Saturday, October 25, 2014

Asking for help (the hard way)

Some days I come home from work feeling as if my clients all hate me.

Now don't all jump in with the "oh, come on, they don't hate you! Why do you insist on seeing yourself that way? They appreciate you, why would you say such a thing?!" comments. 

Because that would be missing the point.

The things is: it was hard being a music therapist today. And, yes, I did (and always do) say to myself, "oh, come on, they probably don't hate you. Well, maybe they do, but probably it's not really about you." 

Here's what I'm thinking (hoping) (thinking and sooort of hoping, because, really, it's not a great thing to hope): I'm thinking my clients absorb so. Much. Hate. Every. Single. Day. And here I come in, Ms. Gosh-I'm-so-glad-to-be-here-guys-let's-listen-to-each-other-and-see-what-we-can-hear-in-each-other's-music. And there's crying and yelling and toileting accidents and more yelling and more crying and running around and trying to run out the door and handing me my guitar case and climbing on things and hitting each other and pulling and pushing and more toileting accidents.

And we sing, and we play about it, and we stop to get people cleaned up. Okay, well, usually I'm the one playing about it and singing about it, because my clients don't really use speech, and they are often too busy being overwhelmed. And I put it out there, "I know things have been really difficult for you, and it's a lot to cope with all the time." 

And I feel inadequate. I feel like one of those teeny little bandaids that keep falling off. My words and my music hardly cover any one of my clients' deep wounds. And I try to remind myself, "this is what chronic trauma and chronic grief look like. What can I offer in the music, in my words, in my presence? Will it mean anything?" 

Thanks to juliaf for the image!
Then I start in with the whole internal drama of "What if I'm just making assumptions? What if they just think I'm being a pain in the ass? And wrong? What if they wish I wouldn't come because I just remind them of what sucks in their lives and then I'm standing there singing and talking about it and happy to see them, for God's sake?"

So there I was driving myself home (and crazy) today, feeling kind of crappy. And I reminded myself of how much hatred my clients have internalized. How there's nowhere for it to...go! I mean, it just...sits there and festers in them. And my acknowledging it and hearing it is probably new and unexpected. And uncomfortable. 

Listening to the hatred many autistic people (especially those who live in congregate care) have been asked to hold over and over again is plain intense. And I leave sessions feeling as if my clients hate me.

Actually, though, after the initial "oh, woe is me" phase, I do manage to realize, "um, this is countertransference." And I start to wonder if what's really happening is that my clients are asking me to help them - to help them cope with the hatred they're having a hard time metabolizing. In their own way, I think they're asking me to hold on to the hate, to figure out what to do with it, say it out loud for them, and help them find a way to make sense of it. 

And the only way they can ask for that help is to get me to a point where I feel as if they hate me. And I have to be able to experience that awfulness. That terrible "nothing I do has any effect on you, I feel as if I have no power over my life" feeling.

Because until I've fully gone through the pain and rejection with them, they don't know that I've heard them. And until I go through it I don't know how they're feeling.

Next week, I will go back to them. I will sing about it, and I will say it out loud and give it a voice in the music. And hopefully the relationship will grow just a little deeper. Because I allowed myself feel as if they hate me.


This is one of the songs that came up in the session. 



Monday, April 7, 2014

5 Reasons Why You Need To Process in Music Therapy


I was off listening to a terrific podcast on processing over at the Music Therapy Round Table (and I highly recommend you go over and give them a good, solid listen). Well, I wanted to make a comment, but it turned out to be, like, six paragraphs, so, um, I figured I'd better head back to my own blog home and write it all out here and link it back to the hardworking Round Table folks: Kimberly Sena Moore, Rachel Rambach, Michelle Erfurt, and Matt Logan

As Michelle mentioned (either in the Round Table podcast or the Music Therapy Pro podcast), this business of processing (especially in clinical supervision) is kind of my "thing" (which makes it all sound a little...suspect) (but, really, it's not). I mean, if we're going to be honest (and I think we must), this whole blog is about me processing my experiences as a music therapist. 

