The Mindful Music Therapist

Beautiful and thought-provoking quote

2012-01-20T06:00:00.005-05:00

From the transcript of the January 15th, 2012 On Being episode in which Krista Tippett interviewed singer/songwriter/author Roseanne Cash.

Ms. Cash: Sure. You know when I first became a performer, I was so anxious about it and it took me a long time to grow into it, because I thought that being a performer was about getting a lot of attention and I didn't want that much attention. I liked the writer's life. I liked the privacy and the solitude and being inside my own little mind cave. And over time I realized that it's not about the attention, it's about the energy exchange. I'm doing something for them, but they're doing something for me too, you know? And there's no hierarchy really. It's — and some nights that exchange is so beautiful, you know, I can feel my own energy stretching out to the far reaches of the room and theirs coming back. And there's something sublime about it, and also the temporal nature of it that at the end of the night it's over.

Ms. Tippett: Right.

Ms. Cash: It's like a monk's sand painting, it's wiped clean. And so you can't grab it, you know, which is part of the — the mystical beauty of it. You can't repeat it. You know, the next night might be just awful, like, your energy might not expand beyond two feet beyond you and they are not giving you anything and it doesn't work, but you know, that's the way life is.

Ms. Tippett: Yeah, it's that spiritual discipline of knowing impermanence.

Ms. Cash: Knowing impermanence and showing up even though you don't know what's going to happen.

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I love that!

"...showing up even though you don't know what's going to happen."

Isn't that gorgeous?

Aside from the fact that it was just...overall, a beautiful conversation about creativity and music and spirituality and how it all melds together, this particular snippet just captured my attention instantly.

Here's what I loved about it:

First, it is so absolutely descriptive of my daily experience as a more or less psychodynamically-oriented, relationally-focused music therapist. I am not (really, I am NOT), by nature, what one would call a "flexible" human being. However, many years of practicing music therapy using this approach (and taking part in my own therapy, of course) has gotten me to a point where "showing up even though you don't know what's going to happen" has become okay. It's a concept I've grown into and have come to embrace with a comfortableness I would never have imagined for myself.

Second, I was drawn in by Roseanne Cash's sharing of her struggle, as a musician and as a writer (basically, as an artist), to come to terms with her art- playing, performing, being musically present, which artistic voice to choose, and what all of that means to her.

Periodically, people will ask me, "Does one have to be a good musician to be a music therapist?" And, until very recently, I've always responded with what my clinical supervisor has said to me, which is: "Well, the more accomplished you are as a musician, the more you have to offer your clients." And that still makes sense to me.

But, in a recent email conversation with my colleague, Brian Abrams (who just had a terrific article published in the Arts in Psychotherapy journal), I realized that not only do we, as music therapists, benefit greatly from this type of engagement with our experience as artists and musical beings, but, on some level, maybe because of our chosen professions, we actually need to go through that kind of a struggle.

Put another way, I think a willingness to come to terms with our own sense of what it means to be a musical self and building an identity as musicians and artists enables us to be present to our clients in a more profound, authentic, and meaningful way.

You might even say it prepares us to "...show up even though [we] don't know what's going to happen."

Music Therapy Advocacy Month- Our Most Powerful Advocates

2012-01-16T21:50:00.001-05:00

Advocacy --> Recognition --> Access

Since 2005, the American Music Therapy Association and the Certification Board for Music Therapists have collaborated on a State Recognition Operational Plan. The primary purpose of this Plan is to get music therapy and our MT-BC credential recognized by individual states so that citizens can more easily access our services. The AMTA Government Relations staff and CBMT Regulatory Affairs staff provide guidance and technical support to state task forces throughout the country as they work towards state recognition. To date, their work has resulted in thirty-five active state task forces, two licensure bills passed in 2011, and an estimated ten bills being filed in 2012 that seek to create either a music therapy registry or license for music therapy. This month, our focus is on YOU and on getting you excited about advocacy.

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A story Paul Nolan (my teacher when I was in graduate school at Drexel University) loves to share is about how he used to constantly drill us in class to answer the question he insisted our clients would inevitably ask us: What am I going to get out of this? How is music therapy going to help me?

I, who had already been a music therapist for thirteen years with people who didn’t use speech to communicate, was convinced this was never going to happen.

Ahem.

Well, I was doing my internship at Hahnemann Hospital when I was referred by one of the psychiatrists to work with a man who was struggling with depression related to the spread of his cancer. Would you believe, the first words out of his mouth after my brief introduction and explanation of who I was and what I was there to do, were: What am I going to get out of this? How is music therapy going to help me?

Seriously!

I think I probably scared him a bit when I laughed out loud, and I asked him if my teacher had put him up to this. And then, after explaining Paul’s perpetual insistence on our being able to answer this question, I answered him.

He agreed to let me sit with him and play music. But he was absolutely clear in his refusal to take part in any way other than to suggest a few songs and to listen. So that’s what we did.

We had a couple of sessions, and he’d gone home and that was the last I’d heard.

A few weeks later, I happened to be walking to the nurse’s station in the different unit of the hospital, and, as I walked by one of the rooms, I heard someone call out: Hey! Music Lady! Would you mind coming in? I have something to show you.

As it turned out, he was back in the hospital- sicker this time. And, although his participation during sessions had been rather minimal, he had remembered his experience in music therapy when he went home. He said he’d told his family all about it. And when he had to be re-admitted he had decided to bring along some of his own music (that he wanted to tell me about), and he also brought a record album (yes, a vinyl record album) of a band made up of a bunch of guys he knew back in the late 1970s. During one of his previous music therapy sessions he mentioned that he had taken a photograph of them, and they liked it so much they made it their album cover. And he had been hoping I’d come by, so he could show this to me.

Now, many years later, as I’m sitting here contemplating this idea of advocacy, I’m realizing that one of the ways we start to know how important music therapy is to our clients is when they begin to become their own advocates- when they want more music therapy, and they do what it takes to get services.

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A question that often comes up when I tell people I’m a music therapist and I work with folks who have a variety of intellectual and developmental disabilities (just after the usual “How interesting! What is music therapy?” question) is: How do you know it’s making a difference? If your clients are severely disabled and can’t tell you, how can you know whether or not your clients are benefiting from music therapy?

And I tell them sometimes it takes the form of my realizing that, after years of my client sitting and waiting for me to invite him or her to music therapy, he is now standing up when I come in the room to greet me and pull me to the door so we can go to his session.

Or it's deciding that snack time (which can be considered one of the holiest times of day for some of my clients) is less important than going to music therapy and rushing through snacks so we can get to a session.

At other times, it’s someone picking up an instrument for the first time to play it and not throwing it across the room.

I always think it’s cool when my clients (again, this is after many years of waiting for me to approach them and ask if they want to come to music therapy), see me go into the room where we have our group session, get up on their own and start to come in while I’m preparing the space.

An even more important way that I know what we're doing matters and is "working" is when my clients tell me (usually through their actions) "no" they'd rather not have music therapy on a given day. Because, ultimately, isn't being one's own advocate what we're working to support?

So, in this month of music therapy advocacy, I want to propose the following:

There is no more powerful music therapy advocate than a person who has been receiving our services and has gotten to a point where s/he wants to make sure those services continue.

And what a wonderful testament to the importance of the work we do when our clients can become their own advocates!

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For lots more blog posts about music therapy advocacy,

please visit:

http://www.musictherapymaven.com/social-media-advocacy-month/

Reflecting on feelings of powerlessness (a video blog)

2011-12-06T18:16:00.000-05:00

I didn't say it specifically in the video, but I think my whole countertransference reaction was very much about feeling a sense of powerlessness - my own ("I can't fix it for you, and I hate that.") as well as what I believe was my client's experience ("I feel abandoned and forgotten and unable to change my life.").

A musical portrait

2011-11-29T06:00:00.017-05:00

Image by mommy peace via FlickrAt first I thought he was angry with me. He certainly looked quite solemn. True, I'd been away for a couple of weeks, but usually he's at least willing to stand up and go to the Music Room with me.

So I pulled up a chair and sat next to him. "You don't want to go to your session?" I asked. He hung his head down. "Okay. Can I just sit with you for a little bit?" He looked up briefly and then face down again.

We sat for a minute. "You can come and tell me in the music if you're upset about something." He was listening, but not moving. "You know, I'm going to just go get your jacket and hold on to it. If you still don't want to come with me that's fine. But if you do, we'll have your jacket. I don't know. Maybe we could just go for a walk. It's pretty nice outside."

I went to the coat closet, fished out his, and went back to sit next to him. The guys in his group were all watching television, so I chatted about that. After a little while, he half-smiled, got up and reached for his jacket. "Cool!"

We headed outside into the sunshine and walked slowly. I wasn't sure whether we were just walking or if we'd be going to do his session. As it turned out, we made it to the Music Room.

He moved the instruments I'd put out for him onto the bench at the end of the couch and proceeded to lie down so he was facing me where I was sitting at the piano. I could hear, from the way he was breathing, that his sinuses were really giving him a hard time.

His facial expression was still quite serious, unsmiling. I sang a greeting and asked how he was feeling. He responded with a heavy sigh.

"I realize you may have some feelings about my having been on vacation. I wonder if maybe you're feeling angry with me." And I invited him to look my way if that was the case. He did not.

Oh. Hm.

"Feeling abandoned?" A little bit of eye-contact.

We stayed there, quiet. Where to go with this?

"I'm having a hard time figuring out what might be going on for you today. I'd like to play a musical portrait of what I think I might be seeing or hearing, maybe just sensing, from you right now. If you can, will you help me by letting me know if what I'm playing makes sense. Also if it doesn't sound right, can you find a way to steer me in the right direction? I'll do my best to listen."

I played, using the piano. It was halting, dissonant- really quite dissonant, and it didn't feel very grounded. I guess you could say it sounded like someone floating and unsettled.

As I played, I realized I had "heard" his initial response accurately. He wasn't angry. The music he inspired didn't sound remotely angry. It sounded, and felt, very sad. And it probably wasn't really about me.

"I misunderstood. I'm sorry. I think, as I'm listening to the music, I might be hearing your sadness." Slowly he turned to face me. Wow. I felt his sadness too.

What now? Where to go with all this sadness?

As I thought about how to respond, how to be present, I was reminded of my friend, Greg, who often quotes John McNeill to me: "If anyone is willing to enter my private hell and stay there with me, then there are grounds for hope."

I invited him to hum with me as I played. I started the music where I had left off- at the musical portrait. Gradually, the sounds on the piano became slightly- only slightly- more consonant. Eventually, I was just moving between A flat and B flat, humming quietly.

I heard sounds from him- not a lot, because it was difficult to vocalize with his nose all stuffy as it was. I moved from humming to a quiet "ee" sound, thinking it might be an easier sound for him to make.

His eyes closed and he smiled briefly. I thought he might fall asleep, as he often does. But he didn't. He listened. And we sat together in the sadness and in the music.

It was time to go. I sang a quiet goodbye, reminding him I planned to be back on Thursday. I got up to get my sweater, and he followed me to get his jacket.

He took my hand and we walked back to his cottage in the sunshine.

Behavior? Or unanswered question?

2011-11-27T08:00:00.009-05:00

Image via Wikipedia
For at least the twelfth time in the last few years, I sat in a session today with one of my (many) clients who doesn't use speech, asking him if he might put his thoughts and reactions to the fact that we hadn't seen each other in two weeks (because I was away at the music therapy conference) into the music, and I was struck by the thought, "Geez, what if he has questions that he wants me to answer?"

I don't know whether anyone else ever wonders about this, so I'm throwing it out into the blogosphere, because it bugs me.

All of us have questions, and when we're little kids we have about a million of them! And we ask our parents (and aunts and uncles, and any adult person, frankly) at least nine hundred thousand of the many gazilions of questions that happen to come into our excited little curious minds.

But...my clients who don't use speech can't do that! And who's to say they don't have a million questions of their own? Yet, how do you ask all your questions when talking isn't your thing?

So, as I've given this some thought, my theory is that the folks I work for are sort of forced to come up with other ways to get their questions answered. And those ways may involve doing some unusual things- maybe we could call them experiments- although more likely we call them "behaviors"- which often seems to imply "doing something that someone finds aversive, offensive or annoying and must attempt to stop".

Hm.

Well, what if those "behaviors" and unexpected and odd things that this person is doing are really about asking questions that s/he needs to have answered? And what if instead of listening and collaborating to try to help figure out the question/answer, we're focusing on the fact that the "behavior" must go?

Grateful

2011-11-24T16:57:00.000-05:00

On this quiet Thanksgiving day, it seems right to reflect on the many aspects of being a music therapist for which I'm grateful.

Since I've just returned from a trip to Atlanta where I participated in the national music therapy conference, it's one of the things that's very much on my mind (oops! That was very "Georgia On My Mind" there, wasn't it?). To that end, I'm sending out a big thank you to all the folks at the American Music Therapy Association (AMTA) as well as the conference chair-people and numerous volunteers for the huge amount of work that went into putting together a conference of this size! It was a great conference, and I truly enjoyed being there.

I'm also appreciative of the fact that I had the opportunity to meet many of the large collection of music therapists I've gotten to know through their blogs, tweets and list-serv postings in person. Even though I've been a part of this field for quite a long time, it was a comfort to be a part of an already existing online community, many of whom would be at the conference. Now I can imagine all of your faces and voices as I read your online thoughts! Yay!

A particularly cool element of all that was having the opportunity to be a participant in a social media as music therapy advocacy tool panel, conceived by Kimberly Sena Moore, and joined by Michelle Erfurt, Michelle Strutzel, Matt Logan, Kat Fulton, Sarah Sendlbeck, Meryl Brown, Rachel Rambach, and Bill Matney. What a joy to be with this articulate and energetic group of professionals!

The renegade jam session (for those of us who can not function after 11 PM) was a lot of fun, and we sang and played our collective hearts out in a quieter corner of the giant hotel.

As I gradually transition back to my usual hectic schedule (not to be confused with the completely crazy conference schedule! Yow!), I extend gratitude for the fact that I have a job and work with clients who, even after almost 24 years, challenge me to learn and grow and get better at serving them. And nowadays I get to add my supervisees to the list of folks who help me think and invite me to push the limits of my knowledge.

