Wednesday, December 26, 2007

"Will you remember me?"


B has been having a tough time of late in music therapy.  I think it’s a combination of holidays and feeling safe enough with me (after ten years) to start dealing with his feelings.  He’s been so down-hearted and angry in his sessions.

This afternoon he came to music therapy with God-only-knows-what all over his hands and face.  I set about polishing him up a bit (we have Sani-Wipes or something in the Music Room), because he was starting to rub whatever it was off onto me and because I knew he’d want to use the instruments (if only for target practice). 

We use different instruments, which we’ve designated to express specific feelings, so he can give me an idea of what’s up for him (since he doesn’t use speech).  The tubular shaker is used to say “I’m okay today” (interestingly, he almost never picks up this instrument),  the maracas tell me “I’m frustrated/angry,” the cabasa is for “I’m feeling sad/disappointed,” and the tambourine is for “I’m uncertain/anxious/scared.”  It’s not the best idea in the world, because it has occurred to me a number of times that these particular instruments may not (for B) express the feelings we’ve designated for them, but it’s at least a way to get started and to give him a voice.

We’ve used this system for quite a while now, so he’s pretty much got the hang of it, I think.  Lately he has been alternating between choosing the cabasa and the maracas.  What he usually does is pick up the instrument he chooses to let me know how he’s feeling at a given moment and then hurls it across the room.  Well, let’s just say there was a lot of instrument hurling going on today, and my initial inclination was to respond in frustration and anger myself.  I mean, I don’t like having to worry that a cabasa is going to hit me in the head or that the instruments are going to break. 

I heard myself starting to get preachy and into lecture mode after the fifth or sixth time the maraca was sent skidding across the floor (“You do not need to throw the instruments around to let me know how you’re feeling.  You can hand them to me, please- or just put them back down next to you.”).  For some reason I stopped myself and I said, “you know, B...I think you might be trying to tell me you’re in a lot of emotional pain, and you don’t know how else to help me understand.”  He looked my way (he’d been avoiding eye-contact with me since we’d arrived in the Music Room).  Sigh.  It’s so hard to be in the part of therapy where all your feelings are right there in your face and making you ache a lot.

We had about five minutes before it was time for us to head back to his cottage.  Here’s how the last few minutes went:

B:  Made a very small quiet sound. 
Roia:  I wonder what it’s like for you to be here in the Music Room and actually hear yourself (and to have me hear your voice).  I know it’s usually pretty loud in your cottage, so I can’t imagine that people really hear your voice very often. 
B:  Threw the mallet across the floor.
Roia:  Maybe throwing the instruments around is a way to make sure you have some sort of an impact- especially since it’s hard for you to be heard most of the time.  We’re going to need to end- is there anything else?
B:  Made a silent screaming sound with his lips closed.
Roia:  Your sound just now made me think of a line from the song “I Will Remember You”:  “We are screaming inside, though we can’t be heard.” 
B:  Listened quietly and then made his sound again.
Roia:  Interesting that that particular song should come to my mind, given that it’s about wanting to be remembered, and we were just talking about the wish to have an impact.   Maybe that’s an important song for us to think about together next time.  (I noticed his shoe was untied and we were about to walk outside in the rain.)  Can I tie your shoe?
B:  Stopped moving his foot and allowed me to tie his shoe.
Roia:  You seem to need a lot of mothering today.  (I referred to the washing up I’d had to do when we got there and to a zipping up by his staff person and now the shoe tying.)
B:  Sat quietly.

He decided we would not be singing “Goodbye” and we walked back to the cottage in the rain.  When I got back to the Music Room after dropping him off I wanted to read the words to “I Will Remember You” (Copyright 1995, Sarah McLachlan, Seamus Egan, and Dave Merenda). 

