Friday, December 26, 2008

Borrowing Ryan Howes' Seven Questions

In response to my last post Adam suggested I answer the seven questions Ryan Howes posed to well-known psychotherapists.  That seemed like an awfully nifty idea to me, so I'm going for it.
1.  How would you respond to a new client who asks: "What should I talk about?"

Hmm, this is an interesting question for me, because the vast majority of the folks I work with don't use speech, and they all have some form of developmental/intellectual disability.  Also, since I'm a music therapist, I think the larger fear tends to be, "oh, my God, she expects me to know how to play music!"  Given that fact, I do spend some time talking about what music therapy is, some of the ways we'll be using music, and making sure to explain that music therapy is not meant to be for professional musicians (although there are music therapists who do work with people who fall into that category).  Then I do a lot of modeling and invite people to begin to play with sounds in a new way. 

It actually takes quite a while before my clients are able to grasp the concept of psychotherapy. In spite of their having experienced years of skill development activities and behavioral interventions, most of the people I work with have rarely had the experience of someone doing psychotherapy with them- let alone music psychotherapy.

2.  What do clients find most difficult about the therapeutic process?

I work with folks who live in an institution and who have major abandonment issues (often complicated by trauma and ambiguous loss), and I think the hardest things for a lot of my clients is saying goodbye at the end of each session.  I use a relationally-based approach, and it sometimes takes many years (I'm not kidding when I say "many"- it has sometimes taken up to 5 or 6 years) to develop a working relationship with my clients. Once that relationship is established, all of those painful, unexplored, unacknowledged feelings of being left surface with a vengeance. Termination isn't a lot of fun either, but that happens a lot less often than ending weekly sessions.  

3.  What mistakes do therapists make that hinder the therapeutic process?

I can speak to mistakes I made as a beginning therapist.  One major one (in the beginning) was making assumptions about what my clients knew/understood and what they didn't.  I always treated my clients (labels and all) respectfully, but it was a surface respect.  As I truly got to know them (and received good clinical supervision and learned how to really engage in the process of music psychotherapy) that turned into a deep respect for the wholeness and intelligence within each person.

Another mistake I made initially was not focusing on the relationship.  I spent a lot of time trying to get my clients to do musical things, so I ended up focusing on what they were doing/not doing and on the things that I wanted them to do instead of focusing on the process and the building of the therapy relationship.

Something that has challenged me (and students I've supervised) over the years is thinking I needed to know the answers, always know what to do in a session, and be the "perfect" music therapist.  I guess that's probably a familiar stumbling block for a lot of therapists. An extension of that is not taking vacations when I've needed them. 

An issue specific to music therapists is the need to know when we are avoiding using the music in the process and when we are using the music to avoid the process.  Something my clinical supervisor pointed out to me many years ago is that playing music through the whole session is like having a verbal psychotherapist talking the entire time and not letting the client say a word!

4.  In your opinion, what is the ultimate goal of therapy?

I would say that coming to terms with and accepting ourselves as we are in this lifetime and maybe not taking ourselves so seriously would be an ultimate therapy goal.  But I'd probably be projecting.  :-)  

5. What is the toughest part of being a therapist?

Institutions can be a hard place to live.  Knowing that many of my clients missed out on opportunities to grow up with their families because of now outdated beliefs about disabilities, knowing the continued overt prejudice and disrespect they continue to experience because people can't or choose not to be bothered to look beyond the outside appearances or question beliefs about developmental and intellectual disabilities, knowing how much abuse goes on, and, worse, knowing that, were my clients to move into a group home, their risk of abuse goes even higher, because there's even less oversight...these things truly hurt my heart in ways I can't even describe.

6.  What is the most enjoyable or rewarding part of being a therapist? 

There's a very specific moment I most love in my work.  If you read my blog, you know that I have to go pick up my clients from their buildings and walk them over to mine.  As I said, above, it can take a long time to establish any kind of rapport. The first time my client jumps up to meet me for his/her session is a special moment indeed, because it means that I've become a specific person to him/her, and it indicates to me that s/he is now invested in the work we're doing together.

