A solid, trust-based, positive relationship between the practitioner and individual is fundamental to achieving effective outcomes. Establishing this inter-relational precedent early on is particularly pertinent in this realm because it directs the therapeutic process down the path of least resistance.
Building a trust relationship is an interaction-by-interaction process. Just like building a wall is a brick-by-brick process. Placing a cracked brick, leaving gaps, or any other form of slovenly, inattentive work will compromise the structural integrity of your wall of trust.
Of the best ways to build trust in a therapeutic music session is to facilitate the occurrence of what I call 'pivotal moments'. A pivotal moment is when an individual experiences the successful completion of a musical task with a challenge variable. This accomplishment results in a boost in confidence, a dopamine release and ultimately ensconces the individual in a pattern of automatic, functional responses to sensory stimuli.
Pivotal moments are achieved by levering something called 'the zone of proximal development', a term coined by the psychologist Lev Vygotsky that describes a learning transition between 'can't do and 'can do'. This transitional space is where the individual can conceptualise the completion of a task but needs varying degrees of support (known as scaffolding) to get it done. Thus turning a 'can't do' into a 'can do'.
The challenge variables needed to bridge this space should be hard enough to sustain interest but easy enough to move through the zone of proximal development without the risk of a meltdown. These variables (essentially music interventions in and of themselves) should contain both volitional and prescriptive elements to foster a 'can do' state.
The volitional aspect would be to encourage choice. These could be static choices such as 'what song shall we play?' Or dynamic choices such as incorporating a mix of drums as options for spontaneous play.
The prescriptive element could be: assigning numbers or colours to notes and using a corresponding chart to play tunes, choosing a melody, regulating the content or any other similar variable.
Both volitional and prescriptive elements should be increased or decreased depending on the needs of the individual and most importantly, the interplay between the two should be observed. A therapeutic music session has the potential to be a constant stream of change.
Furthermore, prescriptive elements could become volitional. For example, the practitioner sets a steady tempo (prescriptive) and the individual decides to speed up without detriment (volitional). Conversely, volitional elements could become prescriptive. For example, if the individual has decided to play so fast as to induce a state of over-arousal, then a slowing down of the tempo or cessation of the activity should be prescribed.
Remember that as time passes, the bar will need to be raised with each interaction. The trust engendered by continued dynamic, responsive navigation though a multitude of interventions will pave the way to powerful changes across the board: communication, interaction, sensory regulation, behaviour, social integration, motor function, cognition et al.