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„You live to express yourself_ and in doing so_ you enhance the

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					Music Therapy Today
Febr uar y 2003




                      „You live to express
                      yourself, and in doing so,
                      you enhance the world“
                      (Henry Miller)

                      Karen Thoms




                        FIGURE 1.   Karen Thoms




                      Abstract
                      For several months now, the inhabitants and staff members of Leben-
                      sarche Königsborn have been suffering from construction noises – walls
                      are torn out, floors taken up, new parquet floors laid … All this noise is


                                                                                              1
Thoms, K. (2003) „You live to express yourself, and in doing so, you enhance the world“ (Henry Miller). Music Therapy
                                                     Today (online), February, available at http://musictherapyworld.net




                                due to the conversion and new arrangement of the living and therapy
                                quarters at Lebensarche Königsborn; at the same time, it is the symbolic
                                expression of a reorganisation in structures and concepts pursued at this
                                institution. For almost two years I have been part of this reorganisation
                                with my music therapy sessions and have been trying to give the inhabit-
                                ants room to discover and develop their communicative and practical
                                artistic abilities in music therapy.



                                The Institution

                                The institution Lebensarche Königsborn is located in Unna-Königsborn
                                in the Eastern part of the Ruhr district and gradually, step by step, has
                                become what it is today: a centre for children, adolescents and young
                                adults with neurological impairments.

                                The history of the Lebenszentrum ( or “centre of life”) Königsborn
                                started in 1882 with the foundation of a health resort for working class
                                children. For some time it served as a tuberculosis sanatorium and later
                                became a hospital specialized in child neurology and social pediatrics.
                                After a variety of expansions and additions, e.g. a kindergarten (1971),
                                hospital school (1978), centre for social pediatrics (1994) and Haus
                                Königsborn (1997), the focus of work at the centre today is the care and
                                treatment of children, adolescents and young adults with serious multiple
                                disabilities and neurological damage.

                                The last part of the centre to be opened was Lebensarche (“ark of life” as
                                in Noah’s Ark) in 2000. A unit of 50 beds at the neurology clinic is being
                                restructured to form a residential facility. This form of care is adapted to
                                the needs of children and adolescents: their impairments in daily life are


                                „You live to express yourself, and in doing so, you enhance the world“ (Henry Miller) 2
Thoms, K. (2003) „You live to express yourself, and in doing so, you enhance the world“ (Henry Miller). Music Therapy
                                                     Today (online), February, available at http://musictherapyworld.net




                                so considerable that they require continuous treatment and nursing (see
                                info box I). For a variety of reasons, this type of care is not feasible at
                                home; this is why children and adolescents from all over NRW live at the
                                Lebenszentrum Königsborn for many years.

                                    FIGURE 2.   A new residential facility is ready




                                Such a reorganisation involves changes as to premises, nursing staff and
                                concepts. Step by step, long hospital wards are converted to resident
                                units. The team of therapists is expanded and new therapy fields like
                                music therapy and arts therapy are added. (From 1997, music therapy has
                                been part of the treatment plan in Königsborn.)

                                Subsequent to the conversion as scheduled, 7 resident groups will com-
                                prise 7 to 8 inhabitants each, with family-like structures and the support
                                of an interdisciplinary team of care-givers. 15 therapists working in
                                physio, ergo, music and arts therapies and also logopedics are involved in
                                projects geared to the needs of the inhabitants. Children and adolescents


                                „You live to express yourself, and in doing so, you enhance the world“ (Henry Miller) 3
Thoms, K. (2003) „You live to express yourself, and in doing so, you enhance the world“ (Henry Miller). Music Therapy
                                                     Today (online), February, available at http://musictherapyworld.net




                                of school age also attend the school at Königsborn, which is a special
                                school for disabled children with official state recognition.

                                The objectives pursued here have been developed in close cooperation
                                with Prof. Dr. A. Fröhlich and are based on the principle of normalisation
                                (see info box II) defined by Nirje: patients with serious disabilities cannot
                                be equated with other patients; their serious disability is their individual
                                normality.

                                The general objective of the interdisciplinary team is to enable the inhab-
                                itants to enjoy as much normalcy as possible in leading their lives and
                                pursuing their school education or training, with a maximum of indepen-
                                dence, self-determination and social integration.



                                Music therapy at the Lebensarche

                                Due to the current rebuilding activities, therapists frequently have to
                                accept compromises as to rooms for sessions – the music therapy room,
                                however, is far better than just a compromise solution. In the centre of the
                                room there is a black piano, with a woolen blanket on the lid so that chil-
                                dren and adolescents may be positioned on top of the piano. Drums, rat-
                                tles, castanets and a triangle hang on the walls. Between the two windows
                                there is a slit drum (Big Bom), and scattered all over the room are cym-
                                bals, a metalophone, singing bowls, and chimes. A mattress has been
                                placed beside the door – it is important to have many different ways to
                                lay down or position patients for therapy.

