Saturday, September 29, 2007

Getting there is half the battle

I don’t care how much it’s not about’s still a bummer when my client refuses to attend a session.  If this were a “normal” therapy situation, and my clients could just call me up and cancel it would be hard- I can’t deny that.  But...I work in an institution, and when my clients refuse, it’s usually on public display.  For one thing, I have to go and pick up my clients for their sessions.  They don’t just show up at the Music Room door (wouldn’t that be fun?).  The usual routine is as follows:  

1.  Walk (usually quickly, because I’m usually late from the last session) to the cottage.

2.  Go to the office. (This generally involves the need to say “hello” to a whole lot of people in the Day Area on the way to the office, some of whom firmly believe I am there solely to visit with them at that given moment.  The objective, however, is to get to the office without offending too many people or hurting anyone’s feelings too badly along the way.)

3.  Read the cottage log (if there’s time) to find out what’s been  happening and to see if there’s something my client can’t tell me about (since most of the folks I work with can’t tell me about stuff) that’s significant (family visits, didn’t sleep the last three nights, sick, they got hurt, had a dentist appointment, etc.).

4.  Sign out the person (or people) I’m there to pick up using the Detail Sheet. (This usually requires finding a pen or some other writing implement coupled with a period of frustrated searching.  Ditto for the Detail Sheet.)

5.  Go and find the person (unless it’s cold or they use a wheelchair- then I have to find a jacket among the thirty-two jackets which may or may not be hanging in the closet in the day area, get the wheelchair- if they’re not already in it- find the foot pedals, rummage around for a hat, etc. and then I find the person).  Meanwhile, finding my clients can be a challenge, because, depending on who it is and where they live, there are a lot of places a person could be these days now that the cottages are unlocked.  It also necessitates more walking through the Day Area (and we know how that went the first time around...See item #2 above).

6.  Ask the person if s/he wants to come to music therapy. (This can be slightly complicated by the fact that some of the people I work with don’t do well with questions, in which case I sometimes have to rephrase things in the form of a sentence which still implies and means that the person has a choice...something along the lines of “it’s time for music therapy.  Come with me if you’d like to go”.)

7.  Wait for a response of some sort.  (Usually that looks like getting up to come with me; but variations can also include running to the bathroom, coming with me but only as far as the door and then not wanting to go back to the group but not wanting to go with me either...?   There’s also pushing one’s wheelchair backward when I offer to attach foot pedals, a raised arm- which, I believe, means “no” for that particular person, needing to get changed because none of the staff noticed the person needed bathroom assistance, a big smile and some bouncing, running me over with a wheelchair, etc.)

Most of the time the folks I work with know the routine, know that it’s their day for music therapy, and know that I’m coming for them, and they leap up to meet me (always a nice thing which reinforces- if I may get all behavioral for a moment- my need to be all kinds of “special”). 

Then there are folks who use wheelchairs and either can not or do not choose to move their chairs independently.  With them the response can be a bit more uncertain, because I want to be respectful of their choice, but it’s hard to tell what the choice is if there isn’t a clear movement or gesture of some sort.  Sometimes I have to just wait for a while, or I’ll let them know to set up a real fuss if they really didn’t want to go, and we’ll come back.  Sometimes I just don’t know, and I hope to God that my client knows that I mean well and I’m doing my best to honor their wishes.

Well, today’s rejection (and, let’s face it...refusing to attend music therapy with me is a rejection, and, in this case, certainly a public one) was one of those, “No, Roia, don’t put my foot pedals on my wheelchair.  I’m not coming with you.”  He was nice enough to take my hand and look at me for a moment (which, of course, just made me temporarily think I was misunderstanding him and he really did want to come).  But, no, he really didn’t.  And he watched me walk out the door.

Oh, the humiliation. 

You know, though?  I think about the fact that sometimes my clients feel humiliated and publicly rejected.  Sometimes people make degrading comments about them as if they’re deaf.  As if they have no hearts and minds that hear the what’s being said about them.  And I know I’ve blogged before about how important it is to have someone to safely say “No” to in a life where saying “no” can be dangerous.  

Perhaps I can try to see this as having done my client a favor today.  Today I got to be the rejected one.  Today I was the one who felt humiliated and inadequate.  Today I got to the be the one who said, “ouch!”

Monday, September 24, 2007

Healing touch

I will not lie to you.  I went to work in a very unhappy state today.  It wasn’t anything to do with work, and I made every effort (as I always do) to keep my focus on the people in my sessions.  As you can imagine, by the end of the day, I was fading a bit, and it was sort of hard to stop my sadness.