My co-workers at the developmental center also inspire my appreciation. We have struggled together to understand what might be going on when our clients try to convey their distress. At times we've sung and laughed and at times we've cried together. We don't have an easy job, and, at this point, I don't think we'd really want one.

I'm thankful for the happiness that comes with playing music (either by myself or with other like-minded folks), and when people say, "wow, you're really lucky," I have to say, "Yes! Yes, I am!"

Happy Thanksgiving to you all. May you also feel lucky and fulfilled in your chosen profession!

Going South!

2011-11-11T15:02:00.000-05:00

I know, I know, where the heck have I been?!

I'll tell you, it's been busy around here. Mostly, though, I've been preparing to present a five-hour CMTE at the national conference for music therapy in Atlanta next week! I haven't been able to attend a national conference in a few years now (not since 2006 when it was in Kansas City, MO!), so I must shout "hooray" that I'm finally able to go again (meaning, it's within driving distance).

What will I be talking about (you may well be wondering)? "Developing the Art of Self-Reflection: Exploring the Relationship Between Therapists and Clients" (I mean, how would you recognize me if I didn't have a ridiculously long title?).

I'm quite excited about it! From what I gather, so far anyway, there will be around ten people there, and that sounds like a very nicely sized group (although I imagine we could work just as well with a few more). I'm planning for a lot of interaction, music-making, and thinking (truly...who wants to sit for five straight hours and listen to me lecture? Well, lucky for you, I can't sit for that long these days).

Anyway, here's the blurb. If you have any thoughts about the topic, do tell! If you end up coming to the presentation, I'm a fan of feedback! I'm so looking forward to meeting those of you who are heading down to the conference (especially the lot of you I only know through online adventures). Safe travels!

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Developing the Art of Self-Reflection:

Exploring the Relationship Between Therapists and Clients

The relationship between therapists and their clients is an intimate one. When we add music, the level of intimacy increases. As with any relationship, as the level of intimacy increases, the levels of resistance, uncertainty, and investment also increase- on both the therapist's part as well as that of the client. One the one hand, we may put up unconscious barriers, preventing a deeper connection with our clients. On the other, we may become so merged as to be in danger of violating important therapeutic boundaries. As such, the music therapy relationship can become difficult to negotiate.

In this interactive workshop we will begin by defining countertransference. Using case examples, we will work toward an understanding of: What is it? Where does it come from? How does it affect therapy? How do we begin to identify and use countertransference in our work with clients?

Participants will then be invited to share some of the difficult aspects from their own work with particular clients that challenge them in some way. Through dialogue, journaling and music-making we will process and explore some of the following questions: What are some of the ways we use to avoid looking more deeply at some of the clinical challenges we face as professional music therapists? What are some of the beliefs and ideas we, consciously or unconsciously, hold about ourselves, about music therapy, about our clients? And how do these ideas and beliefs affect our work and our clients? Why are certain topics so difficult to bring up in sessions- even if we know our clients need us to do so? What is it about the topics? What is it about our beliefs and ideas that makes it scary? What kinds of messages are being communicated by us to our clients when we don't address difficult issues?

Through these workshop experiences, participants will work toward developing the skill of self-reflection, using a variety of techniques to process thoughts and reactions that emerge in relationship to their clients.

What do I (think I) know?

2011-09-16T21:21:00.000-04:00

Gosh, it's been an absolute age since I posted. Ack! Hopefully you're all wondering what the heck is going on, and asking yourselves, "where in Pete has that girl been!?"

So, here's the scoop: this has been the summer of ailments (and, evidently, I forgot to mark it on my calendar). No, really. It's been a little bit ridiculous.

Since April, I've caught two colds (I hardly ever get sick), one monster case of allergies that led to never-ending coughing and ended up requiring two asthma inhalers (I don't have asthma), and, just because life wasn't going to be complete without it, I've been limping (very painfully) around for four solid weeks with my backside, hip, thigh, and knee out of whack.

Honestly! Is this truly necessary?

I say all this to you, not just to whine and kvetch about it (because, I mean, who would I be without my whining and kvetching?), but because getting around with extreme pain (it's finally starting to settle down somewhat, thank goodness) has forced me into an awareness I've never had before.

I'm ashamed to admit to you how completely ignorant I've been of this fact: There are a lot of people walking around in constant and terrible pain. They're not complaining and carrying on (like I am). They just go about their business and do what they've got to do. In pain.

It's one thing to get this on an intellectual level (and, of course, I've always understood this on an intellectual level), but that doesn't mean anything.

Sure, I've seen my dear friend get to a point where she's had to walk around with a cane (and only for very short distances) because she has extremely painful knees. I always known that she's in pain most of the time, but until recently I'd only understood it on a peripheral level.

Until I experienced what it's like to be absolutely unable to get from point A to point B (forget the fact that moving made me want to scream and/or cry)...I had no clue.

Do I have a point I'm trying to make here? Well, yes, I think so.

I'm realizing (yet again) how important it is for me to question some of the things (maybe many of the things) I think I "know". Because a lot of the time...I really don't. Often, all I have is some vague idea in my mind about what someone's experience is- whether the person's in pain, has a serious illness, comes from a culture or ideology different from mine, has some sort of a label (whether s/he wants that label or not), is socially ostracized...The list goes on indefinitely, as you can imagine.

I am struck by how limited I am in my understanding of what any of these things actually mean in terms of a person's life and how it affects who the person is and how they relate to other people and to the world.

In short, I am, yet again, astonished by how much I just don't know. And, more to the point, how much I'm not even aware I don't know. And I have to ask myself: as a music therapist, what are the things I think I know? And how willing am I to find out my assumption(s) may be incorrect?

Journal Prompt #5: A person of interest

2011-07-31T11:09:00.006-04:00

Image by On Being via Flickr
...And are we not of interest to each other?

The very last line of Elizabeth Alexander's poem- to which I'd only been half listening as I prepared breakfast with the radio on- came into my consciousness in such a profound way that I literally tripped over the garbage can, knocking it over, on my way to the computer to go and find it and re-read the whole thing.

And I again came to rest on the last line:

...and are we not of interest to each other?

How beautiful!

You are by now, I'm certain, well aware of my love of good questions. So, as you can imagine, on principle, I love Elizabeth Alexander's ideas about poetry and how it leads to inquiry. Here is what she had to say about the matter in the interview she did with Krista Tippett from On Being:

I was thinking about the act of asking real questions in poems as a kind of spiritual practice. I ask questions relatively often in poems and I ask them because I don't know the answer. And I ask them because I think that poems are fantastic spaces with which to arrive at real conundrum kinds of questions, to go as far down the road as you can of understanding something and then sometimes that road ends with a real question.

I wonder if one might describe the process of music therapy (and, indeed, maybe someone already has) as a form of collaborative poetry-making and inquiry- an effort to create an evolving piece of relational art- one that often ends with more questions than answers. And one that invites deep self-reflection and, as my mother (who is a poet) often points out, frequent editing.

...and are we not of interest to each other?

Elizabeth Alexander elaborates:

[The question] ...to me isn't about, oh, you know, I like her shoes or ...he has a fascinating job. It's much deeper than that. Our human beings who are in community, do we call to each other? Do we heed each other? Do we want to know each other? And I think reaching across what can be a huge void between human beings.

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As you consider your work as a music therapist (and as a participant in life), you might ask, not only do we interact with each other, but how do we interact with each other, who are we to each other, and in what ways are we with each other?

More questions to ponder:
*Are my clients "of interest" to me? In what ways are my clients "of interest" to me? As in, what do I mean when I think of someone as being "of interest" to me? How do I define "interest"? Is it as "you're an interesting person"? Or is it deeper than that? And how deep am I willing to go?

*Are my clients "of interest" in terms of how I am defined when I am with them? Are they "of interest" in terms of: "This is who I think you are in relation to me"? In other words, is the "interest" defined largely by the roles we play? And how willing/comfortable am I to look beyond the assigned roles?

*Does being "of interest: mean that I know certain things about you as my client? And how does that affect the power dynamics in our relationship? On another level, what and how much am I willing to know about you?

*What do I, as your music therapist, want you, the person called my client, to know about me? Are there things I wish you could know about me? And whose need am I meeting in wanting that?

*What if our clients don't hold our interest? What then?

My deepest thanks to Elizabeth Alexander for her inspiring poem and to Krista Tippett for the willingness to "go there" in her interviews!

You can read the entire poem and learn more about Elizabeth Alexander and her books of poetry here. And you can listen to (or read) the entire conversation (and many other engaging interviews) with Krista Tippett here.

Thank you!

2011-07-23T17:51:00.001-04:00

I want to interrupt this (not so) regularly scheduled blog to thank you, kind readers! My follower list just hit the big 50!

(And, with any luck, in five more years, so will I!)

Image via Wikipedia

Welcome to all of you, and thanks so much for supporting the Mindful Music Therapist!

The eyes have it

2011-07-14T06:00:00.002-04:00

I was very conscious of my clients' eyes this past week.

I'm not sure why I was struck more than usual this week (as opposed to most other weeks), but I noticed there was a lot of eye-contact (which you would kind of think wouldn't really be the case when working with folks who aren't usually all that comfortable with looking directly at people). Anyway.

Here's a summary of my, um, eye-catching (sorry) moments:

1. D stared at me for quite a while during his session. Really. I'd classify it as staring. Something was going on for him, which became even more apparent when he got up and pulled me to the Music Room door (which he has only done once or twice in the 13 years I've worked with him) and headed us back to the cottage. I found myself feeling uncertain as to what was going on with him. Was he excited? Angry? Attracted? Frustrated with me? When he decided to leave the session unexpectedly, I felt disappointed and a bit confused.

2. R looking at me rather intently and frequently today. This is very unusual for him, because he usually looks at my hands and at what I'm doing on the guitar. I have very little conscious memory of him ever even looking at my face! I was joking with one of the other music therapists at work that I must be doing one heck of a job. After working together for almost 23 years (seriously), R finally approaches me and greets me when I arrive in his home. Maybe this is an extension of that?

3. W has been expressing some intense feelings toward me. I have, of course, been responding with "that's not our relationship." During a recent session, I said to him, "you know, it seems as if I'm really frustrating you a great deal lately." He responded by looking at me. Very. Pointedly. [Insert slight squirm here.] And then he left his session early also. But this time, aside from feeling a bit confused, I also felt (yes) frustrated. ("Take that, you blasted music therapist!")

4. V greeted me today by scooting over to me, looking me in the eye, and taking both of my hands in hers when I arrived in her group. This, I must say, was a way friendlier "hello" than she had been using when I showed up over the past three weeks! (Observe, to your right, the fascinating and unusual unhappy face she somehow managed- without even intending it- to create on my arm with her nails...isn't that wild?) (And, no, don't worry. I'm fine.)

It certainly looks as if the eyes have it this week! (Sorry, again, for the dreadful string of puns.) (Really, I can't help it.)

Journal Prompt #4- Uncertainty

2011-07-12T15:16:00.000-04:00

Image by cowbite via FlickrOne of the hardest aspects of being a music therapist, at least for me, has been working to come to terms with the experience of uncertainty as I work with clients. I'm sure this won't come as a surprise to you, because I've written about it a number of times (here, here, and here- to name a few).

I think part of what makes it difficult to sit with the sense of "um, I'm not sure what's going on here" is this mythology we tend to buy into as music therapists (I guess as any kind of therapists, really) that tells us "you must always know what's going on with your clients and have the perfect intervention and/or response to address it."

Even after doing this for 24 years, there's still a nagging sense of "I should know" in the back of my mind- even though I know (intellectually anyway) that I don't have to know, and even though I'm well aware my clients aren't always ready for me to know (or aren't ready to know for themselves), and even though I realize it's just a matter of sitting with the feeling and trusting the process.

I understand that some of my uncertainty comes from the fact that I work with people who don't use the usual means of communication or ways of relating to people. Using a process-oriented approach (and not a product-oriented one) also increases the likelihood that I won't always know what's going on in my sessions.

And, really, I'm okay with all of that. I'm just...very aware (shall we say) of a feeling of "hmm" when I'm faced with a situation and I'm not sure how to proceed.

So, lovely readers, I invite you to join me in looking at this part of our work as you journal.

-Do you allow for a bit of uncertainty as a part of your music therapy practice? If you do, in what ways? If you don't, why not?

-How do you approach uncertainty when it comes up in your work as a music therapist? Do you power through it on your own? Do you seek supervision or consultation? What kinds of questions do you ask yourself?

-How do your beliefs about what it means to be a "good music therapist" affect the way you deal with uncertainty? What does it mean about you, about your abilities as a music therapist, about how people might view the field of music therapy to "not know" what to do or how to approach a therapy situation?

-What if the "perfect" song or intervention isn't coming to you and you're in the middle of a session?

-What are some of the things you're doing in your music therapy practice that help you avoid the experience of uncertainty? How does that affect the therapy relationship? What might you be communicating to your clients?

I'd love to hear your thoughts about uncertainty (written out, sung, played as a piece of music, acted out as a play, whatever works for you), so please share them freely.

Holding on to our clients' stuff

2011-06-12T14:15:00.002-04:00

I seem to be slowly amassing a little pile of stuff from RD (the young man who makes sure I take a little bit of his space along with me when I leave his cottage).

FIrst it was the purple battery cover for something along with the red disc-ish thing.

Then, a couple of weeks ago, I had to ask one of the other music therapists (who also works in that cottage) to take back the two air hockey strikers that he'd put in my instrument box . I figured they'd need them if anyone wanted to play air hockey. (Uh-oh, I think I just realized what that red disc-ish thing is- it's probably the puck! Oops! Guess I'd better get that back to the cottage as well. The strikers aren't going to be of much use if there's nothing to strike. Ulk.)

Then last Saturday he put in two dominoes, and today it was a big yellow wooden bead.

Today he used the cabasa and the kalimba, and he put them back in the instrument box (not under the couch or on top of a very high cupboard) (thank God).

I'm excited to say his sessions are lasting the full forty-five minutes these days (as opposed to ending abruptly after a few minutes, which was the case for quite a while). I think acknowledging his need to know what to expect and saying out loud that I don't tend to tell people what to do in music therapy (unless some specific limit needs to be set) really helped him. Ironically, I think it let him know, well, what to expect. Now he doesn't seem to feel as anxious when he comes to his sessions.