I'm determined (determined, I say!) to convince the  music therapy world that we need to make processing a regular part of our work routine. And, yes, I'm sure I've probably said all this before, but I'm saying it again. And this time I'm going to try to be more succinct (stop snickering, I can do this). Okay. Here goes:


5 Reasons Why You Need to Process in Music Therapy:   


1. Processing helps you move your work to a deeper level.
Put simply: processing helps you move beyond observation to trying to understand what you’re seeing, experiencing, hearing, noticing in a session. Matt Logan wisely pointed out that a part of processing is looking at the relationships between the therapist, the client(s) and the music. It's so easy to get caught up in “what do I do? What should I do next?” and completely forget to look at what’s there in the session in a deeper way.

 2. It helps you gain a better understanding of what you're doing and why. 
Thinking through your sessions and trying to understand what happened in your sessions helps you get a stronger grip on the ever-present question:
 What is music therapy?
The longer you practice, the more your understanding of the work you do evolves and your answers to that question change and grow more meaningful. Processing asks you to consider: what is the role of music in my work? What is therapy? Who are the people I'm supporting? 
The more deeply you understand your work the better able you are to communicate why a client, a facility, an organization, a state, a country, the world needs music therapy.  

3. We all have feelings about our clients, and it's important to consider their impact on the therapy process. 
You have feelings about your clients, I have feelings about my clients. It's a normal part of therapy called countertransference. It doesn't matter who you work with (infants right on up through elders) and it doesn't matter how long you've been working and it doesn't even matter what approach you use. It's all part of the process. 
And the things is: just because you aren't necessarily having strong feelings or reactions you might think of as being "negative" (sad, angry, frustrated) it doesn't mean that your feelings aren't getting in the way of your clients' growth. Of course, I'm not saying that they are - just inviting your awareness that they have the potential to do so. 
I'll use myself as an example:
When I pause and reflect on the folks who are in my caseload, I notice there are some clients who stick with me all the time, because the work with them is difficult (or because they appeal to me in some particular way), there are some folks who I avoid thinking about, some who I forget about entirely, and some whose sessions I truly enjoy. 
Processing helps me step back and look at the larger picture of what’s happening. Otherwise, I can easily get bogged down in the "session notes version" of things (you know...what happened first, then what happened) and never move beyond it. 
Processing means I start to be curious and ask questions: 
Hm, why do some of my clients appeal to me more than others? Why do some not? What is it about some people that makes me completely forget about them until I see them in a session? Why is a particular client frustrating me so much? What's my role in this? Is s/he reminding me of someone else in my life? Is my complete joy in working with a particular group of clients making it hard for them to explore feelings of anger they may be feeling toward me (whether it's about me or not)? Is my discomfort about a specific topic obvious to my clients to the point that they're they avoiding looking at it to "please" or protect me


4. Processing helps you realize that music therapy doesn’t usually happen in one single session 
Well, okay, depending on where you provide services, sometimes it does. In general, though, processing helps you start to put things together (from one session to the next, over a period of time of working with someone, etc.). If you’re someone who tends to use an activity/therapeutic music experience approach, it’s important to think about what’s going on from moment to moment in a session that you might not have thought to look at. A process paper can help you do this and encourages you to ask questions, such as:
What happened? What patterns am I noticing in our sessions?  Then you move on to: What was I hoping to do with this particular person/group? How did it go? What do I think about that? 


5. Processing with a clinical supervisor helps you see your blindspots.
You don’t see your blindspots. That’s why they’re called blindspots. You don’t know what you don’t know! And, like anybody else, you don’t think to ask yourself something you wouldn’t have thought or known to ask yourself.
And that's okay! That's why there's such a thing called professional clinical supervision!  Yaaay!
Processing with a clinical supervisor helps you begin to see things you might not have looked at before. It doesn't mean you're a bad therapist. It just means that having an extra set of eyes and ears (who happen to have more experience) will help you think about things you hadn't thought to think about before. (Shout out to Michelle Erfurt for your great point that you didn’t really look at stuff to the extent you did until you had supervision!)

