Wednesday, October 31, 2007

"Killing me softly with [her] song"

One of the guys I work with has been flatly refusing to allow me to play music during his sessions.  He hasn’t always been this adamant about the music needing to be stopped.  And I do mean stopped.  When I start to play he pulls the guitar off of me, or he takes my hands off of the piano.  He’s even thrown my sheet music to the floor.  He’s also tossed quite a few of my rhythm instruments across the room- to the point where I only leave the lighter weight instruments available so that they won’t break or kill me if they land on the floor too hard or hit me in the head.  We’ve worked together for ten years, and during much of that time he was willing to let me play- not all the time, but there was music going on in the sessions, and I was the one doing the playing.  

A lot of years ago (I mean...a LOT of years ago), I went to a presentation by Ken Bruscia at a music therapy conference, and I took a lot of notes (as I tend to do).  One of the things that I recall most vividly from his talk was his description of music therapy as having three components:  the client, the therapist, and the music.  And the music therapist’s job is to sort out all of the various relationships which occur between these three...elements (or maybe aspects is a better word?) in a music therapy session.  

See, now this is what makes music therapy so fascinating and complex to me.  If you think about it (and obviously this is not news to music therapists who use a psychodynamic approach), the music therapist and the music act as co-therapists.  You might notice the nicely parental quality that this duo implies. 

At any rate, it’s interesting (to me anyway) to speculate as to what it means when a client “abandons” the music.  It has crossed my mind that by abandoning the music my client is playing out the abandonment he himself has felt in his life.  He has some issues around parental abandonment, I believe (he hasn’t seen his family for years), and the music is part of a “parental team” (so to speak), so I wonder... is this his way of protecting himself from being abandoned again?  Or maybe “I’ll abandon you before you abandon me” is his unconscious thought process.  

He is clear that the relationship with me is important, but his relationship with the music has been ambivalent, to say the least.  Maybe there’s some sort of splitting involved (as in, I could be temporarily playing the role of the “good mother” while the music has taken on “bad mother” qualities).  

I guess another possibility is that he doesn’t particularly like the music I’m choosing, or he doesn’t like the way I sing or the way I play (which would be an interesting enough issue for us to explore).  Or the songs I’m choosing have no relevance to him.  I doubt that’s the case, but I could be wrong.

From another perspective entirely, could there be something around being heard (or not being heard, as the case may be)?  It occurs to me that an autistic person who doesn’t use speech to communicate and who has lived in an institution for the vast majority of his life is used to a lot of silence when it comes to his feelings, his thoughts, dreams, opinions, fears, loves, and so on.  To hear them suddenly expressed (spoken out loud) in the music- even if I’m not exactly right on in my guesses- can be daunting and feel rather like being exposed, I imagine.

I was thinking about that this afternoon during his session, and the song I chose to use was “Killing Me Softly With [Her] Song”.  And you know what?  He didn’t stop me from playing this song:

I heard [she] sang a good song.

I heard [she] had a style.

And so I came to see [her] to listen for a while.

And there [she] was, this young [girl]

A stranger to my eyes

Strumming my pain with [her] fingers,

Singing my life with [her] words.

Killing me softly with [her] song,

Killing me softly with [her] song,

Telling my whole life with [her] words,

Killing me softly... with [her] song.

I felt all flushed with fever,

Embarrassed by the crowd,

I felt [she] found my letters 

And read each one out loud.

I prayed that [she] would finish

But [she] just kept right on

Strumming my pain with [her] fingers,

Singing my life with [her] words.

Killing me softly with [her] song,

Killing me softly with [her] song,

Telling my whole life with [her] words,

Killing me softly... with [her] song.

[She] sang as if [she] knew me,

In all my dark despair.

And then [she] looked right through me

As if I wasn’t there.

But [she] was there, this stranger,

Singing clear and strong

Strumming my pain with [her] fingers,

Singing my life with [her] words.

Killing me softly with [her] song,

Killing me softly with [her] song,

Telling my whole life with [her] words,

Killing me softly... with [her] song.

© 1972 by Charles Fox and Norman Gimbel

As I talked about this with him, we noted the irony of the fact that his silence affords him a measure of privacy in an institution, one of the least private places in which a person can live.  

