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!”

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