Borrowing Ryan Howes' Seven Questions

In response to my last post Adam suggested I answer the seven questions Ryan Howes posed to well-known psychotherapists.  That seemed like an awfully nifty idea to me, so I'm going for it.

1.  How would you respond to a new client who asks: "What should I talk about?"

Hmm, this is an interesting question for me, because the vast majority of the folks I work with don't use speech, and they all have some form of developmental/intellectual disability.  Also, since I'm a music therapist, I think the larger fear tends to be, "oh, my God, she expects me to know how to play music!"  Given that fact, I do spend some time talking about what music therapy is, some of the ways we'll be using music, and making sure to explain that music therapy is not meant to be for professional musicians (although there are music therapists who do work with people who fall into that category).  Then I do a lot of modeling and invite people to begin to play with sounds in a new way. 

It actually takes quite a while before my clients are able to grasp the concept of psychotherapy. In spite of their having experienced years of skill development activities and behavioral interventions, most of the people I work with have rarely had the experience of someone doing psychotherapy with them- let alone music psychotherapy.

2.  What do clients find most difficult about the therapeutic process?

I work with folks who live in an institution and who have major abandonment issues (often complicated by trauma and ambiguous loss), and I think the hardest things for a lot of my clients is saying goodbye at the end of each session.  I use a relationally-based approach, and it sometimes takes many years (I'm not kidding when I say "many"- it has sometimes taken up to 5 or 6 years) to develop a working relationship with my clients. Once that relationship is established, all of those painful, unexplored, unacknowledged feelings of being left surface with a vengeance. Termination isn't a lot of fun either, but that happens a lot less often than ending weekly sessions.  

3.  What mistakes do therapists make that hinder the therapeutic process?

I can speak to mistakes I made as a beginning therapist.  One major one (in the beginning) was making assumptions about what my clients knew/understood and what they didn't.  I always treated my clients (labels and all) respectfully, but it was a surface respect.  As I truly got to know them (and received good clinical supervision and learned how to really engage in the process of music psychotherapy) that turned into a deep respect for the wholeness and intelligence within each person.

Another mistake I made initially was not focusing on the relationship.  I spent a lot of time trying to get my clients to do musical things, so I ended up focusing on what they were doing/not doing and on the things that I wanted them to do instead of focusing on the process and the building of the therapy relationship.

Something that has challenged me (and students I've supervised) over the years is thinking I needed to know the answers, always know what to do in a session, and be the "perfect" music therapist.  I guess that's probably a familiar stumbling block for a lot of therapists. An extension of that is not taking vacations when I've needed them. 

An issue specific to music therapists is the need to know when we are avoiding using the music in the process and when we are using the music to avoid the process.  Something my clinical supervisor pointed out to me many years ago is that playing music through the whole session is like having a verbal psychotherapist talking the entire time and not letting the client say a word!

4.  In your opinion, what is the ultimate goal of therapy?

I would say that coming to terms with and accepting ourselves as we are in this lifetime and maybe not taking ourselves so seriously would be an ultimate therapy goal.  But I'd probably be projecting.  :-)  

5. What is the toughest part of being a therapist?

Institutions can be a hard place to live.  Knowing that many of my clients missed out on opportunities to grow up with their families because of now outdated beliefs about disabilities, knowing the continued overt prejudice and disrespect they continue to experience because people can't or choose not to be bothered to look beyond the outside appearances or question beliefs about developmental and intellectual disabilities, knowing how much abuse goes on, and, worse, knowing that, were my clients to move into a group home, their risk of abuse goes even higher, because there's even less oversight...these things truly hurt my heart in ways I can't even describe.

6.  What is the most enjoyable or rewarding part of being a therapist? 

There's a very specific moment I most love in my work.  If you read my blog, you know that I have to go pick up my clients from their buildings and walk them over to mine.  As I said, above, it can take a long time to establish any kind of rapport. The first time my client jumps up to meet me for his/her session is a special moment indeed, because it means that I've become a specific person to him/her, and it indicates to me that s/he is now invested in the work we're doing together.

7.  What is one pearl of wisdom you would offer clients about therapy?

I must admit this question has me a bit stumped.  I'd probably encourage my clients to not give up hope.  Also a lot of my clients don't quite get the "as if" part of therapy, and they seem to feel very frustrated with me for not being able to "fix" their lives by taking them away from their particular challenging life situation.  I remind my clients that their goodness, their happiness, and their worth doesn't come from being in therapy or from me (the therapist).  It's an inherent part of their being human.  They might discover those things about themselves in the context of music therapy, but they were already a part of them.  The challenge is to recognize those things in ourselves (because it's not only our clients who struggle with this) outside of the therapy space and to live from that truth.