After I sang the song, he got up and moved to a different area of the room.  It seemed as if he needed to think about this for a while.  I’ll be thinking about it too.  A part of me felt as if I needed to apologize to him for being musically invasive in some way.  On the other hand, it’s my job to offer him a different way of seeing his life and his experiences.  I do that using music.  Well, it certainly does remind me of, first, how powerful music is, and, second, how much power I have as a therapist (and the need for me to be conscious of that power and to use it with care).  

Having been through my own therapy, I know how hard it is to recognize something in yourself suddenly.  In music therapy, the effect is even more sudden, because, as my clinical supervisor, Janice, notes, “Music hits you at the speed of sound.”  


Monday, October 22, 2007

Thoughts while on vacation

Last week most of my sessions went to hell.  Now...I try to be a responsible music therapist, and I let everyone know that I’ll be on vacation, being specific as to when I’ll be away and when I’m planning to return.  

I realize that some of the folks I work with may not care that I’ll be away, some won’t remember that I told them I’d be away, some will remember and will hold it against me for a long time, some will think I’m abandoning them, and some will be jealous or angry that I get to go on vacation and they don’t.

I get this.  I’ve been going on vacations for a long time, and my clients have been dealing with it for a long time.  But every time I start the process of letting my clients know “we’ll be missing music therapy next week” and they start the International Grump at Your Music Therapist Day proceedings, I start to wonder (okay, okay, I start to worry), “do they even care?  Is it really me (and my guilt) making a bigger deal out of this than is really necessary?  Am I really helping by letting my clients know that I will temporarily be gone?  Is it actually me who is going to have such a hard time letting them go while I’m away?”

Yes, I suppose they’re all good questions, and to be an effective music therapist I will probably need to be aware of these concerns on some level.  On the other hand, in spite of the implied “No, Roia, I don’t care that you’ll be away on vacation!  You just leave!  I’m tired of music therapy with you anyway!  Hmph!”  attitudes that I get on my way out, there’s usually an awful lot of “I want to hold your hand” when I return.

So, um, maybe the real point for me is to have something to worry about.  Sigh.

Tuesday, October 16, 2007

People who have things to say

Back in September I mentioned a new book, Music Therapy with Adults with Learning Disabilities.   I was reading it this morning (since I’m an incredibly slow reader, I haven’t gotten very far yet) and thinking how much I like the approach which seems to be used in the UK.  It reminded me of some papers I’d read online at the Paradigm website (not about music therapy) with regard to folks with intellectual and developmental disabilities.  Tony Osgood is my current favorite (or “favourite” as they say in England) writer from that collection (even though he is a behaviourist).  He’s written such thought-provoking commentaries as: ‘Suit you, sir?’:  Challenging Behaviour in Learning Disability Services”“‘Doing it For Attention’: Non Physical Reactive Strategies”, and ‘Falling on Deaf Ears’: Self-Harm, Self-Injury and Ourselves:  Different Rules?”- all of which, in spite of the heavy material, are written with his wonderful sense of “humour” tossed in throughout.  

I think what I like best about Tony Osgood’s writing is that he is willing to poke fun at himself and he’s not afraid to fuss about the various organizational elements which, I think we’d mostly agree, figure strongly into the mix when supporting people with various disabilities.  

Tony Osgood seems to be the British counterpart to the United States’ David Pitonyak  and Canada’s Dave Hingsburger (I just discovered his blog!).   Definitely people who have important things to say.   And how nice of them to share so much of it on the internet where we, the masses, can access it, eh?


Monday, October 15, 2007

International Grump At Your Music Therapist Day

I should probably re-name the blog “Grumblings” for today.  Yeesh!  

My right shoulder is still sore from foolishly struggling with a gentleman I worked with on Friday.  The man (who is a head and a half taller than I am) felt a strong need to lunge into every room we passed on our way to not get to the Music Room.  Um...ouch!  

Today I discovered (a little late) that the person I was taking out of his cottage to go to music therapy was in need of a change of clothing.  To say the least, he was not (I repeat NOT) happy about walking out the door and my belated realization.  To let me know just how unhappy he was with this upsetting turn of events, he tried to bite, scratch and head-butt me (all at the same time).  Then he decided that his best course of action was to sit me out, so he dropped himself down on to the ground and sat there angrily, lashing out every so often.   That was when my back stopped working effectively.