I am, as always, amazed by the power of the songs that unexpectedly come to mind while I work.  Here’s a part of the verse I quoted to him that I hadn’t consciously recalled during our session:

“I’m so tired, but I can’t sleep.
Standing on the edge of something much too deep.
It’s funny how I feel so much but I cannot say a word
We are screaming inside or we can’t be heard.”

and

“So afraid to love you, more afraid to lose.
Clinging to a past that doesn’t let me choose.”

Wow.  Just...wow.   Talk about finding ways to communicate.  Yet again I behold the power of music.

Saturday, December 22, 2007

Getting lost

Last weekend I had to drive home in the middle of a sleet/rain/snow “event” at 11:30 at night.  So there I was traveling slowly homeward (or so I hoped) when I realized that I had made a wrong turn, and I was now driving along some very curvy roads I’d never been on before- even in the light of day.  I wasn’t particularly panicked, because I had a general idea as to which way I had to go in order to eventually get to where I needed to be (so I could, theoretically, get home at some point).  It did, however, take a lot more time than I expected to finally get to a road I recognized.  Mercifully, I didn’t do any sliding around and ending up in a ditch, and I did finally get home some time after midnight.  


Now, the reason I didn’t freak out when this happened is that I regularly go out driving with my friend, Darrin, and I make a point of getting lost and driving in unfamiliar places so I’m forced to find my way back.  My reasoning is that this way I won’t get so scared when I get lost.  I don’t tend to like having unexpected things occur, so I figure that practicing helps me get used to the experience.  


I started to think about this theory of mine, and I realized it applies just as much to being a music therapist.  I use a process-oriented approach.  That means that I don’t have a specific plan in mind when I do sessions.  We’re not doing Activity A then Activity B followed by Activity C.  Moreover, I work with people who don’t use speech to communicate.  This means I’m lost a lot of the time when I’m doing therapy.  I have an idea of where we want to go (increased communication, greater ability to cope with strong feelings, using the music to express anger rather than using actions, etc.), but I don’t always know how we’re going to get there.  And that can be scary.  


Lucky for me I practice getting lost a lot so I don’t have to worry as much when it happens.

Wednesday, December 19, 2007

"How could I be anything but grateful?"

Some days are the pits, and some days there’s that one moment when it all counts.  W and I were walking out of the Music Room, and I asked him if he would shut the door behind him (which I always do).  He did (which he always does), and we were walking down the hallway, and I suddenly realized he was looking at me and smiling.  It was one of those beautiful smiles with his whole entire face.  It was a very gratifying moment.  


P.S.  As soon as I get a fairly decent version of my song “At the End of the Day” recorded I’ll add it in here.

Friday, December 14, 2007

Okay, so maybe it's not SO bad

I think it helped to acknowledge how frustrated I was feeling with the guys, because as soon as I was able to do that I felt a lot better.  I managed to settle myself down enough to ask myself some of the power and control questions.  


I had to put some thought into why I sometimes seem to need music therapy to look a particular way (or my clients to behave or respond in a specific way) in order for me to decide that I’m doing my job properly.  The thing is...when you work with someone for years and years, as I have, there’s not going to be a lot of noticeable change.  It’s not that what we do doesn’t matter- it may in fact matter quite a lot.  It’s more that, after a while, the changes are a lot more subtle.  And, as I’ve said before, to change too much within a system which is set up to discourage change is, well, frustrating.    


I suppose this goes back to the thoughts I shared with regard to having an effect.  I’ll probably end up repeating myself (what can I say?  I’m in my 40s now...I’ve started to repeat myself already), but there are times when it can be hard to know if music therapy  is having an effect (more to the point, a positive effect) on my clients.  Don’t get me wrong- there are times when it is very obvious that it really matters that I’m there.  It is, however, possible to go for quite some time where nothing much seems to be happening in a session, and I start to wonder, “is there something I’m missing here?  Am I doing something I shouldn’t be doing?  Am I doing too much?  Are my clients doing too little?  Is it legitimate to call this music therapy when this person refuses to use music most of the time?”  


Sigh.  If only there were easy answers. 