So, lovely music therapists: What new and unexpected thoughts are you thinking about your clients and about your work? 



Sunday, January 12, 2014

It's that time again (and not a moment too soon!) - A guest post from Judy Simpson


January marks the beginning of our annual Social Media Advocacy campaign, spear headed by the incomparable Kimberly Sena Moore. This year I'm feeling a particularly strong affinity for our theme, which is exploring and honoring our unique identity as music therapists, as I'm finding myself in the distressing position of having to fight to keep a long-term music therapy position in our facility, a battle which we may be losing. 

I will be working hard over the next few days to clearly and succinctly articulate to the state decision-makers exactly what, how and why the Music Therapy Unit offers the men and women in our developmental center something they are unable to get from any other service. While I'm doing that, I'm truly grateful to Judy Simpson (who has written a guest post honoring this month) for helping me get started by so beautiful saying...

“We are…MUSIC THERAPISTS!”

Judy Simpson, MT-BC
Director of Government Relations, American Music Therapy Association

When I started my career as a music therapist in 1983, it was not uncommon for me to describe my profession by comparing it to other professions which were more well-known.  If people gave me a puzzled look after I proudly stated, “I use music to change behaviors,” I would add, “Music therapy is like physical therapy and occupational therapy, but we use music as the tool to help our patients.” Over the years as I gained more knowledge and experience, I obviously made changes and improvements to my response when asked, “What is music therapy?” My enhanced explanations took into consideration not only the audience but also growth of the profession and progress made in a variety of research and clinical practice areas. 

The best revisions to my description of music therapy, however, have grown out of government relations and advocacy work.  The need to clearly define the profession for state legislators and state agency officials as part of the AMTA and CBMT State Recognition Operational Plan (http://www.musictherapy.org/policy/stateadvocacy/) has forced a serious review of the language we use to describe music therapy.  The process of seeking legislative and regulatory recognition of the profession and national credential provides an exceptional opportunity to finally be specific about who we are and what we do as music therapists. 

For far too long we have tried to fit music therapy into a pre-existing description of professions that address similar treatment needs.  What we need to do is provide a clear, distinct, and very specific narrative of music therapy so that all stakeholders and decision-makers “get it.” Included below are a few initial examples that support our efforts in defining music therapy separate from our peers that work in other healthcare and education professions.

·        Music therapist’s qualifications are unique due to the requirements to be a professionally trained musician in addition to training and clinical experience in practical applications of biology, anatomy, psychology, and the social and behavioral sciences.

·        Music therapists actively create, apply, and manipulate various music elements through live, improvised, adapted, individualized, or recorded music to address physical, emotional, cognitive, and social needs of individuals of all ages.

·        Music therapists structure the use of both instrumental and vocal music strategies to facilitate change and to assist clients achieve functional outcomes related to health and education needs.

·        In contrast, when OTs, Audiologists, and SLPs report using music as a part of treatment, it involves specific, isolated techniques within a pre-determined protocol, using one pre-arranged aspect of music to address specific and limited issues. This differs from music therapists’ qualifications to provide interventions that utilize all music elements in real-time to address issues across multiple developmental domains concurrently.

As we “celebrate” 2014’s Social Media Advocacy Month http://musictherapystaterecognition.blogspot.com), I invite you to join us in the acknowledgement of music therapy as a unique profession.  Focused on the ultimate goal of improved state recognition with increased awareness of benefits and increased access to services, we have an exciting adventure ahead of us. Please join us on this advocacy journey as we proudly declare, “We are Music Therapists!”

About the Author: Judy Simpson is the Director of Government Relations for the American Music Therapy Association (http://www.musictherapy.org). She can be reached at simpson@musictherapy.org