I mentioned, again, to RD I thought it was interesting to keep finding little objects from his space tucked away in mine. And I asked if maybe it was because a part of him was concerned as to whether or not I'd remember him when we ended the session.

True, there wasn't any earth-shatteringly clear response or anything, but I figure if I keep commenting about it and pondering the situation with him, letting him know I'm curious and want to understand him better...he'll find a way to tell me what he needs me to know.

Music and countertransference

2011-06-07T22:09:00.003-04:00

If you're a person who has been reading this blog, then you know I make liberal use of songs that emerge as a part of music therapy sessions (a couple of other examples can be found here and here). The way I think of these countertransference songs is as a form of unconscious communication that's going on between therapist and client- the stuff that's not being said.

Obviously, since the vast majority of my clients don't use speech, it would stand to reason that these songs are a particularly helpful (and necessary) aspect of the work.

So, I've been thinking a lot about one of my clients who has been falling asleep in his sessions lately. He gets tired from his medications, I think, but he also doesn't tend to sleep particularly well (a lot of my clients don't).

At any rate, it seemed to me as if there was more to it than just being tired (I'll explain in a second). I mean, sometimes he'd look fairly wakeful, want to come for his session, get to the room, go lie on the couch (I know, I know, how Freudian can you get?) and suddenly he was exhausted.

Hey, man. I know how it goes. I've been there before when there's stuff I'm having a hard time looking at- I start journaling about some difficult issue, and suddenly...I need a nap. I get it.

Anyway, here's something that completely fascinated me about our sessions: for the longest time, whenever I played an improvisation in his sessions, I'd think, "Wow! That was gorgeous! I must write down some of those chords, because they'd be great to play around with when I'm writing a song!" And I'd quickly write down the chords, and then, after the session, I'd play them, and what the hey? They never sounded quite the same after my client left. They were nice, but there was something...missing, and it just...didn't sound right.

After a while of this unusual musical situation happening over and over and over (hey- these things take time!) I started to wonder, "What is this about? Why the heck is this happening?" And I realized this was some kind of countertransference, so I started to talk about it with my client, trying to enlist his assistance in figuring out what he might be needing me to hear (through the music that was only beautiful during our sessions but never afterward).

I've spent the last couple of months with the following working hypotheses:
1) Maybe he feels like he has to put on a nice, happy face because somehow he's gotten the idea that this is what people in his life want from him (can't imagine where he could possibly have gotten that message).

2) Maybe he only feels as if he's "beautiful" when he's in music therapy.

Of course, I could be wrong about all of it, but these are what I started working with and bringing up in sessions. So, I started talking about this with him. And the more I talked about this, the more he'd get to snoozing!

Think I hit a nerve? I think so.

As you can imagine, he and I have been stumbling along now, and somewhere back in May, we were in a session together, and I suddenly heard the lyrics of this song (Joni Mitchell's "Trouble Child") enter my mind. And, as always, as I mentally sang through the song, I thought, "Hunh! This is worth giving a joint listen."

Interestingly, it's taken a while for us to actually get through the whole song in a session (did I mention he keeps falling asleep?). And as soon as I share the lyrics with you, you'll see why.

[I debated whether to use my version of the song or the original, and I opted for mine- but linked Joni's version- because it's about the therapy and the use of songs to have a deeper understanding of our clients. I'd add a lot of disclaimers, but they're not going to be of much use to any of us, so here it is. I had to cut out all of my blabbering because I talked for too long, so that's why it sounds as if I started in mid-sentence.]

Trouble Child

Up in the sterilized room where they let you be lazy,

Knowin' your attitude's all wrong, and you gotta change and it's not easy.

Dragon's shinin' with all values known,

Dazzlin' you, keepin' you from your own,

Where is the lion in you to defy him when you're this weak and this spacey?

So what are you gonna do about it, you can't live life, and you can't leave it.

Advice and religion you can't take it, you can't seem to believe it.

The peacock is afraid to parade, you're under the thumb of a maid.

And you really can't give love in this condition, still you know how you need it.

They open and close you, then they talk like they know you, they don't know you.

They're friends and they're foes too,

Trouble child, breakin' like the waves at Malibu.

So why does it come as such a shock to know you really have no one,

Only a river of changin' faces lookin' for an ocean.

They trickle through your leaky plans,

Another dream over the dam,

And you're lyin' in some room feelin' like your right to be human is goin' over too.

But some are gonna knock you and some'll try and clock you,

You know, it's really hard to talk sense to you,

Trouble child, breakin' like the waves at Malibu.

Okay. First of all, Joni Mitchell is...brilliant! (By the way, go and listen to her singing this song. I seriously don't do it justice.) Second, oh my God! Look. At. These. Lyrics! The experience of a man living in an institution? With a serious reputation for having been a major bad-ass in his younger days?

I can't say it enough times- I marvel, again and again, at the amazing ways we human beings find to communicate with each other!

Journal Prompt #3 (When music therapists go bad)

2011-05-29T14:31:00.002-04:00

Image by Esparta via FlickrYesterday, I felt like a bad therapist.

I was tired from awful allergies (and the ends of a lingering cold), and I didn't feel great physically (and, let me tell you, there was some serious whining going on). And, yeah, okay, the truth is I just plain started out the day with an attitude.

But I figured, "Come on, Roia! It's Saturday, you only have three sessions with three different guys. They're good guys. You really like working with them. It'll be fine. Stop your kvetching, and go do your sessions and you and your aches and pains will survive."

Great. Pep talk done. Let's do it!

Maybe it was because it was a holiday weekend (with little hope of their seeing family members), maybe it was that it was a fairly nice day outside and they were all stuck indoors, maybe they all had allergies, maybe they thought my sunscreen smelled weird...I don't know what it was! But my clients weren't exactly in jovial moods either.

So.

There we all were with our collective attitudes in the various sessions, and there I was just...not making sense, not saying or doing anything particularly- I don't know- therapeutic. I found myself wondering why the heck I was saying what I was saying.

And all I could think was "what is with you today, woman?"

I was so not being a shining example of music therapy and all the fabulosity that goes with it.

Yes, I know that I probably wasn't as awful as I felt I was being. And, yes, I realize that it's all "grist for the mill" (as my clinical supervisor has always said), and it's all part of a much larger process/context. And, sure, it's true that even a bad day of music therapy (when you live in an institution) is probably not as bad as all that, but I like my clients. I want to do right by them, and I felt kind of badly that I was less present than I would have preferred.

And I was also annoyed that they were (at least in my perception of things) making me work so damned hard! Waaah! [We're whining...we're whining...]

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

So, perhaps you can journal (or sing, or play, or create some form of art, or develop your own whining rant) about a day (or, heck, a week or a month) when you felt as if you were having a hard time being the kind of music therapist you like to think you are.

What are some of the idea(l)s/myths you have about who/how you "should" be as a music therapist?

What are some of the idea(l)s/myths you hold in your mind about who your clients "should" be and how they should act/respond/deal with stuff when they're in music therapy with you?

And how do all these idea(l)s and myths affect how therapy goes some days? And how do you cope with days when you feel as if you are less than stellar?

Bring it on, my fellow bloggies!

It's a (musical) process

2011-05-22T12:48:00.000-04:00

As I thought further about Video Journal #1 I did some writing about it and this is the song that emerged from that bit of processing.

I think I said everything else I needed to say on the actual video.

I do, however, want to reiterate the fact that using music to process my sessions has been incredibly useful in terms of trying to understand what may be going on for the folks I see for music therapy. Since they aren't able to use speech (and even if they were, none of us are always completely aware of why we feel out of sorts, and that's what we have our therapists for), I try to use the countertransference material so that I have better questions to ask.

Here, as promised, are the lyrics (with my further hypotheses thrown in for good measure in between things). (Apparently I didn't say everything I had to say on the video.) (Oy.) Sorry if it gets a bit difficult to read:

Blowin' In the Wind

(Thank you, Bob Dylan!)

How many roads must a man walk down before you call him a man?
   (So much in just the first line alone! Many of the initial countertransference songs with this particular person were songs sung by girls- not just women, girls. And I have had the sense, off and on, that trying to develop an identity as a man has been an issue for him. Living in an institution, not using speech to communicate, and being seen as a disabled person first doesn't exactly enhance one's sense of self much either.)
Yes, 'n', how many seas must a white dove sail before she sleeps in the sand?
Yes, 'n' how many times must the cannon balls fly before they're forever banned?
The answer, my friend, is blowin' in the wind, the answer is blowin' in the wind.
   (This may or may not be stretching it a bit, but I wonder if he feels as if he's "blowin' in the wind" without a real sense of direction/meaning/purpose in his life.)

How many times must a man look up before he can see the sky?
   (Maybe this means something and maybe not, but his days are spent in a room that doesn't have any windows at eye level, and the windows that are there are, ironically, very high up and next to the very high ceiling.)
Yes, 'n' how many ears must one man have before he can hear people cry?
   (There's that whole sense of futility there and feeling unacknowledged and frustrated.)
Yes, 'n' how many deaths will it take 'til he knows that too many people have died?
The answer, my friend, is blowin' in the wind, the answer is blowin' in the wind.

How many years can a mountain exist before it is washed to the sea?
Yes, 'n' how many years can some people exist before they're allowed to be free?
   (I'm sure this line speaks- loudly- for itself, but it certainly connects to the feeling of being bound and stuck.)
Yes, 'n' how many times can a man turn his head pretending he just doesn't see?
   (I don't know about any of you, but this line always makes me sad, and it is particularly poignant in this context.)
The answer, my friend, is blowin' in the wind, the answer is blowin' in the wind.
   (Oh, I just realized that one of the struggles I've had in this man's sessions is this sense of "I don't know" and perpetual uncertainty. The answer, indeed, seems elusive!)

