Friday, August 31, 2007

"Feelings...nothing more than...feelings"

For the umpteenth time today, while I was with a client, I noted that the folks I work with who are on the autism spectrum are far from “removed” from their feelings.  


One of the men I work with was, to my eyes anyway, clearly struggling with his feelings a great deal when he arrived at his session.  For the record, he, as with most of the people I support as a music therapist, does not use speech to communicate.  


Truly, the fact that he even came to his session was a big deal, because he has been in his, let’s say... apparently ambivalent?  Yes, we’re experiencing his apparently ambivalent phase again.  He seems to want to come for his session, then he gets stuck (as in, stops moving and seems to want me to pull or prod at him) at every door (hmm, that whole getting stuck at the door thing is an interesting symbol in and of itself, eh?).  


Today, though, he agreed to put many of his beloved plastic objects into a clear plastic Ziploc bag I’d brought for him.  (That way he can have his stuff- mostly blocks and little plastic items- with him but not need to tap them all on the pavement outside in the middle of the road.  And his is still be able to see his objects, because the bag is clear.)  He came out the door with me, and we got to the Music Room alive and well, in spite of a few unexpected lurches forward as we walked.  


He immediately went to get the mallets so he could whack the xylophone and to whack at the piano with them.  He did this while I was trying to get my guitar strap over my shoulder and organize myself to play with him.  Too late.  By the time I got it together he was pretty much done with the playing, and he’d hidden the mallets (and a tambourine he found on the piano) in the other music therapist’s cart.  


As I watched him roam around the room (he doesn’t generally sit with me), I realized how hard of a time he was having with his feelings and trying to cope with them.  I had such a strong sense that he was doing everything in his power to be in that room with me, because it was important to him- even though it was also very difficult. 


I commented on this to him- this supposed disconnection from feelings that autistic people are “supposed” to have and how it seems as if the opposite is actually true- particularly in this moment we were sharing.


I told him that a friend of mine, who is also on the autism spectrum, has expressed envy of me on more than one occasion with regard to my seeming ability to “take it all in” (“it” being life and all the emotions which accompany life) and not seem phased by it (versus needing to take a long break from people just to process it all). 


His facial expression didn’t change much, but he did move to stand in the music-making area (where I was sitting) instead of hovering around in the office area.  The song that came to my mind was “Think in Colors”- a song I wrote.  I actually wrote it, because of a deep caring I was feeling for the folks I work with, but, for the first time, I wondered if it could be sung from my clients’ perspective instead.  


I didn’t sing it immediately, because I wasn’t sure it was time or if it was the right song.  When I did decide it was time and I played it, he came and stood in front of the chair I always put next to me, hoping that someday he’ll come and sit there.  As I played, I managed to reach over and move his bag of objects (which I’d put there when we arrived and which he’d ignored since we left his cottage) to the floor in case he wanted to sit.  


And he sat with me until I finished playing the song.

Thursday, August 30, 2007

And now...playing the role of "The Bitch"

We music therapists have this investment in being “nice”.  You know?  We’re the ones who are “nice” to our clients, we treat them differently from the staff who does their direct support (of course, it’s because we don’t have to make people brush their teeth and take rectal temps and stuff like that).  Dare I say?  We need to be seen as “special” by our clients as much as they want to be “special” to us (see yesterday’s post).  Oh yeah.


Anyway, when my clients respond in a positive way to my treating them respectfully and caring about them (and generally being “nice”), it’s a good feeling...for all of us...UNTIL it becomes clear that we’ve got a crush going on.  Then I have to start the old “we don’t have that kind of relationship” speech.   I say “old” because I have given this speech so many times over the last fifteen years it’s ridiculous.  


Now, it’s not as if my clients believe me or take me seriously when I say this to them, so I have to remind them over and over and over.  I have to keep saying repeatedly, “I will not act on your feelings, but you are welcome to explore your feelings in the music, and we can talk about them” (well, okay, “I can talk about what I think you might be feeling, and I’ll feel embarrassed and worry a lot that I’m just putting ideas into your head that really aren’t yours...”). 


It’s not enough for me (because this is all for me, isn’t it?) that I have to worry that I’m misinterpreting some innocent affection from my clients as a huge crush.  I also have to feel guilt (are we noticing a theme here with the guilt?), because I have to consistently and in as caring a manner as possible keep rejecting my clients’ (possibly, or more likely probably) skewed perception of me. 


I’m not insane (well...).  I mean, I realize that this is a necessary part of the therapy process, and it’s helping my clients, and consistency is next to Godliness, and appropriate therapeutic boundaries are new and unusual to people whose space and person-hood have been regularly and incessantly violated, and crucial to their feeling safe (eventually).  I also realize that it’s because I keep maintaining those boundaries that my clients are able to trust me enough to somehow attempt to communicate that they have very strong feelings for me.   Okay.  I get all that. 


It’s still hard not to feel like I’m being cast into the role of “The (rejecting) Bitch”.  A-ha!  Guess who’s involved in a traumatic reenactment now!  


See, now this is why I like to journal and write about my work experiences.  In the process of blah-blah-blah I sometimes recognize something I neglected to recognize, or forgot that I knew on some level or at least at some point in the therapy process. 


Yup.  I can see how this can definitely be a reenactment.  “Fine!  You, Roia, can reject me...just like my family.”  It’s a hell of a lot easier to be angry with me for being “The (rejecting) Bitch” than it is to be angry with Mom (“I mean, maybe there’s hope that she’ll return and see the error of her ways, so it wouldn’t be wise to be angry with her- especially if anger was why I was rejected in the first place!”).  Someday I’ll have to write about ambiguous loss.  (Pauline Boss has an excellent book about this subject called- conveniently enough- Ambiguous Loss:  Learning to Live With Unresolved Grief.)