The afternoon brought a disagreement with one of my clients who uses a wheelchair.  He feels strongly that he should drag his foot underneath his chair while we walk outside.  I feel just as strongly that his foot should not be broken while I push his chair to the Music Room (which requires going over a somewhat bumpy cement and then asphalt terrain).  During our quite animated discussion over this issue, he decided to stop his wheelchair entirely (you can do that when your foot isn’t on the foot pedal), lean down and eat leaves. 

By 2 PM I was fairly certain that I should have taken the day off.   Mind you, it had already crossed my mind that part of the problem in the first place was that I let my clients know that I would be on vacation and we wouldn’t see each other next Monday.  Separation anxiety anyone?

Two very lovely things did happen though- reminding me that no day is a total washout.  One was a very sweet smile from the person with whom I’m “sitting in limbo” when I dropped off a group of guys in his cottage.  At first he looked a bit peeved that I was with other people (and not him).  I told him I’d stop over and say “hello” and when I did, he gave me one of his glorious shiny smiles.  

The second delightful thing was that, after a rather tough session, my last two clients still insisted on touching my (achy) shoulder gently and walking me to the door to say “goodbye” (actually, one of the guys almost followed me right out the door).  A cynic would say that they just wanted to make sure I was good and gone.  But I’m not a cynic.  And I thought it was awfully sweet. 

Tuesday, October 9, 2007

Sitting here in limbo

For some time now I’ve struggled during my sessions with a particular gentleman, trying to figure out whether he is ready to terminate or if he’s depressed and having a hard time doing anything or if he simply needs for me to fail him in some way.  

At some point last year he appeared to be bored in sessions- moving around the room in a somewhat listless manner, not seeming to be angry with me but also not particularly enthused about being in music therapy.  Please don’t misunderstand me- it’s not as if I think that people should come to music therapy and be all peppy and cheery and full of vim and vigor or anything.  It mostly seemed as if there was a gradual change in the relationship, but I couldn’t be more specific than that.  It was just that, for him, he seemed...well, it seemed to me that he may have been letting me know he’d gone about as far as he was meant to go with me.  My reasoning was that we’d been working together since 1995, and he had come quite a long way in that period of time, so I figured that was the logical conclusion.    

Now, termination of music therapy services is something that doesn’t happen all that often in an institution.  Well, okay, maybe it just doesn’t happen much in ourinstitution.  The feeling in our facility has generally been, “if the client is getting something out of being there, and there aren’t any problems, then carry on.”  I’m not necessarily against that way of doing things.  I think our clients need emotional support, and, since it takes quite a long time to develop a solid and consistent relationship, it seems sensible to continue indefinitely.  I suppose another way of saying it is that those of who work in developmental centers really become our clients’ support systems.  Taking that away when there isn’t necessarily an option to develop a non-paid support system doesn’t seem very fair or particularly therapeutically helpful.  

I’ve had to terminate with people when they moved out of the center to live in the community, and I’ve had clients who have chosen to simply stop participating in music therapy.  I also had to work towards closure with a large number of clients when I went to graduate school.  But I haven’t had a lot of experience with working toward termination with someone because they’ve achieved the goals and objectives that were set at the beginning of therapy.   

Well, I thought to myself, here’s an opportunity to have a complete therapy process.  We’ve gone from building a relationship to really using the music, to change (internally and externally), and now we can work toward closure.  So that was my big plan.  We could work toward closure.

I talked about endings with my client, and I started to prepare him, figuring we could start by decreasing our two sessions a week to once a week.  Since he doesn’t use speech to communicate, I had to rely on his actions, his reactions, and my own countertransference reactions to get a sense of how things were going.  For a long time, things just didn’t feel right.  I worried that part of the problem was me, because, if I were to be truthful, it was hard for me to think about terminating with this man.  He is someone I like a lot, and it has been so exciting to watch him grow as a person and in his relationships with the people in his life.  I fretted over the fact that he may have picked up on my reluctance to let him go, fearful that he was trying, in some way, to please me by not wanting to end.  