The answer is blowin' in the wind.

~~~~~~~~~~~~~~~~~~~~~~~

One last thought: I'm always amazed at how clearly my clients are able to convey to me when I am (finally) on the right track. There is such a sense of discomfort within me until I'm finally able to process (or at least start to make sense of) the feelings that come up as a result of projective identification. Once the processed material is shared with my client, and the response seems to be, "yes, you're understanding me," I experience a literal internal shift, and the discomfort eases almost immediately.

Video journal #1 (So THAT's what Countertransference Sounds Like)

2011-05-16T20:05:00.003-04:00

Seriously. What is with me and all this numbering?

Anyway...

With all this conversation about trying different forms of journaling (okay, maybe there wasn't any actual conversation, but it's definitely something that's been on my mind), I decided I wanted to try a video journal. So I did an improvisation after a session. Here's what that looked/sounded like:

After I listened to it, it occurred to me that it sounded sad and sort of poignant. I was struck by how extremely consonant it was as well. I didn't think it would be. I guess the point is that maybe on some level I did know what might have been going on in the session, but it just hadn't become conscious yet.

Journal Prompt #2 (Who are you again?)

2011-05-13T23:10:00.001-04:00

Image via WikipediaWow! First, let me thank all of you who were kind enough to join me in this path of self-reflection and exploration! It has been so neat to hear from you and read your thoughts and responses. I've truly been honored that you've taken the time to share your experiences, and I'm excited to hear/read/see more as we progress!

For my part, I have started to make short videos after some of my sessions (particularly with clients who challenge me or about whom I find I have a lot of feelings) in which I share my thoughts and reactions regarding the therapy experience on that particular day and then play a musical improvisation describing what it was like to be in the session.

It has been interesting for me to hear how being with different clients "sounds" (at least from my own musically and verbally expressed point of view). Of course, it's hard not to hear my own issues and musical patterns creeping into the music (oh, yeah, therapy 'til I'm dead, baby).

I'm sort of wanting to share some of the videos, but I want to be sure I'm not violating any ethical rules and/or regulations in order to do so.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Meanwhile, it got me to thinking about Journal Prompt #2:

For most of us, during our busy weeks, we see lots of clients. And there are always the people we work with who stay with us and stick in our minds.

But there are also clients we completely forget until we see them the next week.
And I started to wonder, why?

Who am I forgetting? Do I forget this person/group all the time? Or is there something going on with this particular client/group that I just want to avoid? Or that I don't like dealing with for some reason?

What is this person triggering within me? Is it something about this person? Or is something going on with me? Why is it this person/group that I forget?

What is it about this person that feels "forgettable" to me? What might the fact that I'm forgetting this person/group be helping me know/learn/wonder about how this person perceive(s) him/herself?

How does my forgetting this person/group have meaning in the context of this individual/group's life?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~

As you can (plainly) see, it was kind of difficult for me to formulate the questions, but, for me anyway, that's part of the process- figuring out better questions to ask myself. If you come up with a better question to ask (or simply find a better way to word the questions I already tried to ask), do tell.

As always, if you feel comfortable sharing, you're welcome to use the comments section to offer your thoughts or (if you blog) post a link to your blog post or You Tube video. Perhaps you might want to play contrasting musical portraits (a Ken Bruscia suggestion) of a client you think of often and a client you tend to forget, and either video or audio tape the improvisations. Or write a song about a client you've forgotten and share it with us.

I so look forward to your latest installments!

Journal Prompt #1 (The sounds of silence)

2011-05-06T22:58:00.001-04:00

Inspired by the very pleasant time I had with the "Joys of Journaling" workshop participants last night (thanks, guys!), I thought it might be cool to dedicate a weekly (or so) (we can always hope) blog post to sharing ideas with you of things you might like to explore and process in some form of journal.

You could do your journaling in the "old fashioned way, with pen and paper and keep it private (which would be glorious). Or you could do it in an alternative (and more public) form (such as in a blog post, a vlog, as a song, a musical improvisation, a piece of artwork, poetry, or in whatever fascinating form you come up with that I haven't even thought of yet).

The way I see it, you'd be welcome (heck, you'd be encouraged!) to share your thoughts through the Comments you leave (just share a link to the web-place you'd like us to visit to check out your thoughts, ideas, insights and artwork).

So, in honor of this being the very first journal prompt (hence the title: Journal Prompt #1- not a particularly inspired title, I know, but this is about you and your journaling journey and not so much about me and my weird blog post titles), I'll invite you to think about what we worked on last night:

Think about the experience of silence in your sessions:

Have you had a session in which there was silence for a period of time? Either your silence, your client's silence, or a silent group?

Explore what this silence felt like?

If you could have given it a sound, what sort(s) of sound would best express this silence?

How do you usually respond to silence (outside of your work)? Why?

What was it about this silence that evoked the particular response/reaction you experienced?

Ask yourself: if I were to visually describe this silence (or perhaps create a piece of art or movement), perhaps to kinesthetically express this silence, what would it look, sound, and/or feel like?

What are the qualities you'd find yourself exaggerating? And what are the qualities you might have ignored?

If there aren't any silences in your sessions at all, what's that like? And why?

Go for it, my friends!

The Joys of Journaling

2011-05-04T21:58:00.000-04:00

Image via WikipediaI will be conducting a workshop tomorrow evening (that would be on May 5th, or Cinco de Mayo, as it were) on The Joys of Journaling. It's a part of the Kardon Institute for the Arts Self-Care Series down in Philadelphia.

In honor of this event, I dug out my very first diary which I got for Christmas when I was ten years old. (I know, I know, why the heck is a person with a Jewish mother and a Muslim father getting Christmas presents? What can I tell you? We like giving/getting presents in our family, and we like Christmas songs. I mean, what's not to like?)

Anyway, I've been reading some of the things I wrote back when I was a mere 10, and I have to say they are hilariously funny and sort of poignant from my now forty-five year-old perspective.

It's interesting (okay, and it's a little embarrassing) to re-visit my younger self and to remember what was so important back then that it caused me all manner of angst.

It's been an absolute delight preparing for this workshop, because it's no longer (ahem) 1976, and the options for journaling have expanded exponentially. I mean, with the advent of technology (let alone the gradual expansion of my no longer all that young mind) there are, literally, no limits to the many fascinating and creative ways we can come up with to record and to explore our thoughts, feelings, reactions, ideas, identities, and general...stuff!

Admittedly, even though I very much enjoy writing (and reading!) blog posts, and I've certainly written my share of songs that started out in journal form, I remain true to my favorite form of journaling: I have a big stack of trusty wire-bound, college-ruled notebooks filled with the scribbling of whatever comfortable fine-tipped ball-point pen was serving me at the time.

Now, the plan for tomorrow is to try out some journaling exercises, and I'm hoping to work some music-making in there as a part of the self-discovery process as well. I'll be taking along my little Flip camera and my tape recorder (yes, I did just say that- it's a great gadget, and I adore it for writing songs), so we can try out some alternative journal forms.

I truly love the act of journaling (even though I sometimes actively avoid it for a period of time until I'm ready to jump in there and look at my stuff). The way I see it, journaling is a conversation I have with myself.

In terms of being a music therapist, it's helped me define who I am, what I think about the work I do, and, most importantly, it's helped me to learn how to pay attention.

Writing in my diary gives me a chance to say things I can't say to my clients, and it helps me think about why I want to say those things in the first place. It gives me a chance to think through sessions that confound me, and it's a wonderful way to explore the things within me that make it hard for me to hear what my clients (and the other patient people in my life) are trying to say.

I'm wondering if there are others of you out there who find journaling to be helpful in terms of deepening your work as a music (or any other kind of) therapist. I'd love to hear of your experiences.

Who's in charge here?

2011-04-27T22:26:00.002-04:00

I realize this is going to sound like I'm ranting. And not only that, I'm fairly certain I'm going to sound judgmental. And you know what? Maybe I am. This issue is so profoundly important that I think it deserves a bit of a rant, so I'm going to ask you to bear with me today, because this is serious.

It's not exactly news to anyone that I work with people who have intellectual and developmental disabilities (many of whom also happen to have autism and many of whom do not use speech). When I'm talking about clients (below), I mean it to apply not only to doing music therapy with folks who have a whole bunch of labels, but I'm talking about working as a music therapist in general.

So, why am I carrying on? Let us commence with the rant now, shall we?

I have an important question I want us to consider: Is it our clients' jobs to listen to us? Or is it our job to listen to our clients?

I ask this, because I've been noticing what seems to be a tendency in music therapists to go in to a new session and expect their clients who have severe disabilities to just do what they ask them to do. As in, "here are the planned activities/events, and here's what I think you ought to do. Your job, client of mine, is to perform these tasks/activities. And my job is to get you to do that. Period."

Well. Okay...but...

Let's pause a second and think: whose need are we here to meet?

If we want to teach our clients to be better listeners, are we modeling that by listening to them? If we want to help our clients to be be better at paying attention, how willing are we to pay attention to them? If we want people with significant disabilities to engage with us, what steps are we going to take in order to engage on their terms?

If we can't understand the language someone is speaking (particularly if their language does not contain words), are we truly serving that person when we expect him/her to do what we ask before we even make the effort to try to learn about who they are?

Again I ask the question that my college music therapy professor asked us all the time: whose need are we here to meet? And is that need best met by our coming to our clients in a music therapy session and expecting that they will do what we'd like them to do?

Or is that need best met by asking that person to help us learn about who they are (even if they don't use speech to say it) and then creating the musical space within which our client can find a way to communicate and then making a point of hearing it?

We are music therapists. Let us honor that fact and work hard to develop skill in the art of listening.

Let me end by saying this: when we work with folks who confuse us (and even if we think we know what's going on), the first place to start- always, always, always!- is by paying close attention and listening as hard as we can!

Can I get a witness?

2011-04-09T15:21:00.000-04:00

Maddeningly, I managed to catch a cold the minute I returned to work. Well, I suppose it has to happen once in a while. As such, I've spent the last two days mostly napping and reading (and, of course, feeling guilty about missing work) (so much for my "perfect music therapist" fantasy) (ahem).

So, while I'm sneezing away here, I figure it's a good a time as any to post an update.

Update #1: The two taboo topics presentations seemed to go fairly well. There was a lot of dialogue, and a couple of people came up to me afterward and told me they had continued the conversation (some from last year) at their workplaces (which is very cool).

Update #2: I submitted a proposal to do the CMTE (the one I just did at the Mid-Atlantic Regional conference) at the national conference (that would be for the American Music Therapy Association). I changed the title though (just the title). I proposed it as "Developing the Art of Self-Reflection: Exploring the Relationship Between Therapists and Clients". We shall see what happens.

Update #3: I'm in the process of organizing myself (a task, I admit) so I can put a goodly portion of the work I did on the CMTE into a book (or a monograph of some sort). Why am I telling you this (you may well be asking)? Because now that I've put it out into the blogosphere, I'll be forced to get on with it and do it!

Update #4: I had a very touching experience (when I got back to work) with a small group of women who usually react to my absences by being quite challenging and doing a lot of testing and such. This time around, when I showed up on Monday, they all gathered closely around me while I sang "hello" to them. It was so sweet! And...

Update #5: ...the whole session was made even more phenomenal by the fact that their staff person (when approached by a client from another group who wanted to come and sing with us) very beautifully and kindly explained to her, "It's really nice that you want to come and sing, but this is a music therapy group, and Roia is working specifically with the ladies in this group on goals and stuff. She'll be here on Thursday to do the singing group, and you can go join her then." Sproing!!! Somebody shout "amen!" because that was probably one of the most respectful moments I've had in my career as a music therapist! I am so sending her boss a happy note of "check out what your cool staff person said!"

I think that's pretty much the story so far. It was a good conference, I must say. It was particularly lovely to put some faces to names I know via Twitter and the music therapy list serv. And there were some really excellent and thought-provoking presentations. Another delight was gathering with music therapy colleagues and students to just play music togehter. Of course, staying up way too late probably contributed to my ending up catching a cold, but it was worth it.

In case you were wondering...

2011-03-15T18:34:00.000-04:00

...why it's taken me so long to post new blogs, it's because I've been working away at preparing for two workshops, including another five-hour continuing education presentation, at the Mid-Atlantic Regional conference of the American Music Therapy Association.

Actually, it all started when I was asked to talk about taboo topics again (who'd have thought?), so I decided to split it up and do one version for students and one for professional music therapists.

Here's where I was hoping to head with the student version ("Taboo Topics in Music Therapy: What They Didn't Mention in School"):

Music therapy training often focuses on helping students to develop techniques and skills in order to support clients’ goals and objectives. It is only when we begin to work, first in field experiences, then in internships and eventually professionally, that we realize there are some topics that weren’t really addressed in our training. How on earth do we deal with clients who masturbate openly in the middle of music therapy sessions? What is the appropriate professional way to work with a client who has a crush on us? What if we are sexually attracted to one of our clients? How do we manage and come to terms with being a music therapist when we are coping with our own mental illness? What is the best course of action when we are dealing with a client who pushes all of our buttons?

These are the kinds of questions student music therapists ask themselves every day, and the answers aren’t always readily available in journals, conferences, in listserv discussions, or even in life.

As therapists we are taught: what we repress we project. Without a safe space within which to bring up such topics, and without support and guidance from mentors, clinical supervisors or peers, music therapists run the risk of acting out their shame and discomfort. This can lead to burnout or, worse, unethical behavior.

The focus of this participatory workshop will be on providing a forum for student music therapists to give voice to their experiences and to have their concerns validated. This year we will dig a little deeper into why these issues aren’t being talked about and try to come up with some constructive ways we can use to figure out how to get the support we need to address the difficult topics.

The five-hour workshop will be a bit more intense (as it ought to be), and it's geared (of course) to professional music therapists. I don't know about you folks, but remember when I asked what your thoughts were about doing a follow-up workshop? Well, as I looked over "The List (So Far)" I realized that out of 33 items, something like thirty of them (seriously! Thirty!) were related to the therapy relationship in some way, shape, or form!

So.

I decided to go for it and do a CMTE (yes, a whole five hours) where we get to look at the therapy relationship (this one is called "Taboo Topics in Music Therapy: The Intimate Connection Between Therapists and Clients"). Here's the plan of action for the workshop:

The relationship between therapists and their clients is an intimate one. When we add music, the level of intimacy increases. As with any relationship, as the level of intimacy increases, the levels of resistance, uncertainty, and investment also increase- on both the therapist’s part as well as that of the client. On the one hand we may put up unconscious barriers, preventing a deeper connection with our clients. On the other, we may become so merged as to be in danger of violating important therapeutic boundaries. As such, the music therapy relationship can become difficult to negotiate.