Well, if being in music therapy is a place where my clients can come for a period of time and just be (as in be themselves or be mellow or be mad or be downhearted) and have someone (okay, me) be with them, then I can consider that part of a good day’s work. 

Thursday, December 6, 2007

Thoughts at the end of a long day...

It's odd how the day goes and how the day ends.  I felt terrible at work.  So many of my clients just frustrated me beyond words today.  E (who acts like he  wants me to do all the work and who sits there, essentially laughing at me), R  (who seems fine all the way to the Music Room, but when he gets there he looks like he’s going to pass out, and then suddenly he’s fine again when we go through the 15 minute process of getting the coats back on and very slowly walking back to the cottage), M (who reenacts the painful loss of his family and home over and over and over again, feeling the need to punch at me in the process, and then he can’t let me go at “goodbye”),  R2 (who didn’t get a nap and was sleeping mostly)... 


Sometimes I'm afraid I'm losing my heart for my work.  Lately I've been feeling so angry with the guys, and I feel so guilt-ridden for being angry.  Honestly, in E’s session I was thinking that I could just walk away from the Center and be done with this. I was so tired of always having to do all the work.  I'm really starting to get that my clients are not going to change, ever, unless something drastically changes in their lives.  They can't change, because if they did it would be hell for them.  To be too aware within a system that's so difficult is torture. Maybe it's not fair to ask any more of them.  But, yet, I want to.  I want them to be bigger than this tiny fishbowl they live in.  Is that totally unfair to ask?  Probably.


Before I left work this evening I stopped by the Exercise Room, looking for a colleague.  I knocked on the door, opened it, and there was B, standing right in front of the door.  He immediately approached me and took my hand and clung to me for a little while.  L, his staff person, got the treadmill started for him, and he guided him over to it, and B hopped on, got his balance in ten seconds, and then turned around and just as gracefully, hopped off (after walking backwards on this moving machine for a second or two, watching me), seeming still to want to come on over and hang out with me.


I guess that’s why I stay.  Because of the B moments.  Somehow, for now, they make up for the E, R, M, and R2 moments.   And because even though we have these horrible moments (sometimes weeks and months), I think it still makes a difference that I’m there.    

Tuesday, November 27, 2007

Having an effect

I have been thinking about a session I had last week with one of the men I work with who is on the autism spectrum.  He and I have worked together, first in a small group and now individually, for the past ten years.  I have noted that I often feel quite lost in his sessions.   While it seems to be very important to him to have an opportunity to get out of his living area and walk to the Music Room (which is in another building), he generally just sits quietly when he gets there.  Occasionally, he’ll reach out and take one of the instruments I place near his chair (he is clear that he does not want to get up and come to the piano or explore any of the other instruments around the room), putting it back shortly thereafter.  He doesn’t use speech to communicate, although occasionally he may vocalize quietly.  So quietly, in fact, that I can barely hear him. 


I have been slowly making my way through Music Therapy with Adults with Learning Disabilities (Watson, ed., 2007), and I admit I felt relieved when I read the following: 


“The music made with adults with learning disabilities will be varied, as with other clients, but there may be particular characteristics.  The therapist may find that she is working with very little material (for example, when working with clients with profound and multiple learning disabilities).  This demands that the therapist is able to wait and listen, avoiding playing to fill the silence rather than in response to the client.  Other clients, whilst bringing music, may find it hard to initiate or lead music, leading to fragility in the contact between the therapist and client, where the therapist may feel as though they have complete responsibility for sustaining the music.”  (Watson,  p. 28)


I frequently feel as if I’m doing most of the musical work in my sessions at the institution.  Obviously there are a lot of reasons for this.  For one thing, the people I work with have movement challenges, making it very difficult (as Watson comments) to initiate and/or sustain interactions, musical and otherwise.  Another likelihood is that living in an institution for many years can bring about an intense case of learned helplessness.   I think, also, there tends to be an idea that I’m the one who knows how to make music, so it’s sort of left to me to do the main music-making.  Put another way, this is a setting that lends itself strongly to maintaining specific roles.