7.  What is one pearl of wisdom you would offer clients about therapy?

I must admit this question has me a bit stumped.  I'd probably encourage my clients to not give up hope.  Also a lot of my clients don't quite get the "as if" part of therapy, and they seem to feel very frustrated with me for not being able to "fix" their lives by taking them away from their particular challenging life situation.  I remind my clients that their goodness, their happiness, and their worth doesn't come from being in therapy or from me (the therapist).  It's an inherent part of their being human.  They might discover those things about themselves in the context of music therapy, but they were already a part of them.  The challenge is to recognize those things in ourselves (because it's not only our clients who struggle with this) outside of the therapy space and to live from that truth.

Wednesday, December 24, 2008

The Holiday Tour de Blogs

Since it's "The Holidays" and all, I figured I'd take a break from actual thinking and reflection about work to read about some other people's ideas and thoughts.  

Here are two I particularly liked:

1)  I was over reading Zen Habits, Leo Babauta's blog, and I thought this particular entry about "The Six Greatest Gifts You Can Give Your Loved Ones" had some very useful advice for music therapists as well.  I particularly liked #4, which was about giving your loved ones "a voice". He notes:
Too often our children or spouse might talk to us but are only met with a disinterested nod or other small acknowledgment, or we’ll make light or fun of what they say, as if it’s not important. But giving a person a voice, and showing that their words matter, will have a long-lasting different in their lives.
If we substitute "our clients" for "our children or spouse," and we acknowledge that people who don't use speech still have things to say and are making an effort to be heard, then I think this could just as easily be directed to those of us who work in institutions.

2)  Here's another interesting blog I happened upon today.  Ryan Howes has been interviewing well-known psychotherapists, using the same seven questions for each, and today he interviewed Glen O. Gabbard (someone whose work I have read and appreciated a great deal).  

Here's a particularly nice thing he said about what he likes about doing this work:
Therapists are paid to talk to interesting people all day. In this regard, we are in a privileged profession. The pleasures are many: connecting with someone at a profound level of intimacy that is rare in other situations, learning about other cultural and psychological perspectives on matters of great importance to the human condition, and helping others enrich their lives and make changes for the better.
Nice stuff out there to read while you're taking a break from celebratory adventures.  

Thursday, December 4, 2008

See, Now THIS is Why I Like Being a Music Therapist

I have to admit that I started out today in a bad mood.  For the second day in a row I got stuck (on my way to work) driving behind a slow-moving vehicle (complete with the orange upside triangle and everything), and I just plain had a bad attitude going on.  

It took me a while to get RI to realize who I was and that I was trying to find out if he wanted to go to his session.  He finally realized this, and he decided he was going to go with me.  Then I had to get a coat on him.  I was relieved when he had decided to let go of the backpack (whose straps he had been busy flapping) until L decided to be "helpful" and hand the bag back to RI (who, by that time, was busy flapping the zipper pulls on his coat).  "Thanks, L."  This, of course, meant working on RI all over again, because he tends to lose focus rather rapidly, to help him remember "we're going to music therapy.  Let's leave the backpack here for now."  

OK, so I finally got him to put the bag down again (with a warning look to L to stay back, damn it).  I figure this is our chance to escape.  Never mind that the day area is blasting with music on the TV, different music on the radio, people shouting back and forth to each other, et cetera amen.  Nothing like trying to help a person with sensory and processing issues to understand what we're trying to do in that kind of madness (crikey, if I lived there I'd probably be in restraints most of the day).

Then I was trying to hurry RI along a bit, because he walks very slowly (the flapping continues as we walk, and it is augmented by great long pauses to watch various vehicles trundle by). Generally, as long as the weather's not bad, I don't mind walking slowly with him, but it was cold, and it was starting to rain, and he refused to keep his hood on his head and did I mention I was having a bad attitude today?