In this interactive workshop we will begin by defining countertransference. Using case examples, we will work toward an understanding of: What is it? Where does it come from? How does it affect therapy? How do we begin to identify and use countertransference in our work with clients?

Participants will then be invited to share some of the difficult aspects from their own work with particular clients that challenge them in some way. Through dialogue, journaling and music-making we will process and explore some of the following questions: What are some of the ways we use to avoid looking more deeply at some of the clinical challenges we face as professional music therapists? What are some of the beliefs and ideas we, consciously or unconsciously, hold about ourselves, about music therapy, about our clients? And how do these ideas and beliefs affect our work and our clients? Why are certain topics so difficult to bring up in sessions- even if we know our clients need us to do so? What is it about the topics? What is it about our beliefs, ideas that makes it scary? What kinds of messages are being communicated by us to our clients when we don’t address difficult issues?

Through these workshop experiences, participants will work toward developing the skill of self-reflection, using a variety of techniques to process thoughts and reactions that emerge in relationship to their clients.

But I'm wondering if maybe this topic is too taboo. So far I've only got three people signed up (and it's happening in a little over two weeks). When I consulted with a psychiatrist friend to ask her if she thought I ought to cancel if our group was so small she (wisely, I think) pointed out that doing so would convey to people that the subject should and would remain a taboo- never to be looked at by music therapists.

So, I'm kind of thinking I'd like to go for it. A small but mighty little group can do amazing things, I imagine.

I'd be curious to hear if you folks out in blog-reading land have any thoughts about this. Do you think I ought to cancel the whole schmear? Might this topic actually be a little too close to home for people?

The Act(ion) of Thinking

2011-03-05T19:34:00.000-05:00

Image via WikipediaI've been thinking about RD of late (well, particularly today, because we had a session this morning).

RD is a very sweet young man on the autism spectrum (he does not use speech to communicate), and he is very particular about things. And by this I mean that he seems to believe that all things should have a place (I think I can thank one of his family members for his excellent manners and his tidy nature.)

It so happens, that we work in a terrifically messy room in his cottage (oddly enough, it's the, um, "sensory room") (yes) (well).

Anyway.

No matter how much I try to clean up all the clutter in the place before I go and pick him up for his session, he still finds things to, er, tidy.

He also likes checking out all kinds of objects. He has a collection of action figures with giant feet (I don't want to know!), and his staff people find him books and various things that have moving parts to them. He keeps them all in a big box with his picture on the front. Great!

So. Back to the aforementioned "sensory room"...

Because this is, apparently, a full service sensory room, there are almost always broken battery-operated sorts of things lying around in varying states of function and dysfunction. This means that the batteries are lying around (lovely), and the little parts that keep the batteries quietly tucked inside the gadgets are also roaming about freely.

RD, being the tidying kind of guy he is, and being the kind of person who likes to bond with objects, has been picking up these little plastic parts that were supposed to hold in batteries. He just turns them over and over in his fingers and holds them close to his face so he can examine them.

While he's doing that, he sings. He hums little melodies (I've come to learn that he repeats specific melodies with small variations here and there). I either sing them back to him or play them on the guitar (with my own variations and chords). And while he's scurrying about the room arranging things, we sing and play back and forth with each other.

The other thing you need to know is that, when he borrows an instrument from me (to check out as described) he often puts it back in the closet that's in the sensory room. As such, I have to go and retrieve the instrument quickly because otherwise it'll be there for all eternity (I have reached the official limit on my brain's memory card, and, let's face it: some things are just going to have to go!).

Now, not only does he take my stuff and put it in the cottage closet, but he puts stuff he picks up in the cottage on my music cart or in my instrument bag. I am forever pulling things out of my bags (after his session) and putting them back in the room (back in circulation, as it were).

Okay.

So, as I mentioned above, I was thinking about RD, and I was wondering: why does he keep putting cottage things in my bags? And why does he keep putting my stuff in the sensory room closet? What's that about? Is there something he might want me to know? Or that I should be noticing about this?

And I thought, hm. So I mentioned to him during his session that maybe he needs to have me hold on to a small piece of him when I go (i.e., don't forget me, please). And maybe putting my stuff in the cottage closet is a way for him to keep a piece of me as well.

When I gave it some more consideration, it occurred to me, again, that here's a guy who likes everything to have its own place- whether it's the "right" place or the "wrong" place. And I remembered that he himself grew up in a few different places, being sent around to various family members, because his mother died when he was an infant.

And now here he is with us, in an institution.

And it made me think about objects. And about having a place to be. And I wondered (out loud to him) if maybe it was important to him that he have a specific place to be. And what his thoughts are about being in the "right" place or the "wrong" place. And which one he feels the institution might be.

RD's response was to increase his singing. He and I sang back and forth for ten more minutes than usual today (we usually make it for 20 minutes, but today it was 30!) before he hopped up and began pulling the guitar off of me to indicate that we were finished.

So, I'm thinking this is veeeery cool.

Definitely warrants some more thinking...

10 thoughts about music therapy advocacy- Part 2

2011-01-17T10:00:00.117-05:00

I'm thinking that it might be helpful to know where I'm coming from in terms of music therapy advocacy as I share this list of thoughts with you. After all, you may be wondering what the heck qualifies me to preach at you about becoming an advocate? Here are some of the things I've done over the past twenty-three or so years:

During my time as a music therapist I have spent a lot of years as an active member of my state organization, the New Jersey Association for Music Therapy (NJAMT). I was originally asked to join the board because I was a member of the former American Association for Music Therapy (yes, back then there used to be two associations, and they merged in 1998). I continued to serve, becoming Secretary, Treasurer, President, Newsletter Editor and ending as Public Relations co-chair. I am no longer active as a board/committee member, but I maintain my connection to NJAMT as the listserv coordinator.

While I was President of NJAMT I also served on the NJCATA board (that would be the New Jersey Coalition of Arts Therapies Associations) as the music therapy representative for a period of time. I've helped to organize Music Therapy Day in New Jersey (which we have been holding in Trenton in the State House), and we organized a celebration of 30 years of music therapy at the facility where I work.

As a performing singer/songwriter, I've talked about music therapy when I've had gigs, and I regularly find myself engaged in conversations about "what is music therapy" when I meet new people. These days I share stories about my work with you, kind readers.

So. Yes. I've spent a good portion of my music therapy life advocating. I feel strongly about the work I do, and I care a great deal about the people I work for, namely my clients. With that in mind, here are my thoughts about what is helpful as we learn to become advocates:

1. Connect with other music therapists. Join a peer supervision group, connect through various social media outlets on the internet, or simply get to know the music therapists in your geographic area. I'm lucky. New Jersey has a lot of music therapists, and we have a fairly strong community, but we work at it, because it's important to us. Doing this type of work with a group of like-minded people standing next to you is a lot easier.

2. Know who you are and what it means to you to be a music therapist. It's very hard to advocate for yourself and for your clients if you don't know who you are professionally and why what you're doing is important. Really work at developing an identity for yourself as a music therapist. And I don't mean branding (although at some point that's important as well). What I mean is figure out your beliefs: about music, therapy, about what works for you and what doesn't, your approach, and hone your skills.

3. Be really good at what you do. By this I mean, find yourself a clinical supervisor. Yes, I know I sound like a broken record, but it's that important and that helpful. If you decide to get peer supervision instead, challenge yourself to go deeper- even if it means getting your own therapy- music therapy if you can. Look at your own issues. Figure out what issues and blocks come up for you when you're providing music therapy services, and work on them. This makes you accountable.

4. Learn everything you can about the population with whom you're working. Try to get as deep an understanding of the group of people you work with every day, and, as much as possible, try to learn from the people who experience the condition/illness/life experience. Learn what the issues are from their perspective, and then make a point of figuring out why music therapy is important for this particular group of people. When you have an idea of what someone's actual lived experience is like, you will be a more respectful and effective music therapist. And, by extension, you'll be a more effective advocate for your services (to people who may want to use your services, to facilities that may hire you, and, eventually, to legislators).

5. Chat with people about music therapy. If you're a performing musician, you have a perfect forum for talking about music therapy (and sometimes a captive audience). Talk about what you do to high school students who are musicians. Tell people what you do when you're getting your hair cut. I mean, really. The possibilities are endless.

6. Answer questions about music therapy. Because I have a website or two, I get a lot of emails from high school and college students who are writing papers about music therapy. Do your best to be helpful. Sometimes people I've met (or relatives of people I've met) are considering the possibility of becoming music therapists. If they live nearby, invite them to come and observe you in your work (get permission from your clients/facility first, of course).

7. If your state has a music therapy organization, join/volunteer. If not, start one. True, it's been a while since I was a very active member of NJAMT, but it was, and continues to be, one of the best decisions I made as a music therapist. It helped me to develop my skills as a leader, as a public speaker, as an organizer. It connected me with a lot of really great people, and it gave me a sense of being a part of something (which can be important, especially if you happen to be the only music therapist at your facility). It gave me the opportunity to do a lot of things I didn't think I could ever do. Your state organization keeps you up-to-date on what's happening with regard to legislation and can provide you with training so you know how to go and talk to your elected officials about music therapy. They can be a resource for jobs in your state (or in a state in which you might want to relocate).

8. Don't burn yourself out on advocacy. This may sound like kind of a strange thing to say after a big long pep talk, but it can happen. You can be all gung-ho for a long time, and it's great when you can do that! But you can just as easily burn yourself out without noticing it. And that's no good for anyone. So make sure that you have a life outside of music therapy as well. One of the best pieces of advice I got was when I observed my first music therapist ever. She said to make sure you always have somewhere to play your own music. Cultivate the many other things you love to do- cooking, hiking, reading, kayaking, sky diving...whatever excites you and lets you have your own personal identity as well.

9. Sometimes in spite of your best advocacy efforts, things don't go as you hoped. It's the truth. Being a music therapist can sometimes be very frustrating. One of the most devastating experiences for me was spending twenty years at my job talking about music therapy, doing presentations for administrators, making sure people had information about what a qualified music therapist is, what skills we have, what training we have, and on and on. And one day, one of the other departments decided to hire a person who is not trained as a music therapist to work in a music therapy title and to "do music" with our clients. And there wasn't a blessed thing I could do about it. (Mercifully, the guy is really cool and never calls what he does music therapy, but that doesn't mean that the rest of the staff understands that he's not a music therapist.) It's important for you to know: it happens. It happens a lot. And when it does (because it will), you go back to the support system you've developed. You re-connect with the community of fellow music therapists and allies. Because you will need them.

10. In spite of it all, love what you do. Celebrate when your clients take little and big steps. Theirs are the faces you'll see in your mind as you tell people what it is you do. Feel a passion for getting to be someone who gets to connect with people and who uses and plays music for a living. Because that is living.

And, ultimately, that's what it's all about!

What is advocacy and why do we do it?- Part 1

2011-01-17T08:00:00.012-05:00

Advocating for music therapy is, at its most basic, about telling people who we are, what we do, where we do what we do, with whom and how. It can be as simple as meeting someone at a party and responding to "what do you do for a living?" with "I'm a music therapist." And it can be as complex as working with legislators to get licensure for music therapists in your state.

The reason we spend so much time advocating for music therapy is so that, when you and I are a lot older music therapists (and that's not to say that I'm not seriously getting to "older music therapist status" at a rapid rate here), when we say "I'm a music therapist," people will say "oh, my child is receiving music therapy services" or "I work with a music therapist in the hospital where I'm a nurse" instead of the blank stares that I used to get when I first started out back in 1987.

In fact, the reason some of you younger folks (you know who you are) have even heard of music therapy is because there are a lot of us older folks (ahem) who've been talking about what we do for a long time.

Now, as more people are starting to learn about music therapy our focus as a profession has been turning toward gaining state recognition for what we do. After all, people who use our services (heck, sometimes music therapists use our services!) need to know they're receiving music therapy from someone who is trained, qualified, certified, and, in some states, licensed.

Another thing we're working toward is third party payment. While there are some music therapists who are getting reimbursed by insurance companies, it is still extremely rare. Creative arts therapy providers will become a lot more accessible to those who need them when health insurance companies add "music therapy", "dance therapy" and "art therapy" to their lists of reimbursable services.

On another level, advocating for music therapy services is about creating jobs and opportunities for ourselves. We know why what we do is important, and we want to educate the people who could use our services. It also means helping the public to distinguish between music therapy, provided by a trained, board-certified music therapist, and the therapeutic use of music, provided by talented musicians who are sensitive to the needs of others. Sometimes advocacy is about making sure we're appropriately compensated for the services we provide. The fact is that music therapists in many work situations are vastly underpaid in comparison to other allied health professionals.

So, as you can see, advocacy is an important enough element that we need to, literally, build it into our work. In Part 2, I'll address some of the things I think are helpful as we engage in this process.

Thank you and a preview

2011-01-16T10:03:00.003-05:00

Well!

First, I want to express my deepest appreciation to all you kind souls who follow my periodic blather. I am humbled by your willingness to allow me to share mental space with you- especially in this world of perpetual information and overwhelming amounts of weblife! Truly. Thank you!

Second, as some of you who are music therapists in the United States know, the American Music Therapy Association (AMTA) and the Certification Board for Music Therapy (CBMT) have designated January 2011 as the month in which they've invited those of us who spend way too much time online to make a commitment to address music therapy advocacy in our various blogs and podcasts.

Neat, huh?

What the heck is "music therapy advocacy" (you may well be asking)? Well, here are a whole lot of blogs you can go to in order to find out:

Beyond the Music (blogger: Michelle Strutzel)
Developmental Community Music (blogger: Kalani)
Eclectic Guitar (blogger: Sara Sendlbeck)
Key Changes Music Therapy (blogger: Natalie Mullis)
Listen & Learn Music (blogger: Rachel Rambach)
Mindful Music Therapist (blogger: Roia Rafieyan) (Hey! That's me!)
More with Music (blogger: Amanda Ellis)
Mundana Music Therapy (bloggers: Megan Resig and Kimberly Thompson)
Music For Special Kids (blogger: Pamela Ott)
Music Sparks (blogger: JoAnn Jordan)
Music Therapy Drumming (bloggers: Bill Matney and Mike Marcionetti)
Music Therapy Maven (blogger: Kimberly Sena Moore)
Music Therapy Research Blog podcast (co-hosts: Blythe LaGasee and Andrew Knight)
Music Therapy Round Table podcast (co-hosts: Michelle Erfurt, Rachel Rambach, Kimberly Sena Moore)
Music Therapy Source (blogger: Matt Logan)
Music Therapy Tween (blogger: Michelle Erfurt)
Revolution Rhythm (blogger: Jason Armstrong Baker)