At any rate, during this particular session, I had a strong image of the notes from the music I was playing just bouncing off of my client and falling quietly to the floor.   I mentioned it to him, and then I let my mind wander around with that thought for a while.  If you read this blog regularly, you know that I am a firm believer that the feelings (and songs) that come up for me (and all therapists) while in the middle of a session are important pieces of information.  Naturally, it occurred to me to wonder (out loud) whether he too might be feeling a sense of ineffectiveness- in other words, of not having an effect on his life, on the people around him- a powerlessness in the face of the unfixability of...his life?  His surroundings?  His body (he has been going through some health issues lately and really has difficulty with medical type people)?


He didn’t make any clear overt response to my suggestions that day, but, as it happened, the following week, on our way to the Music Room, it was snowing out, and he was actually singing!  He had a quiet little melody which he was humming (with enough volume so I could hear that it was an improvised tune), and, while it was difficult to make out, it was clearly melodic.  Of course the minute we got to the Music Room he stopped singing, but he did add a few vocal sounds to the session.  Maybe it means something, and maybe it doesn’t...but it was nice to hear him sing.


References

Watson, T. (2007).  Music Therapy with Adults with Learning Disabilities:  Sharing Stories.  In T. Watson (Ed.), Music Therapy with Adults with Learning Disabilities (pp. 18-32).  Great Britain:  Routledge.

Monday, November 19, 2007

Mental Disability Rights International

I don’t even know where to begin.  I happened to find a video on the CNN siteabout the hideous conditions for children and adults with disabilities in institutions in Serbia .  I’m not sure how to link to it, but if you want to search for it the title is “Tied to cribs, left to die.”  A group called Mental Disability Rights International works to ensure that the rights of people with developmental and psychiatric disabilities are respected around the world, and they are the ones who created this video.  


I urge you to go to their website and read their reports and see the very painful videos they have made of the dreadful lives of the people left (apparently to die) in the various facilities in ParaguayRomania, and Turkey (among others).  


Horrified does not even begin to describe my reaction to the fact that in 2007 this level of inhumanity and injustice continues.    On the other hand, why should it shock me?  It is true that we have moved a long way in this country- a very long way from the deplorable situations you will see if you visit MDRI’s website and read their reports.  But the tremendous prejudice felt toward people with disabilities remains.  The abuse stays constant.  The inability to see beyond labels, the belief in lack, limitation, inability...it goes on and on.  


And again, I wonder, why would it shock me?  When our own country is apparently not concerned with the fact that torture is considered an acceptable form of treatment for prisoners of war.   Why should I be surprised at all?

Thursday, November 15, 2007

Belonging

I was sitting with one of my clients yesterday afternoon, trying to remember what we had focused on the last time we saw each other.  He had refused to attend the previous session, and I had taken a few days off, so my brain was blanking a bit.  


I started to play the guitar (which, for some reason, always helps me think and hear more clearly and to remember what we’ve been doing), and I recalled that the song I had played recently was “Part of Your World” (yes, I know... it’s a Disney song from “The Little Mermaid”).  The focus was on what (I think) seems to be his longing to take part in what he perceives as the “world” outside of his cottage, his housemates, and his staff.  Only... yesterday, when I thought of the song, the word that came to my mind was “belonging”.


Belonging.  I was aware that that wasn’t the word we had used in his last session, but it seemed an interesting word to explore.  My mind immediately free-associated to the idea of belonging to someone, because that also seems to be an issue for him (okay, and maybe it’s an issue for me too).  


As my mind wandered I thought about the following:


*do we identify ourselves by the people and places we belong to? 

*And, when we don’t have any family (or don’t know whether our family remembers that we exist), do we lose a sense of belonging?  

*What does that do to our sense of identity?  

*If we have a severe disability, and we’ve listened to people’s opinions about who we are and what we are without being able to put in our own views, then what does that do to our sense of belonging (let along our sense of identity)?