At any rate, it takes a long (long) time, but eventually my clients get it.  We’re not going to have a big triumphant rescue from the institution.  I’m just going to continue to be your boring old music therapist who will invite you to look at your darn feelings and figure out how they connect with the rest of your life.  Great.   And when that happens I hear a guy in my head on an echoing loudspeaker saying, “And now (now, now, now) playing the role (role, role, role) of ‘The Bitch’ (bitch, bitch, bitch)...Roia (roia, roia, roia)!”  And, of course, the crowd goes wild.    

Wednesday, August 29, 2007

Owning your music therapist

Well, it turned out that none of the guys actually said “no” to music therapy today.  There was some ambivalence though (we’ll always have ambivalence, won’t we?), so I thought I might end up going back to the Music Room and doing paperwork (yahoo.) for much of the afternoon.   Thankfully, that wasn’t the case.
Part of my job is picking up my clients for their sessions.  That means that I walk over to the buildings where they live, sign them out, and we walk over to the Music Room.  This, in itself, is not a big deal (well, it is a big deal when I have to break into a sprint if someone I’m walking with takes off in another direction).  The difficulty is that I work with more than one person in a building, so when I’m picking up one person for his session, someone else I work with is very likely to be watching me.
I think we all have a quiet fantasy that our therapist likes us best out of all of his/her clients.   If you happen to be someone who is treated like nothing special, it’s a particularly intense wish.   Let’s face it, living in an institution is not exactly fun, nor is it inspiring, and if you’re a generally sweet, quiet person who doesn’t assert him/herself too strongly, you’re pretty much ignored.  If you don’t use speech, and you have an unusual way of being, people don’t tend to act like they like being around you. 
So, along comes a music therapist who is paying attention to you and who genuinely seems to like you.  How wonderful and gratifying!  But then you see her picking up someone else for his session, and your whole “I’m the special person in her life” fantasy?  Shot to hell! 
The men and women who live in our center (and I dare say in every institution everywhere) are acutely aware of their perpetual loneliness.   An awful lot of people never get visits from their families, have no idea what it means to have or be a friend, and they rely on staff for pretty much everything (because that’s how it’s been set up)- including emotional support and connection.  That connection thing doesn’t always happen.  Being resourceful and hopeful (and how on earth can you not love and respect a person who after years of institutional garbage still has hope?!), my clients keep an alert eye out for people who are truly present and who care about them (not just for them).  
Which brings me to this idea of “owning” your music therapist.  Sometimes it feels as if my clients wish to “own” me.  All three of the folks I worked with this afternoon are somewhere on the autism spectrum, and two of the gentlemen seem to have strong reactions to my working with other people who live in their buildings.  
Interestingly, to me anyway, a couple of weeks ago I used the song “You Don’t Own Me” in a session with one of these men, because it suddenly came to my mind while I was working with him (ah, the miracle of the countertransferential song!).  The song had meaning on a couple of different levels, I thought.  One was my initial experience of him, sensing that he wanted me to back off and let him figure something out on his own.  Another element was my sense that he quite dislikes my working with other people in his living group (yes, people live in groups in institutions) and that sense of his “owning” me.

Just say "no"

After I wrote my blog last night I realized that I had only described what it takes to be designated as a Board-Certified music therapist.  I didn’t really explain what it means to be a music therapist.


Right now what it means (to me) is feeling guilty, because I don’t feel that well, and I have clients I need to see this afternoon.  Even if they decide they don’t want their sessions, it’s important that I be there.  I think it’s therapeutic for a person living in an institution to be able to have someone they can 1) reject and 2) say “no” to and still be safe.  I mean, I don’t enjoy being rejected, and it would be a pain if I dragged my fighting off a cold self in to work only to have my clients decide they don’t want music therapy today, but it’s part of the job.


Off I go.

Tuesday, August 28, 2007

What the heck is a music therapist anyway?

Every day I go to the institution where I work.  Many of the people I serve, who live there, have autism and everyone has some sort of intellectual and/or developmental disability. Most of the people I provide services to don’t use speech to communicate or they use very few words.   I’m their music therapist.  

Many people don’t know what it means to be a music therapist or to do music therapy.   That’s okay, because there are probably a lot of us who work as music therapists who don’t know what it means to be a music therapist either.   I’m not saying that to be rude or disrespectful.  There’s a lot to know about music therapy, and I’m realizing that it takes an entire career to learn it.  I’ve been at this for twenty years, and I still think there’s a whole lot I don’t know.

Anyway, in a nutshell, a music therapist is someone who uses the various elements of music (for example, rhythm, timbre, melody, harmony, lyrics, etc.) in the process of helping someone to change or grow in some way (for example, emotionally, behaviorally, physically, etc.).   

Music therapists can practice at the Bachelor level of education, but many of us have opted to get Master’s degrees and beyond.  In the United States we take an exam which, when we pass it, designates us with the credential MT-BC (which means “Music Therapist-Board Certified”).  We’re expected to maintain that credential by going to conferences and engaging in continuing education.

We have studied our major instruments, and we are proficient (hopefully) on piano and guitar as well.  As it happens, my major instrument is guitar.  We use our voices, and we use a variety of percussion instruments.  We can pretty much use any instrument therapeutically, and I would have to put forth that we’re limited only by our skill and imagination.  In addition to music, we study the major psychotherapy approaches, group dynamics, and human development along with learning specific music therapy styles and methods.

I completed my studies at Temple University and Drexel’s Hahneman Creative Arts in Therapy program.  So that’s the general overview of how I got to be here.