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.”


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

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.