Rhythm For Good (blogger: Kat Fulton)
Rhythmic Mind (blogger: Stephanie Kuester)
The Music Therapy Show with Janice Harris (host: Janice Harris)

I invite you to read our blogs and listen to our podcasts and find out ways that you too can be a music therapy advocate.

I'll be posting my thoughts and ideas about this topic tomorrow (I know! Two posts in a row? Wow! It's a miracle!), so I'm going to go and write that now, and I'll see you back here shortly!

And how was your day, dear?

2010-12-27T20:07:00.001-05:00

Image via Wikipedia
On the plus side, nobody got hurt (although there were some brief reminders to the effect of "nobody really likes to get their head tapped unexpectedly, K."). On the not-so-plus side, I'm guessing it'll take kind of a while for my co-worker in recreation to sort through the two big stacks of paper from her desk that, um, well, er, ended up all over the floor when I turned my back for a minute to deal with L.

I think I can safely say that this particular session felt like it was the exact opposite of the lovely one I described to you a few weeks ago.

Here's how this whole party started:

I arrived in the cottage, fully aware that the women there were almost all sick with colds and stomach viruses (lovely). I had called earlier in the afternoon to ask if I should come over or skip it, and I was told, "well, people are running around with the sniffles and stuff, but..." (which I'm fairly sure was code for "Get your a** over here, lady! We've all been suffering through this, and you'd just better do your time!")

First thing, G (one of the more chatty ladies who live in this cottage) came over to announce to me that I should "stay away" from her because she's "sick as a dog," after which she proceeded to follow me around and ask me questions repeatedly until I finally got the women who are actually in my group assembled and closed the door with a firm "I'll see you later, G. Hope you feel better." [Insert heavy sigh here.]

Honestly, I was quite happy as we got started (although a bit nervous) because M had actually joined us. Her staff person walked her over (at my request), and she had miraculously managed to convince M to walk in to the session area with us! Usually I get her as far as the door to the room where we work, and she starts to hum loudly. Then she won't go in to the room with the other two or three women from the group, and she won't go back to her day area either.

Inevitably, V gets annoyed because she is waiting for the session to begin, so she scoots (she moves on her knees usually- she has a wheelchair, but she tends to hop out of it when she gets to the room) out of the room where we work and sits on the floor, watching me and looking impatient (I'm sure if she were able to stand more comfortably there'd be foot-tapping involved).

It took some doing for N to get in to the room, because her OCD was making it plain difficult to get through the door. We waited for her and she got in. The problem, however, was that K was sitting in the chair that N prefers to use. Stop. The. Presses.

So. N pushed and pushed (in spite of my requests that she stop doing so) at K (who, on any other day, prefers to wander around the room and throw everything she touches on the floor or across the room), trying to get her out of "her" chair. Having very little luck (K is pretty hardy), N (no slouch herself) took hold of K's shoulder and her behind and unceremoniously shoved her out of the chair.

Oh, dear.

Somehow, I managed to get K moved to another chair at last (to the one that V prefers, God help me). Mercifully, V decided to stay in her wheelchair for a short period of time.

Then I had to figure out what to do to get M settled, because she kept coming over to me with magazines that were in the room and insisting that I hold them. Finally, I got the message, tore out a page and handed it to her. That seemed to be what she wanted and she promptly found herself a chair and proceeded to rip paper peacefully.

For twelve blissful seconds, we were all sitting quietly (it was such a glorious moment) when we heard a loud crash at the door.

"[Expletive deleted]! What now?!?" (I thought, loudly, and in a rather un-music therapist-like fashion.)

L arrived, right behind her giant walker (the thing that had crashed into the door), and she decided she needed to come in and sort through the plastic groceries in the faux grocery basket (that lives in the room we use) right now!

And L, I need to tell you, is not exactly Miss Let's-Talk-About-This-Shall-We-America."

Dear Lord!

Of course, since we were all sitting (for those twelve brief, yet happy, seconds), this required rearranging everyone so L could get to the table (which was, of course, behind everyone).

Well, not entirely unexpectedly, in the process of tending to L, and rearranging the furniture and the various people contained therein so nobody would get run over by L's giant walker, K got up to explore, and that's when we heard the two huge piles of paper from the recreation staff's desk hit the floor.

Cheeeeeeck!!!!

I couldn't, for anything, get K to sit anywhere, so I gave up and tried to pick up the giant mess of paper and put it somewhere somewhat unreachable until after the session.

While I was dealing with the paper, V decided she'd had enough, so she headed out the door and sat in the hallway, chin in hand, waiting for me to chase after her. Since I'm not supposed to leave V alone (and I'm not supposed to leave M or K alone either), I put a chair in the doorway so I could keep an eye on the group and on V at the same time.

V, in spite of my best efforts, turned tail and headed back into the day area (through the bathroom door that's across the hall from our room). And, much as I hate to admit it, by that point I just figured, "Okay, that's one less person to worry about right now. Amen."

K roamed around the room some more, tapping N on the head unexpectedly. And M continued her page tearing adventures, assembling the tiny pieces neatly on her lap.

Now.

I'd love to tell you I was able to make a brilliant interpretation to the women in the group about their actions and how they seemed to be all about going from crisis to crisis, and there's all manner of "no, pay attention to me" and some sadistic teasing, all in conjunction with the incredibly overwhelming way they interact with me and with other people in their lives.

But no.

Heck, I'd love to say that there was even half enough emotional space left in the room so we could even start to look at that, but that is so not where the group is yet!

Evidently, the group's goal for right now is to (through their actions/interactions) convey as loudly and dramatically as possible, "Roia!! This is what it feels like to be here. To be us. To live life!!! Do something!!"

And, for now (I have learned) (rather slowly, I must add) that my job is to just listen and get through it. And show up next time and get through it again. And keep setting limits and keep trying to help them use the music or use the music myself.

At some point, they'll be ready to hear me talk about what I'm seeing/experiencing in that group, but not yet.

Definitely not yet.

How wonderful that you're here!

2010-11-30T12:00:00.000-05:00

Image via WikipediaWe music therapists are always trying to define what we do. Or, more specifically, help other people understand what it is we do. We write books and articles about it, we blog about it, we put together podcasts- all in an effort to convey to the masses a sense of what makes us go into this profession that seems to defy description!

But, if someone were to have asked me yesterday "what is music therapy and how does it work?", I would probably have said that it's about inviting people to be present to each other, and we use the music to help make that happen.

Mondays are long days. For me, I go into work a little later and stay a little later. And, I think we can all agree: it's hard for any of us to transition into a Monday, which is, for most folks, the beginning of the work week. And I would say that it requires even more fortitude to get into the Monday spirit of things after a particularly long Thanksgiving weekend, which, of course, marks the beginning of the (dreaded) holiday season.

While staff frantically decorate the cottages and prepare for Open Houses (where everyone's family is invited to come and visit and there's food and music and merriment and so forth), my clients prepare for the annual anxiety of "will my family be coming to spend time with me this year?"

So, this is a bit of the sense I got when I showed up to work with the group yesterday (Monday) afternoon- "the group" being ten men and me.

Oh, where to begin?

Well, let's see. There was a whole lot of messing with chairs (that would be P), switching of seats (that would be R), tossing instruments, trying to pick up instruments and then getting stuck on the floor and needing help to get up (that would be T), repeatedly rearranging and fixing the curtains so the sun wasn't blinding us (um, well, actually, that would be me), coming in, turning off the lights, and then leaving (that would be K), coming in, crying and starving to death and then leaving (a different K who does use some speech), and on and on, all accompanied by a low moaning (courtesy of J), the periodic fist to the head (of B), and the festive crashing of the tambourine (P again).

Can I get a witness? Anyone? Anyone?

Uuuhmmm. Now what?! (And if any music therapist tells you they know exactly what to do when their clients are all freaking out at the same time...just so you know- They. Are. Lying!)

I managed (do not ask me how) to get my thoughts together enough to be aware of the fact that, while the guys were all there, they weren't really There. Nobody was listening to anyone else in the room, we were all kind of...everywhere, but none of us was present to the experience of being in music therapy.

I pointed this fact out to the guys (who, God bless them, heard me above the drama-filled din), and I asked them, "Gentlemen. What can we do here? How can we use the music? How can we use our thinking, to get ourselves to be here in this room, in music therapy, together? Why don't we just work on that, so that if we do nothing else today, we'll know that we cared about each other enough, that we mattered enough to each other, to notice that we were all here together."

Enter music.

I moved over next to B, because I didn't want him to be hitting his head, and offered him my hand (he took it). He had been vocalizing while he was hitting himself, in a kind of a hum. So, since I couldn't play guitar with only one hand, I invited the guys to find some kind of way to hum with B to help him settle down.

I started to hum (in B's general key), and it didn't take long at all before the men found ways to join in with their voices and actions. J moved his arm, every few measures, up and then down to the beat. P, in spite of his tambourine prowess (and he really does rock on the tambourine) used his voice- which has more of an "oh" and "ah" quality. Yet another K quietly chimed in on the cabasa he was holding. R stopped moving around and sat, listening, with his eyes closed, breathing deeply.

B calmed down and kept singing (but stopped hurting himself), so I was able to make use of both of my hands again. I played a very simple progression on the guitar- kind of an Asus4, Cmaj7, to D/F#, B, E (sometimes major and sometimes minor), and I repeated it as we sang and came together.

It was lovely.

There was smiling. The moving around and in and out stuff stopped. There was presence. We were looking at and acknowledging each other.

We managed to be present in the session and we used the music to make it happen. The definition of music therapy on a Monday afternoon.

And what makes this way of using music so cool is that this particular piece of improvised music could only have happened on this day and with this group for it to have had any meaning. Taken out of context, it might sound okay, but it will never have the same impact as it did yesterday afternoon as we all sat quietly, after we finished, even after we sang goodbye, nobody wanting to leave quite yet, watching the sun set together.

So you want to become a music therapist...

2010-11-28T16:39:00.002-05:00

Image by doug88888 via FlickrI, rather regularly, receive emails and blog comments from people who are interested in becoming music therapists. And I regularly send back big, long emails with information I hope they'll find to be useful. Well, suddenly, one of my slower neurons fired, and I thought, "why on earth haven't you written a blog with this advice in it, so you don't have to keep repeating yourself?!"

Somewhere a dog barked.

Aaaand, we're back.

Okay. So you want to become a music therapist. Fabulous! And you want to know what it will take, what kind of advice I can offer, whether you'll ever have an actual salary, what to write for that research paper that's due in 13 hours...and so forth.

(Stand back. I'm about to jump into list-making land.) (Actually, even though my blog posts aren't usually in list form, I have a deep and abiding love of lists.) (But I digress.)

1. It helps to be a fairly good musician.That said, it also helps if you learn to play guitar and piano.
Different schools that offer music therapy as a major have different requirements. I think, ultimately, the more skill you have as a musician, the more you have to offer your clients. If you're busy focusing on yourself trying to play a song or a particular instrument, you're no longer focusing on your client, and that sort of defeats the whole purpose of therapy. You know? You don't have to know how to play guitar and piano before you go to school, because that is part of the music therapy curriculum. Those are, however, two instruments that are used an awful lot in the course of a music therapist's day/week/life, so it's worth getting to a point where you're relatively comfortable with them.

2. And, while you're at it, get comfortable with using your voice.
When I first started out as a music therapist I was really shy, and I found it difficult to sing in front of anyone. Mercifully, I managed to move beyond that. We don't have to be brilliant singers, but it's important to carry a tune and be comfortable improvising and playing around with vocal sounds. I still remember a client I worked with who tore up an entire room and threw my entire music cart on the floor. For a good solid year I had to go and do his sessions with nothing but me and my voice.

3. Be careful of your "helpful" intentions.
When you're trying to figure out what you want to do with your life, it's not unusual to think, "you know, I really want to do something that helps people." We all have our reasons for wanting to somehow be useful in this world, and they're all valid and important. When we come to a profession like music therapy, though, I think it's important to be mindful of the various implications of being "helpful" (in terms of power, control, what it means to be "the helped", etc.). Because Norman Kunc and Emma van der Klift said it a lot better already, I highly recommend reading their article, "Hell-Bent on Helping: Benevolence, Friendship, and the Politics of Help". It will, I hope, give you a whole new perspective on being "helpful".

4. Learn to pay close attention. Notice stuff.
So much of my job is about paying attention. Whenever I have students come to do their practicum experiences with me, I have them fill out an observation form that I developed. It's an insanely complicated form, because in a music therapy session there is so much going on at any given moment and on so many levels. You have to be aware of your client (s), the music, yourself, the environment, the history...there's a lot of stuff happening. This is what makes music therapy so completely fascinating! You can practice at an activity level and be quite effective, and you can also decide that you want to go deeper and explore the therapy relationship, the dynamics within it, and how it's all expressed within the music, and that's really nifty as well!

5. Expect that this will be a life-long learning experience.
Music therapy is a growing and evolving field. Because there's so much to know (and you can't cram it all in at school!), so much to pay attention to, and because you can work at a lot of different levels, there's always something new you can be learning. For that reason, getting professional clinical supervision in music therapy after you've graduated is extremely helpful to your growth as a new clinician. Moreover, there are lots of trainings that music therapists can take to deepen their knowledge/skill in specific areas (GIM, Nordoff-Robbins Music Therapy, Neurologic Music Therapy, NICU Music Therapy, Hospice Music Therapy, Vocal Psychotherapy, and I'm sure there'll be more sooner or later).

6. Get used to advocating for yourself.
Music therapy isn't the huge mystery it once was. These days when I say I'm a music therapist, people are way less likely to say "a what?!" than they were back when I first started out. Now I'm usually greeted with something along the lines of "oh, how cool!" As nice as that is, people often think they know what we do, but they really don't. Co-workers who've known us for years may still not have a clear idea of what happens in a session. I'l be straight with you: It can be quite frustrating when you see that someone who hasn't gone through the years of training you have is calling him/herself a music therapist (or being called one by the media). It can be even more challenging when supervisors, colleagues, and various other people/organizations who fund our services (who aren't music therapists) feel compelled to tell us how we should do our job. Having said that, I would still maintain (and I think my music therapy colleagues would agree) that being a music therapist still far outweighs the difficult stuff.

7. You'll need to figure out a semi-quick way to explain what it is you do for a living.
Given that you'll have to spend some time advocating for yourself and showing people what music therapy is, it's important to have your "elevator speech" prepared shortly after you graduate from your program. The ladies of the Music Therapy Roundtable (Kimberly Sena Moore, Michelle Erfurt, and Rachel Rambach) address this very topic here.

8. It's not likely you'll be rich beyond your wildest dreams, but you can definitely make a living as a music therapist.
A few months ago, our Rabbi at work asked me, as nicely as he could, on behalf of one of his congregants, "can music therapists make a living doing this work?" I assured him that we could. We can find jobs (we've been doing a lot of advocating- trust me), we can get health benefits, and we can make enough money to live peacefully. We'll never get the kind of money that, say, a computer programmer or a financial analyst would make, but most of us aren't starving. And if this is truly what you want to do, then you should do it.

9. Get used to not knowing what's going on and sometimes being uncomfortable or awkward. Or at least come to terms with it.