*What does it mean to belong somewhere?  And, really, do we ever belong to anyone or anything? (I’m thinking here of our existential aloneness.) 

*When we feel as if we don’t fit in, and our way of being is so different that we never feel a sense of belonging, do we lose our sense of a “home base”?

*Does belonging to someone or to a place give us an experience of having a “home base”?

*From the other side of things, what does it mean to have someone “belong to” us?  Can someone actually belong to us?


I wondered yesterday whether it makes sense to say that, while we have music therapy together, we sort of belong to each other.  I couldn’t get my mind to move swiftly enough to clarify that thought, so I didn’t mention it in the session.  But I’m throwing it out here to look at it some more.  


It seems to me I’ve read about the idea of belonging a lot in the more recent person-centered literature concerned with expanding the social and emotional networks of people with developmental disabilities.  Heck, it’s enough of an issue for all of us, I imagine, but we may not necessarily be conscious of it all the time. 


I have to get along to work now, but I do want to revisit this idea of belonging to each other.  There seems to be a spiritual element to it that I like.  Yes.  I do believe that, one some level, we all belong to each other.  I suppose if we all thought about each other that way, we’d probably have a less frightening world. 

Monday, November 12, 2007

Paying attention

I’ve been thinking a lot about what it means to pay attention in music therapy.  I believe it started when I agreed to take practicum students from the music therapy program at Montclair State University.  I don’t, by the way, mean “paying attention” as a goal to be worked on with our clients.  I mean as a goal to be worked on for ourselves.  More specifically, I’m looking at what do we, as music therapists, pay attention to when we’re working?  How do we know which observations are relevant?  How does what we see/experience/notice/play musically or miss altogether fit into the context of therapy?  And, for crying out loud, what the heck does it all mean?  


Part of the training for music therapists (at both undergraduate and graduate levels) involves pairing a student (sometimes two students) with a professional in the field and having the student observe the professional as s/he conducts music therapy.   The student is simultaneously learning about therapy theories, the uses of music, and group dynamics and such in their classes at school.  Personally, I think this is an awfully nice way to learn, because you get to see and apply what you’re learning immediately, so it makes more sense.


Understandably, it’s not that easy to teach the skill of observation when you’re in a classroom and talking theoretically...or even when you’re having people role-play that they’re in a music therapy session and have whatever situation you’ve assigned to them (i.e., students might be asked to play the role of rowdy kids with ADHD or the role of an elderly woman with dementia, etc.) . 


Getting back to the practicum placement...gradually, the students begin their interactions with the clients by conducting part of the session (for example, they may start by preparing some form of a greeting song and then trying it out with clients).  By the second semester students are asked to conduct an entire session (while being closely supervised by the more experienced music therapist).    


As a part of the learning process, the students fill out various forms and come up with musical experiences based on the goals and objectives they choose. This is after observing the professional music therapist working with a particular person or group for a period of time.  Most students are also asked to complete logs- which, to the best of my recollection, are a way for them to look at some of the feelings and reactions they notice in themselves as they go through their practicum experiences. 


Because I don’t use an activities approach, I adapted a form for my students to fill out which reflects the relationally-based and process-oriented approach that I do use.  It asks a lot of them, particularly with regard to paying attention and learning how to be in a state of perpetual observation.  


One of my favorite authors is Patrick Casement, who I discovered by accident one day while I was rummaging through books in the Hahnemann University (now Drexel University) library.  His book “Learning From the Patient” is an excellent resource (even though he’s not a music therapist) for learning how to...well, learn from our clients as well as learning from our own reactions to our clients.


There is a lot to pay attention to in music therapy.  There’s the client to notice (and all of the stuff that goes along with being that particular human being);  there’s the music (which, of course, has all sorts of elements), and then there’s ourselves (and the feelings that we notice floating by as we are engaged in the process of doing music therapy).


Clearly there’s more to think about on this subject, and, since I’m working on putting together a presentation and an article about paying attention, you’ll probably be hearing more about it in the next few months.