My last session of the day is with two gentlemen (M and G, both of whom I like very much) who experience life on the autism spectrum.  We had had a tough time in the previous week, because M kicked G on Monday and then he kicked me on Thursday, and G and I were both sporting bruised shins.  G, on the other hand, tends to scream very loudly on occasion (with a tendency to be near one’s ears when he does so).  So, of course, when we started there were reminders to try to use words and musical sounds to express any frustration or distress rather than kicking and screaming as a means to make salient points (thank you very much).  [Hm, I just noticed that together M and G do, in fact, kick and scream.  They do this separately, mind you, but how interesting that they ended up in the same session together.   What a very nifty new thing to know.  Anyway...]

G has a hard time staying with us for the duration of the session (although he usually hovers nearby or returns to check back in to our space in the back hallway of the cottage).  M, on the other hand, likes to draw while we work (I think because it helps him to focus on the session more effectively and less directly).  

Well, something about G’s hovering today triggered the sadness with which I’d started the day, and I had to pause for a moment.   I rested both of my hands on the table and looked across it to M, who suddenly stopped what he was doing, put the pen down, reached out and enveloped both of my hands with his, looking at me quietly.  Then he went back to his drawing.  

It was such a sweet and kind gesture, and I knew that he understood that I was sad, and he wanted to offer me comfort (which he did).  I thanked him for his thoughtfulness, and we continued on peacefully for the rest of the session.

"I got no doors..."

“...and you got no keys.”  This brilliantly insightful comment was made by a man I work with on Saturdays.  He has a very hard time with speech, often saying words that don’t seem to make a lot of sense.  Every so often he comes out with a phrase or sentence that lets me know he is absolutely paying close attention to our conversations- musical and verbal- and he is doing his best to take part.  

It truly must feel that way for him sometimes- as if he’s got no doors and no one else has any keys-  as if it’s hard for anyone to get to know him, and he’s not sure people who try have the understanding to do so.  I know I’ve talked before with him about how frustrating it must be for him that he has such a terrible time saying what he wants to say.  I’ve also expressed my wish to learn more about him and my uncertainty as to how to go about doing so (especially when he usually stops me from playing music).  

“I got no doors...and you got no keys.”

So beautifully put.


Sunday, September 23, 2007

Quotes I have known and loved

I was reading through some notes in preparation for a radio interview I had today, and I found all these quotes that I wrote down.  Many of them, in my mind anyway, relate to being a music therapist.  Actually, I have pages and pages of quotes I really like, but I’ll start with this one:

“If I were to force open a rosebud by peeling back the petals, the results would look nothing like the beautiful flower it could have been had it opened naturally.”

(from the Daily Word, March 26th, 2003)

You know how you read something, or you see something, and you instantlyknow that it was meant to give you some sort of guidance?  Well, that was what it was like for me to read that passage.  

At the time I was coming to an awareness that I wanted my clients to move forward already- to grow (if you will) and flourish.  I also noticed my tendency toward rushing to interpret.   I wasn’t quite getting (yet) the idea that people will come to their realizations in music therapy when they’re ready to do so, and it will mean more because they came to the awareness  on their own.  

I can’t say that I’ve completely let that go, but the image of forcing a rosebud to open was a powerful one for me, and it helped me to see why my approach wasn’t that helpful.  

A variation on that theme would have to be a quote from Ralph Waldo Emerson:

“People only see what they are prepared to see.”

So we impatient folks, yet again, have an opportunity for learning in our work.  I certainly have, over the years, had to (regularly) ask myself what my hurry is, why am I so invested in the outcome, and whose need am I meeting here...not just in my work as a professional but in my personal life as well.   Hmm.  These are all good questions, and I think it’s time to reconsider them now.


Wednesday, September 19, 2007

"Don't let me be lonely tonight"

Dave Pitonyak has written a great deal about loneliness being the greater disability for folks with a lot of labels (in other words the people I work with every day).  It’s worth reading when you get some time to really think about what he’s saying.  

I spent much of the day running around, because there’s just so much going on at work that there doesn’t seem to be a moment to sit still and gather my thoughts.  Mercifully, my clients remind me to do so- usually simply by needing me to be still and listen.

The three men I see on Wednesday afternoons almost always leave a very strong impression on me.   All three guys have had music therapy with me for ten to twelve years, and our work is often intense.  

The last gentleman is still sitting with me many hours later.  During our session he was shoving away instruments.  He actually took them off the cart in order to shove them across the room.   I asked what or who he needed to push away, and he looked at me (oh.).  He’s struggling with a lot of feelings about me of late, and we alternate between his being very happy to see me and feeling very sad dealing with the limits of our relationship.   If this sounds familiar, it’s because I talked about the same person on September 12th.   