I would have to say that it's rarely dull being a music therapist. Sometimes your clients will do unexpected sorts of things, or you'll find yourself dealing with really uncomfortable feelings. And sometimes you can go for a really long time and not be at all sure you're on the right track with a client/group. Again, this is what makes this work so fascinating and so completely worthwhile! It's difficult when your own issues are triggered, but, heck! Your issues will be triggered no matter what you do. You may as well have an interesting job within which to notice them.

10. Consider getting your own therapy (or your own music therapy, if you can).
Being a therapist is hard work. Being a client is also hard work. If you've never gone through your own therapy, and if you've never struggled in a big way with your own problems and emotional baggage, it will be hard for you to have a real understanding of what it's like to see yourself in a new way (which is not always a pleasant experience at first). Making changes in our lives is something most of us resist mightily. Looking at our resistance- ugh! It's not always fun. It's a long, bumpy road. And we ask our clients every day to allow us to stumble along that bumpy road with them. We owe it to ourselves and to our clients to at least bring along the map we saved from our own journey (even if they decide to take a different route). (Okay, I'm getting a bit nuts with the metaphors here, but you get the idea, yes?)

So there you have it. That's the list I have going in my head when people ask me for advice on becoming a music therapist, and now here it is! In blog-land! And if any of you music therapists out there in the world have other advice to offer, bring it on!

The good news (well, to me anyway) is this: I've been a music therapist for 24 years. Even on the worst of days, I have never regretted my decision to do this work! Much good luck to you as you go forth and consider whether or not the life of a music therapist is one you'd like as your own.

Back off, lady, I've got this!

2010-11-21T10:55:00.001-05:00

Image via WikipediaI tried a different approach with B today. My usual tendency is to sit there, paying as close attention as I can (without being too obvious) and trying my best to figure out what he is (not) saying by asking him bunches and bunches of questions (and driving both of us crazy in the process).

Yes, even I realize that asking tons of questions is annoying.

And, no, he doesn't use speech, but when he truly needs to make sure I hear him, he is quite clever in his communicative style.

Well. He was reclining (as he does) on the couch in the Music Room, and he was very specifically looking off in the distance (read as: "I am not looking at you! NOT looking at YOU!"). Okay. Got it. We are not looking at me. Fine. Onward.

I, of course, started to leap in with my usual round of questions ("Rough day? Too noisy in the cottage? Feeling off because we changed our session time last week? Blah? Blah blah blah? Blah, blah, and more blah?"). Okay, I'm not really proud of the fact that I did this, but I did. So. There it is. B's response? Stay the course. Keep staring straight ahead.

Hunh. That was effective.

I stopped (thank God). And I thought, "Try again, Roia. Settle it down, and try again."

So I said to him, "You don't really seem to be ready to be dealing with stuff right now. Why don't I just play piano over here, and when you're ready, you let me know."

I rummaged through the stack (really- there's a stack) of (countertransference) songs I've used in his sessions, and I pulled out the Beatles' song, "Don't Bother Me". I hemmed and hawed (internally) for a bit and decided to just play it on the piano rather than sing it. It didn't seem right to break the silence with words just yet.

I played through. Aside from tossing the bells he was holding and then picking up the mallet, there wasn't much (visible) change. Moving right along.

I rummaged some more, and I found "Out Here On My Own" (from the movie Fame). (Anyone else sensing a theme here?) I really wanted to sing the words, but it still didn't feel like it was time to do that, so I played through it with just the piano.

I feel as if I need to explain two important things here:

One is that the songs I chose were intentional- not as random as it may seem when you read my writing. I wanted to reflect his need for some emotional space, but I also know that he's been struggling with trying to come to terms with what our relationship is and is not (which is a gentle way of saying that I'm trying to help him understand that "we don't have that kind of a relationship.") He has not been happy about that, and although I think that, on some level, he gets why it is the way it is, he still feels very abandoned by me right now.

The second thing is that B spends a part of almost every single session, pulling me to the door and flicking the light switch off and on (you may draw your own conclusions as to what that particular habit may be helping B to say to me).

Great. So you're up to date. Back to the music...

This time the mallet was tossed, but B still sat quietly listening with his gaze firmly averted.

I sat quietly for a while (even I can sit quietly sometimes) and waited.

B leaned forward and tossed the maraca (which he uses to express anger) and tambourine (to express uncertainty) on the floor and was ready to hurl the cabasa (for conveying disappointment and sadness) as well, but I managed to stop him just in time (did I mention he can make sure he's heard when he has something to say?).

"Maybe," I suggested, "I'll play the song I just played again, only this time I'll sing through it with the words. B, why don't you sing it with me. You can use your voice, you can pick the bells back up and use them, you can move...just pick a part of the song that feels right, and join in."

So I went back to the piano and started (again) with "Out Here On My Own"
(Lyrics: Lesley Gore, Music: Michael Gore; Copyright 1979)

Sometimes I wonder where I've been,

Who I am, do I fit in?

Make believing is hard alone, out here on my own.

We're always proving who we are-

Always reaching for that rising star

To guide me far and shine me home,

Out here on my own.

(Chorus)

And when I'm down and feeling blue

I close my eyes so I can be with you

Oh, baby, be strong for me,

Baby, belong to me.

Help me through. Help me need you...

The minute I started singing the chorus, B joined in! He got up, started to hum in a low tone and rock back and forth. Then he headed over to the light switches and started to flick the lights up and down in time to the music (I could tell, because he paused so he could stay with the beat)!!

He stuck with me- moving, vocalizing and light switch flicking- until I got to the very last words of the song ("out here on my own."), at which point he came over and stopped me from playing any more by pulling me to the door (not because he wanted to leave, but because he wanted me to stand with him).

Wow. Just...wow. He was glorious.

Clearly, the strong feelings of loneliness and longing are still very present for him. The beauty of this profound musical moment (as I see it) is that B now feels safe enough to fully participate in the experience of actually making music. And I do need to point out that this has taken quite a lot of years. For much of the first twelve years of our work together, he largely avoided using music- often barely even allowing me to use music!

The fact that B was not only willing to sing with me (and in such a creative way), but to make sure it had meaning when he did it, is what makes this work so amazing!

I guess the question (for me) now becomes: knowing that when you back off and allow your clients to say what they have to say, they will not only do it but do it beautifully (and you don't need to worry them along), what's preventing you, Roia, from backing off so much of the time? And what is it you're afraid of hearing when your clients do "speak" to you through their music?

Listen Hear

2010-11-02T11:21:00.001-04:00

Evidently, November 1st was something of a celebratory day. A day to listen to what autistic people have to say.

It's kind of unfortunate that there's a need to designate a special day for it, because most of us, autistic or not, want to be heard every day, but I guess that's the state of the world in which we live.

Anyway, here are links to some of the blogs I read about this most auspicious occasion:

http://adeepercountry.blogspot.com/2010/11/regular-person-listening-day.html

and

http://adeepercountry.blogspot.com/2010/11/autistics-speaking-day-post.html

and also

http://adeepercountry.blogspot.com/2010/10/autism-is-world-and-youre-not-invited.html

along with

http://flashbackdreamsequence.blogspot.com/2010/11/anatomy-of-autistic.html

and

http://www.journeyswithautism.com/2010/11/01/speaking-my-mind-and-heart/

and one more

http://life-with-aspergers.blogspot.com/2010/11/day-of-silence.html

For my part, I will do my best to keep listening.

The big comfy couch incident

2010-10-29T22:28:00.010-04:00

Image by SimplySchmoopie via FlickrWell! Work, this morning, was a bit crazy (to put it mildly).

Both the 9 AM and 10:30 AM groups were either getting ready to take part in or getting ready to watch the big Halloween parade at our facility (which is actually pretty cool- a local high school marching band comes, there are costumes, people bring their dogs, their babies, etc.).

There was all kinds of flurry and insanity, what with trying to get the guys/gals outfitted with their various costumes and such. There was annoyance, there was attitude, there was drama...well, you know how it goes.

Now, mind you, the guys in the second group weren't actually going to be in the parade. We were just working on getting chairs outside and guys assembled in heavy sweatshirts and caps (it was cold out there today!) so we could all watch before the parade, er, passed us by (as the saying goes).

Mercifully, we got ourselves all out there in time, caught the all-too-brief parade, cheered loudly for the guys who had gone to boldly march in their costumes (the cottage had gone as race-cars, and they were all sporting their "cars" with frames draped over their shoulders- it was pretty nifty), and managed to get everyone safely back inside with only one incident report having to be filled out (um, that was me, because one of the guys who used to love watching parades and being in the middle of the action...well. He wasn't in that good of a mood to be moved around. My deepest apologies to R for my misunderstanding.)

To put it mildly, we were all shot!

I went to join E on a big, mushy couch, because he seemed to have been out of sorts all week, and I just wanted to check on him. We've known each other for 22 years. To not check on him would have been totally rude.

So E and I were just sitting there, hanging out and decompressing from the morning's events, and T came over and decided to join us.

Now, the reason this is news (and very cool) is that T's usual approach to sitting on couches is to shove whoever is on the couch off. This is usually accomplished by pressing his fingers firmly into the back of the person's head, but bopping people over the head has also been employed at various times.

But he didn't do that. T came over, sat on the other side of me (I was in the middle), and he took my hand, carefully, and he held it for about five minutes. Then he smiled, got up, and continued walking around the room

Now, that's what I'm talking about!

Getting to "no" you

2010-10-27T15:24:00.000-04:00

Image by donnamarijne via FlickrWhile I was avoiding writing my proposal for the regional music therapy conference this afternoon, I started thinking about one of the women with whom I work- this would be the woman who spent a lot of time being undressed in our sessions initially.

I thought you might be interested in a brief update.

C has managed to keep her clothes on (although her shoes and socks go flying at times- but who can blame her for that?) since we decided it would work a lot better if we had a much (much) shorter session time of about 7 to 10 minutes.

Most importantly, she has been able to peacefully let me know when she is not interested in having a session, and that seems like a step in the right direction to me.

I've said this before, and I'm saying it again: Any time one of my clients feels safe saying "no thanks, not today" to me, I know I'm on the right track.

Now I just have to hope/trust that, at some point, she'll feel safe enough to say "yes" more often.

So, here's a question for you, happy readers...

2010-10-12T09:33:00.000-04:00

Back in April of this year (yes, the one that's passing us by so quickly) I had a series of posts about a presentation I did at the Mid-Atlantic Regional Conference of the American Music Therapy Association on Taboo Topics in Music Therapy (Part I was the Introduction, Part II was the handout, and, of course, Part III- which was The List).
Image by 姒儿喵喵 via Flickr

I was asked by the conference chairperson if I would do a follow-up, because it was an interesting topic (thank you) and because people felt as if we'd barely scratched the surface of the issue (very true).

So, I'm thinking and agonizing (shocking, I'm sure- I mean, who would have ever thought I, of all people, would think and agonize?) over which aspects of the vast array of taboos to talk about.

Here are some options I've got floating around in my mind:

*We could take the handout (which I could happily reprise), have people fill it out and use participants' case examples to look at as a group.

*Or we could take a specific aspect of The List (So Far) and focus on a particular topic. Some examples of that could be:

*"Feelings for and about our clients and our clients' feelings about us" (which could be an entire graduate class, frankly)

*"Fantasies we have about ourselves and our clients" (these could include fantasies that we'll fix our clients' lives, we'll make them happy, rescue fantasies and beyond)

*"What to do when you make a mistake" (my friend Judy and I did this one a few years ago, "The Myth of the Perfect Music Therapist, or How I Learned to Stop Worrying and Love My Mistakes", and I've been trying- trying, I tell you- to post the handout, but for some reason it's just not working properly)

*And, a variation on the above theme, "Feelings of incompetence as a music therapist" (which could get awkward).

I'm sure there are more options. I'm thinking that the ones I've mentioned are things I could talk about with some intelligence/experience. I would be willing to tackle, or at least create a forum, for other issues on the list (fears of clients committing suicide, fears of getting attacked, clients and boundary violations- particularly in the age of social media and such, therapist/client prejudices, and so on and so forth).

Here, of course, is where my question to you, kind blog readers, emerges:

If you had a choice (and some of you may, because some of you live in this region), which aspects of taboo topics would you want to explore in a presentation?

I'm presuming that I would probably only have about an hour and a half to hash out heavy stuff. It is, of course, possible to put in two proposals and I could ask if I could do two presentations, both of which would be follow-ups to last year's talk.

So have at it, folks. I look forward to your thoughts/comments!

Upcoming music and dance/movement therapy workshop in NJ

2010-09-22T22:36:00.000-04:00

In case you're wondering if I'm still alive (I am)...I've been preparing to present a five-hour Continuing Music Therapy Education (CMTE) workshop on countertransference with my friend, Mark Bottos, a dance/movement therapist at Kardon Institute for Arts Therapies in Philadelphia, PA. If you're a music or dance/movement therapist, and you're interested in attending, here are the particulars:

Date: Sunday, October 3rd, 2010 9 AM to 5 PM

Location: Kingsway Learning Center; Haddonfield, NJ

Cost: Free for NJAMT Members

Title: "It's Complicated: Exploring the Many Aspects of Countertransference"

Presenters: Mark Bottos, MCAT, DTR and Roia Rafieyan, MA, MT-BC

Therapy can be a complicated process, requiring us to attend to many different elements simultaneously. Learning about the role of countertransference (CT) in the therapy relationship as well as developing an awareness of when we are having a reaction in sessions will not only make us more effect clinicians, but it will also help us find ways to cope with difficult feelings that emerge in the course of our work. Participants are invited to share clinical challenges. Through movement and music experiences and dialogue we will explore ways in which CT manifests in our music, movement and clinical choices.

6 CMTE credits are available.

Eating a slice of humble pie

2010-08-23T21:51:00.000-04:00

Image by shandopics via FlickrI knew if I waited a while, calmed myself down and thought about it in a peaceful state, I'd have a better idea of how to proceed with C.

You may (or may not) recall that I wrote about the dreadful session I had with her a couple of weeks ago. I was feeling terrifically annoyed with myself (among other sources of annoyance) because I had allowed my anxiety about staff being upset with my "letting" C strip in music therapy (I mean, really?) cloud my therapeutic judgment.

Ugh!

So, as I was driving back from Michigan (which is quite a long drive when you're headed to New Jersey) to visit my friend (a music therapist turned music librarian, as it happens), I was thinking about the coming week. Naturally, my thoughts turned to Monday morning, C's scheduled time for music therapy.

I had (yet) another twinge of guilt as I remembered our last session before I went on vacation (just for the record, it's not unusual to have a horrible session right before a vacation- in fact, it's one of the, er, perks of being a therapist).

And let me just say, it was not one of my shining moments as a music therapist.

As I was trundling along the Ohio Turnpike (where they have very nice rest areas, I must say), I wondered what I was supposed to do about the stripping. I didn't want to stop working with her, because, in spite of the exposure episodes, there were moments of actual connection in the music.

I tried to perceive the situation from C's point of view (something I've tried to do before), considering the idea (again) that she may, in fact, feel exposed.

Then it suddenly hit me!

A forty-five minute session is way too intense for her! Sure she may appreciate parts of the experience, and she may even find herself engaged meaningfully with the music (maybe even with me), but she's not even close to being ready to deal with that kind of constant attentive interaction for that long of a period of time!

Of course!

I need to start out with very short sessions (five to ten minutes at most) and gradually learn when C is letting me know she's ready for more time.

Honestly, sometimes I think I've been at this a bit too long that I could manage to forget something as basic as that. As basic as: can this client tolerate a 45-minute session, or should we start small and work our way up?