                                A video camara with the appropriate software is available for a compre-
                                hensive documentation of therapy processes. The video and film material



                                „You live to express yourself, and in doing so, you enhance the world“ (Henry Miller) 4
Thoms, K. (2003) „You live to express yourself, and in doing so, you enhance the world“ (Henry Miller). Music Therapy
                                                     Today (online), February, available at http://musictherapyworld.net




                                is mainly intended for follow-up and evaluation of therapies; in addition,
                                this is an ideal way to record the joint musical encounter and make it
                                transparent to family and staff members likewise.

                                I provide 28 weekly therapy units (single sessions) for a total of ca. 12
                                inhabitants. Flexible therapy blocks have proved to be suitable – after 4,
                                perhaps 6 or possibly even 11 months I conclude one therapy phase and
                                start with other children or adolescents in turn. Short-term developments
                                and changes are rare; the desired results require a long period of getting
                                acquainted and creating some familiarity between patient and therapist.

                                I do not want to take the lead with the children and young patients but
                                rather accompany them on their highly individual way. The language of
                                music helps me to adapt to their communicative level; accepting their
                                current condition, I try to build up a relationship which may be the basis
                                for development, autonomy and mobilisation.

                                     Niklas (names of patients mentioned from here on have been
                                     changed for reasons of data protection) is lying on his back on the
                                     piano. In this position he is able to kick his legs. His motoric abil-
                                     ities for hand/arm movements are very limited due to severe spas-
                                     ticity. I start the session with his welcome song, and he joins in
                                     with abrupt kicking movements. I take his tempo up and follow his
                                     movement phases and breaks with my musical phrasing. Niklas
                                     starts to “dance” and thus becomes the conductor of our joint
                                     musik-making.

                                All behaviour in an interpersonal situation constitutes some kind of mes-
                                sage (see Watzlawik, 1969). A head movement, a smile or smacking
                                sound, the lifting of an arm or even a tiny finger movement can be an


                                „You live to express yourself, and in doing so, you enhance the world“ (Henry Miller) 5
Thoms, K. (2003) „You live to express yourself, and in doing so, you enhance the world“ (Henry Miller). Music Therapy
                                                     Today (online), February, available at http://musictherapyworld.net




                                attempt to come to an understanding with oneself or the environment. In
                                the music therapy encounter I try to take up such invitations on a musical
                                level – responding to them with my voice or an instrument and thus mak-
                                ing them audible. The patient can feel that the music ringing out like this
                                is directed towards him exclusively, and that he himself can modify and
                                influence it.

                                    FIGURE 3.   Playing and singing together




                                An encounter with children and adolescents is possible even if any
                                motoric activity seems impossible. The breathing of each human being
                                has the quality of a personal expression; consequently, I can take it up
                                and reflect it in an improvisation.

                                A preliminary significant objective in applied music therapy is to develop
                                auditory attention, i.e. an ability to turn to accoustic stimuli and perceive
                                them consciously. Possible reactions from children and adolescents must




                                „You live to express yourself, and in doing so, you enhance the world“ (Henry Miller) 6
Thoms, K. (2003) „You live to express yourself, and in doing so, you enhance the world“ (Henry Miller). Music Therapy
                                                     Today (online), February, available at http://musictherapyworld.net




                                be observed exactly – changes in facial expression, the turning of a head
                                or a pause in breathing can be indications of auditory attention.

                                     Paul, three years, is lying on the mattress, wrapped in a snake
                                     pillow. His breathing is calm and regular. I sing a pentatonic 5-
                                     note motif for him. After a short time his breathing rhythm
                                     changes, and he stops breathing for a moment at the end of each
                                     musical phrase.

                                Whenever the movements of children and adolescents can be integrated
                                in instrumental music-making, they are no longer merely passive receiv-
                                ers of auditory signals; a close combination of sensory and motoric func-
                                tions emerges which can give children and young persons a feeling of
                                authorship, of originating their own activities and of not originating those
                                of others (see Schumacher, 2000). Instruments serve to make even small-
                                est movements audible; vocal expressions gain significance in the musi-
                                cal context.

                                    FIGURE 4.   Instruments and material should fit to the special needs




                                „You live to express yourself, and in doing so, you enhance the world“ (Henry Miller) 7
Thoms, K. (2003) „You live to express yourself, and in doing so, you enhance the world“ (Henry Miller). Music Therapy
                                                     Today (online), February, available at http://musictherapyworld.net




                                A basic element of communicative skills is to perceive one’s actions as
                                one’s own individual activity. Encounter can be experienced, and com-
                                munication enhanced on this basis.

                                     Jannik, 19 years, is sitting in his wheel-chair; he holds his right
                                     arm at an angle, the fist at shoulder height. He can move this arm
                                     a few centimetres up and down. At his side he has a small table
                                     with two castanets. I sing a short melody which I repeat several
                                     times, with pauses in between. During these pauses, Jannik suc-
                                     ceeds in playing a castanet with his elbow. The effort involved is
                                     very obvious in the photo - but also his delight in this success!