A (countertransference) song that has come up before in our work together is James Taylor’s “Don’t Let Me Be Lonely Tonight”- which is 1) a gorgeous song, and 2) has that wonderful tangle of emotions in it.   The part of the tangle that came to my mind as I watched my client pushing (and then re-pushing) the drum and mallet across the room was

“Go away then, damn you.

Go on and do as you please.

You ain’t gonna see me getting down on my knees.

I’m undecided, and your heart’s been divided.

You’ve been turning my world upside down.” 

© 1972, 1973, 1978 James Taylor

[You can give a listen- at your own risk- to what it sounded like below.]

I sang that part, and then I sang the whole song (I had to do it without my guitar, because I couldn’t remember most of the chords), and he started to move very quickly around the Music Room, pausing to “bump” into me a few times.  

Much of the session was spent with him appearing to want to leave- moving me toward the door, messing with the knob, and pushing my hand up to the door.  The effect, for the most part, was one of “You, Roia, are forcing me to stay here against my will.”   And I said to him, “You know?  We’ve worked together for the past ten years now, and this thing with trying to leave while we’re in our session has been an ongoing theme for our entire history together.  And here we are, ten years later, and I still don’t seem to have a very good idea as to why.  I feel perplexed and uncertain.  Like I’m always doing something wrong.”  And then I wondered “Do you feel that way sometimes?”  He looked away.  

When it was actually time to go he didn’t leap up immediately.   As we walked back he mostly chose to walk on his own (usually he catches my hand or a few fingers and holds on).   I reached out to keep him moving when I saw a car approaching us, and he pushed my hand away.  “I guess that would be another round of ‘Go away then, damn you’, eh?”  

When we arrived in front of his home, he quickly sat down at the table and chairs which are placed outside his front door.  He looked so utterly dejected, and I got such a sense of sadness that I understood at that moment that he really wasn’t pushing me away at all- just trying to cope with his unhappiness that our time for today was ending (and trying to make it last a little longer).  

I know I often talk about uncertainty in my work.  This particular moment, though, did not feel uncertain at all to me.  Obviously I couldn’t articulate the details of his feelings, but it was pretty darn clear that all that effort to “leave” the session was not really about wanting to leave.  

It took us a while, but he was eventually ready to go back inside.   

If I may...(since it is one of my favorites)

Do me wrong; do me right.

Tell me lies, but hold me tight.

Save your goodbyes for the morning light, 

But don’t let me be lonely tonight.

Say goodbye and say hello.

Sure ‘nough good to see you,

But it’s time to go.

Don’t say yes, but please, 

Don’t say no.

I don’t want to be lonely tonight.

Go away then, damn you.

Go on and do as you please.

You ain’t gonna see me getting down on my knees.

I’m undecided, and your heart’s been divided.

You’ve been turning my world upside down.

Do me wrong; do me right.

Go on and tell me lies, but hold me tight.

Save your goodbyes for the morning light.

But don’t let me be lonely tonight.

I don’t want to be lonely tonight.

© 1972, 1973, 1978 James Taylor

Gabcast! The Mindful Music Therapist #0 - "Don't Let Me Be Lonely Tonight"

This is how it sounded.

Friday, September 14, 2007

Egos on parade

I had to chuckle today at work.  I was sitting outside with one of my clients.  This particular gentleman tends to be...let’s say...unexpectedly rough at times, so when he lets me know  he needs to leave (usually he’ll leap up and say “go baah”- meaning “go back”) I know to pay attention and do as he asks.  

Well, it happened that today one of the psychology staff was sitting outside nearby making a phone call.  He kept an eye on us as we walked out to our usual bench.  Meanwhile, my client was super-focused on the guitar today, watching me play through the entire first song.  He seems to prefer a strong strumming pattern to start and then we can move into plucking.  

At any rate, when the psychology staff person was ready to go, he looked over and grinned, and he asked, “Is that the best he’s ever been for you?”  I thought it was an odd question, but I said, “well, R usually enjoys music” (not wanting to be having a conversation about the man while he was sitting there as if he wasn’t listening).  Psychology man continued smiling, noting “I thought maybe he’d behave a bit better knowing I’m sitting nearby.” 

Now, first of all, yikes!  I’m not sure what that whole “big brother is watching, so you’d better behave” thing is all about.  Second, I finally realized that this psychology person believed that my client was having a particularly good day in music because he was hovering nearby.  The sort of silly thing was that I had been thinking, “Oh, I’m glad this guy from psychology is here to see how well R responds to music.” 

I suppose it’s a toss-up as to whose ego is the bigger in this case.    At any rate, I realized both of us were being asses, and this was really not about either one of us but about R- who really was having a peaceful day today.  Hooray for him.

