Using HealthRHYTHMS with the Chronic Mentally Ill
By: Terri Kuberski, LCPC, MA
Population Served: Others
I do psycho-social group therapy with clients suffering from Chronic Mental Illness, permanently housed in nursing homes. Several of the clients have physical disabilities, some are non-verbal, and two of my groups are psychiatric/geriatric populations. In these groups processing is the primary objective. Due to the nature of each individual's illness, it is best to know the clients before trying interventions such as HealthRHYTHMS and have the ability to trouble shoot any issues that may arise in the process.
In standard group therapy the clients struggle to interact with one another, some preferring not to even sit in a circle. As a clinician I struggle to keep the clients focused in "reality". The groups are run under the guide lines of Medicare and a Physician is present to document each client's contribution. My intention is to assist the clients in, bridging the gaps, in a non-threatening way, while providing a service that fits within the frame work of both the Physician and Medicare requirements. In trusting my intuition and setting my intention, I and my clients experienced something that some standard modalities, could not have achieved...connection!
In doing the "Shaker-Pass" we needed to start off with exploring the apple shakers themselves, because several of the clients thought the apples were real. We took time to explore the sounds they make and how they felt. The Shaker-Pass itself turned out very differently. Group after group, despite my best efforts to get the clients to increase the tempo, everyone proceeded with caution, not even allowing me to drop apples. Some clients would not pass their shaker till they received the next one. In one group a client took it upon herself to include the Doctor in the Shaker-Pass by passing her apple to the Doctor who was sitting right outside of the circle. By the end no one was laughing. The clients instead expressed a sense of satisfaction about not dropping any of the apples and we went on to process what loss meant to them.
One of my non-verbal clients who, just moments before group started, came in with his fist raised and was escorted to his room. He sneaked back into group once "Rhythmic Naming" began. I told him he needed to take a seat and handed him a shaker. He watched the other clients and when it came to his turn I encouraged him to play his name, with the biggest smile on his face and this life in his eyes, he shook that simple rattle; I stepped aside and watched his peers continue to encourage him.
In another group during "Inspirational Beats", where we were exploring, with our drums, the question "How would you like to feel?" a client who fixates on Abraham Maslow's theory started off by intellectually describing self-actualization and achieving a state of "one hand clapping." This client seemed unable to translate that onto the drum, so I started running my hand back and forth on my own drum head to replicate the sound of wind. This client in return did the same with out talking. Afterwards this client expressed to the group how hard it has been to express feelings and how that simple sound expressed how he/she truly wanted to feel... calm.
I did do a limited "Guided Imagery" exercise with some of my groups. Using the ocean drum and having the clients replicate the wind on their drums; we took a simple walk on the beach. We talked before hand about pretending and relaxation and made sure everyone was comfortable with the idea. The only suggestions I used was: the warmth of the sun, feel of the sand on their feet, and the sound of the ocean and wind. The Doctor I work with even took a place within the circle and I handed him a thunder tube to play. The clients loved it. Most all the clients commented on feeling calmer after the exercise. In one group while processing the exercise the group spontaneously opened up and started expressing to one client, who struggles to participate in group, how they missed the way she use to act, more outgoing. In the groups to follow this client talked more then she ever has.
I must say, working with this population is very challenging, yet very rewarding when you have a tool like HealthRHYTHMS to promote interaction and expression. I was able to sell the idea to my bosses because it allows room for processing what transpires in the sessions. The information I learn during HealthRHYTHMS allows me to better serve my clients and promote a more proactive environment.
Important Note from Remo, Inc. regarding contraindications