So, today I showed up in the cottage feeling a little more confident (with regard to the staff), and I explained my plan. I'm not sure they were as enthusiastic about my plan as I was, but they were agreeable enough (which I appreciated).

The supervisor (for some reason) decided to get C, and we sat outside of the room where her group was meeting.

The first thing I felt I needed to do was to apologize to C for misdirecting my frustration in the previous session and aiming it at her. Then I acknowledged that I had not remembered that when someone is paying very close, unwavering attention to you for a sustained period of time it can be uncomfortable as hell.

I told C my plan. "We'll start with a ten minute session. I'll practically be singing 'hello' and then 'goodbye' and then we'll stop, and I'll plan to be here next Monday again."

C, tucked under her blanket, tapped her hand against her leg. I sang "hello", she listened quietly, then I heard her giggle and vocalize with me a little bit. Then I asked if she needed anything else from the music before we ended for today. She vocalized a bit more. I sang "goodbye," put away my guitar, and I escorted her back to her group.

She was smiling.

"Expectant waiting"

2010-08-13T15:24:00.001-04:00

Image by thumeco via Flickr

I was reading an article this morning in an old issue of Unity Magazine (September/October 2005) describing a Quaker meeting attended by the author, Mason Hayek.

Here's what he shared of his experience:

The Friends who have gathered have brought in their feelings from life as it is for each of them today...Each person has brought a bundle of feelings and sits clutching it. (p. 44)

Image via WikipediaAs time passes, the silence deepens, so that any sound will seem like a rock breaking the window of one's mind. And yet, part of what we come for is the ministry, the message that we or others may speak. The ministry of presence is helpful and the strength that comes from meditation, contemplation, creative thought, or worship will reward our coming. But the words that arise from the honest and open searching for truth by others can open new paths for us. The words can catalyze our searching. (pp. 44-45)

From one's own worship and meditation, perhaps aided by the ministry of others, may come thoughts that are too strong to restrain. When the words beat against our brains irresistibly, we must speak. (p. 45)

A Friends Meeting for Worship is a gathering in quiet, waiting and listening for the "still small voice within." (p. 45)

The essential elements of worship can all be practiced and experienced when one is alone, but Meeting for Worship has special qualities. It is a shared experience in searching for the truth, a religious experience enhanced by interaction with other persons. That interaction allows us to test reality. We can see our lives, wishes, and fears in better perspective when we interact with others under conditions where we respect our neighbors as well as ourselves. We feel joined to one another. (p. 45)

In her online article, Silent Worship and Quaker Values, Marsha Holliday notes:

...Friends in the unprogrammed Quaker tradition base our worship entirely on expectant waiting.

"Expectant waiting." I think that's such a lovely way to put it!

Two summers ago I attended a class at Pendle Hill, which is a Quaker retreat Center, where we were invited to participate in a Meeting each morning.

I went once or twice, and I reflected then, as I did again this morning, on how similar it felt (to me) to the process of music therapy, especially when working with people who don't use speech to communicate. (I've written quite a few blogs- here and here, for example- about silence as an important aspect of music therapy.)

In particular I was struck by the idea of presence within the silence and being present to the experience of silence.

Unexpectedly (or maybe not), as I was thinking about this, I happened to read a blog, also this morning, about the experience of silence from the perspective of a person on the autism spectrum.

Mike, the author of the blog Journal of an Autist reminds us:

Even silence speaks...Start by listening through all your senses, and you will hear us speak, even in our silence.

I'm not sure whether it's a taboo or not to talk about therapy and spirituality (I certainly don't see music therapy, or any kind of therapy, as a space to conduct one's religious agenda), but it's hard to not see the parallels. We create a sacred space within which the therapist, the client, and the music come together for the purpose of growth. There is complexity within these relationships and an effort to make sense of the complexity. There is a joining together for a common purpose...all of these seem like deeply spiritual experiences to me.

I wonder what your thoughts are about this.

Exposed

2010-08-10T09:40:00.000-04:00

Image by fabbriciuse via Flickr

I'd love to be able to explain why I haven't been writing any blog posts of late, but I'm not sure I could. It's not as if I haven't had things to say. I mean, I've got various notes in journals and on scraps of paper reminding me of thoughts I've had, issues I want to blog about. I've (mostly) accepted that I will write when I need or have to write.

Today I'm feeling a need to write.

Yesterday morning I showed up for a session with a client I haven't been able to see for two weeks. There were some scheduling changes and then there were some scheduling conflicts, and that's the way it sometimes goes.

Fine.

I knew I had to be prepared for possible reactions to my absence. On the other hand, I wasn't sure how "real" I was to her as yet. C and I have only worked together since January. She seems to recognize me these days, but the relationship still feels fairly tenuous.

I found her at the other end of the cottage, and she smiled (which seemed like a pretty good start). She walked along with me and then pulled me toward the bathroom. I was hoping we wouldn't have a stripping issue, but her staff told me she might need to use the toilet. Okay then.

Her staff accompanied her to the bathroom area, reminding C that she needed to be supervised (for a few reasons we needn't get into), and I waited in the empty day area where we'd be working.

While I was waiting, K, one of the supervisors (who happens to be a former music therapist), came over to ask me how things were going with C. She was being nice, because I knew that it was code for "The staff are annoyed with you, because you 'let' C strip when she's in music therapy." To K's credit, she wanted to hear my take on the stripping.

Apparently, I'm the only person who has this problem with C suddenly taking off her clothes (other than the afternoon shift).

Great.

I don't know exactly why C strips in music therapy. Maybe it's because I'm mostly new to her. Maybe it's because I only see her once a week (and even that can vary because of her schedule and mine) not every single day, and she doesn't know me that well. Maybe she's testing me.

All I can say for sure is: I'm trying.

So that was how I went in to the session.

C came on out of the bathroom with her staff person, and she was in good spirits, everything was going along, she picked up her giant beanbag to set it on her lap, sat on a comfortable couch, and we were off.

She was vocal, I was reflecting, she was engaged, I was responding...all good things. She was bothered, for some reason, by a couple of binders sitting on the table, so I took those and put them in the next room, and we resumed our musical interaction.

Until...

C decided she needed to go to the refrigerator (there's a dorm sized fridge in the day area where we were working). Now, understand that:

1)The last time we had dealt with the refrigerator, there was a lot of iced tea to be cleaned up. A LOT of iced tea.

2) She has a very sensitive stomach, and I wasn't sure what she was safely allowed to have.

3) It was 11 AM and not long before lunch when I knew she'd get something to drink anyway.

4) I wanted her to focus on the session. Yes, that was my issue, but for that moment I decided it was a legitimate wish on my part.

Well. I asked her to wait until later, and that was when it all started to deteriorate. Rapidly. Suddenly, the jacket, pants, underwear, adult diaper, shirt and bra were on the floor.

Crap!

I managed to get her into the bathroom area (and pick up the assorted clothing items) and then it just went from bad to worse. I was aggravated, C was freaking out, and it was argue, fight, fuss, refuse, be naked (not me), and consider becoming a hermit so I'd never have to deal with people again.

Finally, after about 10 minutes of achieving nothing I decided to ask for help.

Her staff (the one who had helped her in the bathroom earlier) came in, and C set up a yell, but she got dressed.

Wonderful.

I hung around in the bathroom for a while, trying to watch what her staff did to get her organized (wondering what I had done wrong, not thought of, why I went in to music therapy anyway).

When they came out of the bathroom area (which is a big area, I must tell you, with a bunch of stalls, showers, a bathtub, and so forth), and C was dressed and calmer, I reminded C (and her staff) that I would see her in two weeks, and that I hoped we could find a way to have her stay dressed.

Her staff commented that "Oh, she'll be dressed when you get here. It's after that we're not sure about," which is code for "If you were a competent professional, my client would not be naked by the end of your session, would she?"

"Thanks for your help."

I stewed about this for the entire rest of the day, feeling horrible and inadequate.

And then I realized this morning that the thing that made me most angry about the situation yesterday was that I ended up acting from a place of anger and shame with regard to my reactions to the staff people and not from the perspective of a clinician.

As such, I'm not only frustrated by the fact that the whole session went to hell suddenly, but I'm also bothered by the fact that I felt as if I allowed my feelings about staff's opinions about what I do/don't do/how I do it to get in the way of my being C's music therapist.

Now, I'm sure that as soon as I settle myself down about all of this, I'll be able to use these new pieces of information I have (yes, also known as countertransference) in a more constructive way (you know...like, for one thing, using it to get a better understanding of what my client may be going through that she feels the only way she can communicate with me is by stripping).

Until then, I'm still annoyed and agitated about the whole thing.

Well that's good to know

2010-04-30T21:27:00.000-04:00

http://blogs.psychcentral.com/unplugged/2009/04/ten-things-a-good-therapist-should-be-aware-of/

As a music therapist working with people who mostly don't use speech as their main communication mode, I thought this was a particularly helpful blog post (written by Sonia Neale).

I particularly appreciated her last comment: "Even after thirteen years, therapy can be an inherently exhausting process."

"Rescue me!"

2010-04-15T21:00:00.002-04:00

Image by cotton_man via Flickr

Okay, this may seem like a weird thing to blog about, but I'm doing it anyway.

I was contemplating the fact that I have periodic rescue fantasies that involve my clients.

I don't know what else to call them. And there seems to be an element of "Rescue me!" in them, so there you have it.

I'm sure it has nothing to do with my clients who avoid leaving at the end of their sessions. Or find the longest and/or slowest way back to their cottages possible. Or the fact that as soon as I drop some people off after their sessions, they are pulling me back to the door to leave with me.

No, I'm sure that's not it.

Cup of guilt anyone?

Anyway, I was thinking about the fact that the rescue fantasies that seem most prominent in my mind always seem to involve thinking about driving with my clients (not going anywhere in particular- just driving) and cooking for my clients (I spend a lot of time in the kitchen).

Escape from the life they have and being nurtured and fed.

I just thought that was interesting.

Taboo Topics in Music Therapy- Part III- The List (so far)

2010-04-13T16:54:00.001-04:00

Image by fensterbme via Flickr

Here's a list of taboo topics I generated. I found I had to keep adding to it as I went along. I also included many of the offerings of the conference participants. Feel free to comment and add your own. I dare say there are quite a few taboos to be found in music therapy as yet.

Taboos (I have known and loved)

1. Sexual feelings and/or arousal
a. for clients
b. dreams about clients
c. our clients feelings about us

2. Fantasies
a. that we will be the one person who makes a difference in our clients’ lives (or that we are the be-all and end-all in their lives)
b. sexual fantasies
c. fantasies of taking clients home and taking care of them, also known as “rescue fantasies”
d. dreaming about clients

3. Mistakes on the part of the music therapist

4. Fee disasters/money/financial transactions

5. Hatred for/anger toward a patient
a. hating a patient’s music
b. clients who are hurting/frustrating us

6. Getting sick and not being able to do your job for a while
a. can include mental illness as well as physical (i.e., needing to take a break from work)
b. music therapists who have mental illness
c. fear of getting sick when working with clients who have communicable diseases

7. Feelings of incompetence
a. not knowing what to do in a session
b. feeling lost
c. feeling uncertain musically

8. Feeling that we need to be all-knowing, all loving (a.k.a. “Music Therapist Syndrome”- the belief that we must always be nice and cheerful, and that it is our job to make our clients feel better, and that we should never be “mean” and confront them or push them in any way or to talk about “sad” subjects.

9. Feeling bored or tired/sleepy during sessions

10. Clients who gross us out or offend us

11. Therapist’s fears/terrors

12. Therapist’s personal issues around shame/guilt
a. May include therapist’s own abuse history

13. Being fired

14. Issues with staff/co-workers/clients’ families
a. having to report staff/clients’ families for abuse/neglect/etc.
b. fears of retaliation should we report abuse
c. dealings with staff regarding clients (having differences of opinion)
d. staff undermining our efforts as therapists

15. Being uncomfortable with the system within which we work
a. disagreeing with the way client services are provided
b. having to represent a facility we don’t always feel comfortable with

16. Boundary violations
a. treating clients or their families as friends
b. hugging/touching clients as a matter of course
c. violating client confidentiality

17. Guilt over terminating/guilt over not terminating
a. “I should have tried harder.”
b. not working on closure
c. difficult endings
d. ending because we don’t know what else to do

18. Fear of violent clients or those who act out in other ways
a. constant anxiety when having to go and work with a particular client

19. Clients who fall asleep in sessions
a. leading to fear that we are inept or ineffective therapists
b. that we’re doing something wrong or boring

20. Having favorites
a. when we admit it we’re less likely to act on it than if we deny it.
b. also the belief that we have to love all of our clients

21. Fear that a client may commit suicide
a. along with the fear that we will miss the warning signs and it will be our fault
b. and the corresponding fantasy that we will be the one to save this client

22. Being in the role of “helper”
a. discomfort with being in the role of ‘helper’
b. not being aware of the power difference between client/therapist

23. Seeing clients as more disabled than they are
a. sometimes leads to an attitude that “they don’t understand what we’re doing, so it won’t hurt them” (this is the kind of belief that can lead to situations like the one with Corey Brown, the music therapist who molested his clients)

24. Working with someone your own age
a. Or working with someone you’ve known in a different context (including survivor guilt)

25. Running into clients outside of the therapy context
a. Clients who want to connect through various online social networks
b. Clients asking for sex/marriage/personal phone numbers
c. Clients who grope themselves/who try to grope the music therapist

26. Clients who are better musicians than we are

27. The myth of music as a “non-threatening” medium

28. Guilt over privilege

29. Assuming our clients are heterosexual, or identify as a particular gender

30. Hating a particular style of music and/or refusing to learn or play a particular style in music therapy sessions

31. Clients dying or getting seriously ill (sometimes in the middle of a session)

32. Racism, sexism, able-ism, heterosexism (in all of their infinite varieties and forms)

33. Music therapists who do not dress in a professional manner (i.e., whose dress is seductive or overly casual)

Why we don’t talk about these things (some of these reasons are taboos in and of themselves, I would say):

We don’t always know the answer
We don’t want to look unprofessional/bad
Ashamed/embarrassed/fear of being blamed
Music therapy students who are over-protected/over-directed
Not always recognizing countertransference
Helplessness
Not wanting to deal with repercussions
Competition between colleagues
Not having a supervisor/mentor/safe resource
The need to constantly “prove” that music therapy is a valid therapy
Wanting to be a good example
Diminishing the impact of an issue (i.e., making light of a difficult topic)
Fear of being seen as a fake/incompetent

The Mindful Music Therapist

Beautiful and thought-provoking quote

Music Therapy Advocacy Month- Our Most Powerful Advocates

Reflecting on feelings of powerlessness (a video blog)

A musical portrait

Behavior? Or unanswered question?

Grateful

Going South!

What do I (think I) know?

Journal Prompt #5: A person of interest

Thank you!

The eyes have it

Journal Prompt #4- Uncertainty

Holding on to our clients' stuff

Music and countertransference

Journal Prompt #3 (When music therapists go bad)

It's a (musical) process

Video journal #1 (So THAT's what Countertransference Sounds Like)

Journal Prompt #2 (Who are you again?)

Journal Prompt #1 (The sounds of silence)

The Joys of Journaling

Who's in charge here?

Can I get a witness?

In case you were wondering...

The Act(ion) of Thinking

10 thoughts about music therapy advocacy- Part 2

What is advocacy and why do we do it?- Part 1

Thank you and a preview

And how was your day, dear?

How wonderful that you're here!

So you want to become a music therapist...

Back off, lady, I've got this!

Listen Hear

The big comfy couch incident

Getting to "no" you

So, here's a question for you, happy readers...

Upcoming music and dance/movement therapy workshop in NJ

Eating a slice of humble pie

"Expectant waiting"

Exposed

Well *that's* good to know

"Rescue me!"

Taboo Topics in Music Therapy- Part III- The List (so far)

Well that's good to know