I suppose the best way to describe this period of time was to say it was one of ambivalence.  I got the impression he really didn’t want to end (and maybe he was afraid of ending), but I also felt as if he didn’t have much hope or commitment to music therapy as he used to have.  Much of the time I felt quite confused as to how to proceed.  

At some point I felt as if I’d made a terrible mistake and misunderstood his wish to end.  And, so, after a lot of conversation with my clinical supervisor and with my client (with, of course, the talking being on my end of it), I decided to go back to two days a week with him, feeling that he had actually needed more support from me when he appeared ambivalent and not less.

Now, after about six months of not working toward termination, I still don’t have a sense of what’s going on with him, and there continues to be a quality of “I’m not interested in this” happening at the same time as “this is important to me”.  While I haven’t mentioned it, it has certainly crossed my mind that endings of any sort are a major source of stress for him, and his ambivalence with regard to terminating may very well have been related to his distress around abandonment.  Session endings used to cause all sorts of angst for him (he used to fight me bitterly when it was time to say “goodbye”), but these days he seems rather listless, without a lot of fight left in him. 

I was thinking on Saturday about how I often feel as if I’m failing as his music therapist.  While I frequently realize I’m not quite on the right track with a lot of my clients, I don’t usually feel as if I’m messing up the relationship and really doing some terrible damage of some sort.  As such, I started to wonder whether I was picking up on some of his own feelings of failure, or, as I mentioned earlier, if he, on some unconscious level, needs for me to fail him (like in a reenactment of the many people who have failed him in his life).  

I shared some of these thoughts with him in our most recent session, and, while he was clearly listening (he was actually keeping a closer eye on me this past session than he has been doing of late) I didn’t get the impression that I’d quite gotten to the heart of the problem.  

As I played music with him, reflecting on the situation (because I really do find that I can think more clearly when I’m using the music), I suddenly found a question in my mind...”Is it possible that the real issue for him is his failing body?”  This particular man has always been an active and very independent person.  He propels himself in his wheelchair, he moves to what is of importance to him, and he is one hell of a determined guy.  In recent years though, he has struggled with a lot of health issues- sometimes serious enough to force him to be inactive for long periods of time.  His physical strength has decreased, and he’s not as agile as he used to be, and sometimes I wonder if he is experiencing pain.  Perhaps the real failure here has been his declining physical health?

So, I asked him if he was struggling with strong feelings about the state of his changed body and physical abilities.  He looked at me.  As we sat quietly together I felt a deep sadness descend over us.  It was the kind of sadness that always makes me want to do something, and fast.  I didn’t though.  I just sat with him, because it seemed to me that he needed some time (and maybe my quiet company) to experience his grief over this loss.    

Saturday, October 6, 2007

Silence is golden

A few of my clients often refuse to allow there to be music in their sessions.  They don’t usually play any of the instruments, and their vocalizations are sporadic.  When I start to play they either physically intervene (taking my hands off the piano or pushing the guitar off my lap) or they find ways to make sure the process of the music is stopped.  I suppose I could spend time worrying about this (okay, the truth is that sometimes I do worry about it), but I’m starting to figure that it really is all “grist for the mill,” as Janice, my clinical supervisor, has told me over and over again.  

One of the men I work with is very sensitive to sound (I mean VERY sensitive to sound).  The cottage where he lives is loud most of the time, to say the least.  The ceilings are high, and a large room is subdivided into four group areas, each equipped with various stereo components, televisions, and extremely powerful speakers (or so it seems).  And it is highly unusual for me to be in there and not hear four different sets of sounds coming from four different areas, all echoing off of the walls.  There are no carpets or other sound-absorbing devices, so the sounds are quite “live”.  I have often wondered if my client has grown to hate music with a passion after enduring that kind of intense non-stop noise all day long.  I wouldn’t blame him if he did.  I’d probably feel that way myself.

A thought that ran through my mind during our session today (aside from noting out loud that “in your case, silence is indeed golden”) was this:  if anyone in the world is to teach me that music therapy is not all about sound- silence is just as crucial, and honoring the need for silence is definitely necessary- it’s this man. 