                                    FIGURE 5.   Jannik plays castagnettes




                                In music therapy children and adolescents can give expression to their
                                emotions – independent of any linguistic or motoric impairments – and
                                get a feeling for these emotions in the joint musical play. The encounter




                                „You live to express yourself, and in doing so, you enhance the world“ (Henry Miller) 8
Thoms, K. (2003) „You live to express yourself, and in doing so, you enhance the world“ (Henry Miller). Music Therapy
                                                     Today (online), February, available at http://musictherapyworld.net




                                thus becomes an encounter with a personality, the immediate self of a
                                human being.

                                “You live in order to express yourself…” – in practical music therapy
                                the inhabitants of the Lebensarche have a chance to express themselves
                                and to experience how their utterances are heard, taken up and carried on.
                                “…and in doing so you enhance the world” – the way in which chil-
                                dren and adolescents express themselves in music is an enhancement of
                                their own world, of my work and our joint music-making, every time
                                again!



                                References:

                                Aldridge, David: Music therapy research and preactice in medicine. Lon-
                                       don, 1996

                                Gustorff, Dagmar: Jenseits des Wortes. Bern, 2000

                                Schumacher, Karin: Musiktherapie und Säuglingsforschung. Frankfurt,
                                       1999

                                Thimm, Walter: Normalisierungsprinzip. Marburg, 1995

                                Watzlawick, Paul: Menschliche Kommunikation. Bern, 1969



                                Infos

                                Lebenszentrum Königsborn has 6 different institutions:

                                •   Haus Königsborn / an NRW model institution with 39 places for the
                                    long-term care of patients with vigil coma and involutional phases


                                „You live to express yourself, and in doing so, you enhance the world“ (Henry Miller) 9
Thoms, K. (2003) „You live to express yourself, and in doing so, you enhance the world“ (Henry Miller). Music Therapy
                                                     Today (online), February, available at http://musictherapyworld.net




                                •   Königsborn Clinic for Pediatric Neurology and Social Pediatrics / 40
                                    beds – for in-patient neuropediatric and social-pediatric diagnostic
                                    investigation
                                •   Lebensarche Königsborn / resident institution for 50 children and ado-
                                    lescents with serious multiple handicaps
                                •   Kindergarten Königsborn / day care centre for 61 young children with
                                    multiple impairments and a logopedic unit
                                •   Sozialpädiatrisches Zentrum Königsborn / Day care centre for treat-
                                    ment of 1500 (p.a.) children and adolescents with a variety of develop-
                                    ment impairments and handicaps
                                •   Schule für Kranke Königsborn / school for 57 children and adoles-
                                    cents (residents at the Lebensarche and in-patients of the clinic)


ADDRESS:                        Zimmerplatz 1

                                D-48087 Unna

CONTACT:                        Gemeinnütziger Verein (non-profit association) Lebenszentrum Königs-
                                born

                                Manager: Lothar Schwuntek                              phone: +49-2303-9670 241

                                Director, Administration: Eckehard Lategahn phone: +49-2303-9670 101

                                Lebensarche Königsborn

                                Director, Education: Uwe Wandersee                    phone: +49-2303-9670 504

INTERNET:                       www.lebenszentrum-koenigsborn.de

INFO BOX I                      The children, adolescents and young adults from 0 to 24 years who are
                                residents at the Lebensarche Königsborn suffer from

                                •   craniocerebral injury trauma
                                •   sensomotoric and mental retardation
                                •   muscular dystrophy
                                •   apallic syndrome after reanimation etc.




                                „You live to express yourself, and in doing so, you enhance the world“ (Henry Miller)
Thoms, K. (2003) „You live to express yourself, and in doing so, you enhance the world“ (Henry Miller). Music Therapy
                                                     Today (online), February, available at http://musictherapyworld.net




INFO BOX II                     Principle of normalisation according to Bengt Nirje

                                     “Normalisation as the guiding principle in social politics and
                                     administration, in social and educational activities and as the
                                     main objective governing the relief system for people with handi-
                                     caps means: Citizens with or mental or physical or emotional
                                     handicaps shall be able to lead their lives in a way analogous to
                                     that of people without handicaps. In short: a life as normal as
                                     possible.” (THIMM 1995, p.2)

                                A german version of the article „Man lebt, um sich auszudrücken, und
                                indem man es tut, bereichert man die Welt“ was published in “Musik und
                                Gesundsein” 4, 2002, 4-6

                                This article can be cited as: Thoms, K. (2003) „You live to express your-
                                self, and in doing so, you enhance the world“ (Henry Miller). Music
                                Therapy Today (online), February, available at http://musictherapy-
                                world.net




                                „You live to express yourself, and in doing so, you enhance the world“ (Henry Miller)

				
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