. Dr. Carpente also points out that for some of the kids it’s their way of saying, “You aren’t listening to me!” and that if you want empathy, you’re going to have to give it back.

Behaviour vs. Development

Another thing we tend to do is take for granted that our kids were born that way, but we aren’t born learning that you don’t hit, John adds. You have to develop the capacities that makes you see that you have an impact on the world. Also, if a child is 10 years old but developmentally around age 2, John continues, they may not have gone through the terrible two’s yet, and when a 2-year-old hits, we laugh.

I added that it infuriates me that everyone thinks behaviour is because the child is autistic. Behaviour is about where the child is developmentally and development is development. Dr. Greenspan was saying this before the science came out, and now we know it’s true, John asserts. You don’t learn things in a vacuum. 

Thank you to Dr. John Carpente for sharing his time with us to describe how he uses DIR/Floortime in Music Therapy, trains music therapists, and coaches parents. I hope that you learned something valuable and will share it on Facebook or Twitter and feel free to share relevant experiences, questions, or comments in the Comments section below.

Until next time, here’s to choosing play and experiencing joy everyday!