Another reason he may be “asking” me to stop playing music is that when I do play, it is often a song that has emerged from my countertransference reaction.  Naturally, those songs tend to be intense and full of emotional meaning.  Understandably, he may be hesitant when he hears me fire up the old guitar and start strumming a few chords.  

I wonder, also, if his wanting me to not play music (and his own refusal to participate musically) is a way to fit me into a particular image he may have of me (in other words, his transference).  Maybe something in a “you’re not my music therapist, can play the role of my family, and I can finally have someone visit with me after all these years.”  

Certainly that seemed to be the case with another gentleman I worked with this afternoon.  I usually see that particular person on Fridays, but because of our celebration he missed his session.  I had some time today, so I asked him if he wanted to make up his time.  He did.  I knew he probably wouldn’t make it to the Music Room (he hasn’t for a while, but he has been clear that he wanted to maintain the connection with me).  I presumed that we would walk to the building where the Music Room is located (we did), and he would probably turn around and want to leave (he did).  

Things were going fine (and as expected) until we got back to his cottage.  For the past month or so he has been content to do one of three things:  head back in to his group, head in to the cottage and have me sit with him in the back hallway, or hang around outside (in the front yard of the cottage) until it’s time to go.   Today, though, as his cottage came into view, he pulled me insistently back toward the Music Room building.  It was quite sunny and rather humid out, and I was starting to feel a bit desperate for shade.  

He is at least a head and a half taller than I am, so when he doesn’t mean to be turned around it’s hard for me to convince him otherwise.  I noticed that he was quite clear, also, about holding on to my hand (along with his important plastic objects- I know I’m important to him now, because he actually seems to want me to share space with his beloved objects).  Although I started to feel frustrated with his pulling, and uncomfortable with my own response of trying to pull him back toward the cottage, I knew he needed me to support him in some way.

When we reached the Music Room building, he managed to pull me into the Canteen (which is just inside the entrance).  I didn’t want us to be in there, because, for one thing, I didn’t think I’d be able to get him out, and, for another, neither one of us had any money.  Mostly, though, I continually remind him that he and I don’t have a “canteen-going relationship.  We do music therapy together.”  

Well, at 1:45 PM on a Saturday afternoon, the Canteen usually has a few families scattered about visiting with their sons or daughters.  That was when the light finally went on for me.  I realized that, on my way over to pick him up, I had seen one of his house-mates heading out for a visit with his family and another family on their way in to the cottage.  As we were walking, we saw a man visiting with his brother.  He knows I like him, and here I was, coming on a Saturday and not his usual Wednesday or Friday.  It must have seemed quite familial to him.  

As soon as I acknowledged his apparent longing for family to visit with on a weekend (and that he seemed to wish for me to play that role), we were able to leave the building and go back to the cottage with some measure of peace.  Well, it was difficult for him to actually let me go when we arrived in his group area, but there was, finally, a different level of understanding. 

You’d be hard-pressed to find any music in that session.  But it was, I think, an important session.  Definitely, in spite of the challenges, it was a necessary part of the process for the two of us.      

Friday, October 5, 2007

Thirty years of music therapy

Today we celebrated thirty years of music therapy at Hunterdon Developmental Center.  I’ve been there for a little over nineteen of those years.  It was wonderful to have some of my former colleagues and two of the earliest music therapists share in our party.  We started with a drum circle, lead by my friends fromKardon Institute for the Arts and Drexel University’s Hahnemann Creative Arts in Therapy Program.  After a couple of speeches we had performances from the HDC Singers (our resident chorus) and the Matheny Medical and Educational Center Midi Choir.   

I was thrilled with all of it, but the best part for me was that a number of the men and women I’ve worked with over the years as a music therapist came to celebrate.   Without their being there...well, there wouldn’t have been much point in having a big thing.  I’m grateful to my clients for allowing me to show up every week and making the effort to do the same.  Therapy is hard work.  Don’t let the “music” part fool you.  It’s hard to look at your issues, and it’s harder to avoid them when you’re playing them in the music.  I have always told my clients that it takes a lot of courage to do the work we do together.  So, hooray for our facility for supporting music therapy, and hooray for the men and women who let us  be their music therapists!