Wednesday, September 12, 2007

Rejection and uncertainty

My clients are really good at letting me know when they feel rejected.  They reject me and refuse to come for sessions.  A gentleman I’ve been working with has recently allowed himself to begin to express his strong feelings toward me.  The feelings seem to be a general melange of “take me home with you” and “take care of me”.  

A few sessions ago he chose to sit on the floor and he kept wanting to hold my hand (through much of the session).  When I let go so I could use the guitar, he actually clung for a moment to my skirt (I had a rather billowing long skirt on that day).  I reacted with such a surprised look , he immediately took his hand away (so much for the notion that people with autism are not good at reading nonverbal cues).  The action (holding on to a fold of my skirt), when I thought about it, was just so sweet and child-like to me that the image has stayed with me. 

I, of course, reminded him a number of times that we have a music therapy relationship, because I had a sense that, while there was a definite “I need a mom” quality there was also the adult feelings going on as well.  I reiterated to him that he could express his feelings (preferably in the music) but that we would not be acting on his feelings.

Well, not surprisingly, I think he felt very rejected.  This seemed to be the impetus for the last few “sessions” we’ve had- or hadn’t, as it happens.  These were sessions where he didn’t actually get to the Music Room, ran off a lot, or left his cottage with me and then indicated that he wanted to go back shortly thereafter.

He looked so utterly depressed today it was hard not to want to jump into rescue mode.  I feel kind of dorky now (and I’m not sure that I was necessarily helpful to him), but I got into this “don’t give up” mode in a major way as we progressed through our session.

Sometimes it really rots being a music therapist.  It’s hard to be cast in the role of the “rejecting mother” or “the friend that wasn’t” and variations on those themes.  It’s hard to convey care to someone who has such a strong need for love without it seeming like a total rejection when I try to maintain therapy boundaries.   

What makes it all the more impossible is this:  what if I’m wrong?  I’m understanding all of this from his actions and interactions with me, but what if he really doesn’t have these feelings at all, and I’m simply assigning these various thoughts and emotions to him, and they’re not really his?

Hmm.  I don’t know.  Truly, I don’t know.

I mean, I don’t think I’m entirely incorrect.  As much as he implied a wish to leave the session (he kept messing with the door handle as if he wanted to go) he ended up wanting to sit on a bench for a little while as we walked back to his cottage after our time ended.    

Yalom talks about the therapist being “love’s executioner”.  There you have it.  That’s what I am, I guess.  Ugh.  What a lousy distinction sometimes.  It so goes against my fantasy of being “the good music therapist who could make it all better.” 

Monday, September 10, 2007

Who's responsible for this?

In my very first session this morning (assuming I can remember back that far) I found myself working with my client’s resistance.  He has been receiving music therapy from me for...gosh...a lot of years now.  And while we have a strong relationship he avoids the music-making aspect of things quite a bit.  

He has some movement issues (mostly around organizing his body to move in a specific way), and he does not use speech to communicate, but he has a strong voice, he can be remarkably clear in letting me know what he wants, and he’s quite capable of choosing an instrument and making some sort of sound with it.  But...he doesn’t.  

So I pointed this out to him (because, apparently, being a music therapist means being in a position to point out the obvious) and I invited him to think about it with me:  What prevents him from finding his own musical sounds (rather than relying on songs I choose for him)?  What if he did play his own music/sounds?  What would it sound like?  Is there something he’s afraid to hear?  Is he afraid his sounds won’t be “good enough”?

As I pondered these things I became aware of the fact that, by not playing his own music, by not choosing his own sounds- his own musical voice, he avoids being heard in this world.  Not just by himself but by anyone else.  And if he’s not heard, then he has no power.  

Powerlessness.  Now there’s an issue he and I have addressed in our sessions.   And, without diminishing the reality of how hard it is to live in an institution, I asked him whether he thinks he may have been giving everyone else in his life (me, his staff, his family) the responsibility for his life- for expressing his feelings, for organizing and getting his behavior under control, for his happiness...heck, for his very existence.  

He made a quick sound to indicate “yes” and I honored the courage it took for him to acknowledge that difficult possibility.  It’s not easy for any of us to make that kind of a realization, and his brow became rather furrowed as we continued.  

No one wants to hear that we play an important role in our own lives, and we’re not helpless victims.  Making everyone else responsible for him makes it easy for my client to be angry with everyone for not meeting his needs, for boring him, for not being there when he wanted them to be, for picking the wrong music, for making incorrect assumptions about what is important to him (the list is endless of course).  

What a gift to recognize that we do have a choice, and we are not, in fact, so powerless in our lives.