So we finally got to the Music Room, and I was certain I was going to scream when RI very specifically dumped his coat on the floor. We grumped at each other without specifically grumping at each other for a while (RI doesn't really use speech exactly, it's more of a thing I've heard speech therapists call "jargon speech," where he sounds as if he's having a conversation, but his words are not clear at all- it may be how he processes speech- I don't know.  Anyway, he does have a fine ear for vocal inflections).

Then we started to play a song (at this late hour, I can't remember what song it was), and we hit a groove.  He was able to follow me, and I was able to follow him (I think it was "Carwash"), and when the song was over, he suddenly clapped his hands with great enthusiasm and shouted "Yaaaaay!"  And in that moment, I laughed joyfully with him, and my attitude was finally gone. Then we made music together.


Sunday, November 30, 2008

Speaking of processing sessions...

I had an interesting session yesterday with B (I've talked about him before in terms of his uses of silence).  I figured, since I'm on this whole series of how to pay attention, I may as well use this as an example of how I think about sessions.

As a bit of background, I was on vacation this past Wednesday (when B and I normally have a session).  I had prepared him for this by letting him know when I saw him last week on Friday that I wouldn't see him until the Saturday after Thanksgiving.  

When I picked him up (part of my job is escorting my clients from their living areas to the Music Room), he was more than ready to leave.  His building was super-loud with the televisions all blaring and people loudly talking over them.  He's sensitive to sound to begin with, so I'm sure this was hellish for him (and don't ask me why I haven't asked people to turn the electronica down- I've asked, I've begged, I've discretely found the remote and turned the volume down- it's futile).  I took him to a quieter area (also one in which he wasn't getting kicked at by one of his housemates- who was clearly stressing him out) to help him with his coat and hat.  In the meantime, he pressed the back of his knuckles to the middle of his forehead.  

From here on, in list form, is an overview of what happened in the session and (in parentheses) my thoughts as to what may have been going on. In fact, through much of the session I felt uncertain (okay, through much of most sessions I'm not sure what's happening). My list is not exactly (not even close to) a real process paper, but the point of doing it is to help me think about B and what he might be experiencing. The hope is that, by trying to gain some understanding of his perspective, I can be of more use to him.  So here goes:

-After a while I noticed that he wasn't "allowing" me to play any music. He kept jumping up from the couch where he was sitting and pulling me to the door, engaging with me there. (Maybe he was avoiding the feelings that can come with playing music? When I've played particularly meaningful songs before he has had strong reactions.  Maybe he was feeling a need to connect with me literally rather than through the music?  Maybe he's feeling ambivalent- in terms of wanting to connect with me but not wanting to deal with the feelings associated with connecting with me- or with the music?)

-I tried empathy (I thought he may have been upset about missing his session on Wednesday, so I suggested that it may be hard to have people you like not be there for you.  I need to note here that his family has not paid him a visit in the entire 20 years I've worked there- maybe longer.)

-I acknowledged his possible ambivalence (love and hate you at the same time, Roia?  He did pause, but I still wasn't clear as to his reaction- as in whether I was on target or not.)

-I didn't apologize for not being there on Wednesday. (I included this, because I have had a tendency, in the past, to feel guilt-ridden for taking time off- heaven forbid- and I'm well aware that it is not helpful to my clients to spend a lot of time apologizing for not being the perfect music therapist- or the perfect maternal transference object.  Now, of course, having said that- don't think I didn't feel an awful lot guilty anyway, because he looked so darned upset.  Sigh.) 

-He kept "fighting with me" at the door. (It's hard to describe what I mean by this.  Mostly he just tries to open the door when he doesn't really seem to need to leave- i.e., to use the toilet- or want to end the session- because when I ask if he's finished with music therapy for the day he almost always goes and sits down.  So I wondered if this struggling with me at the door was an externalization of some internal struggle he was having?  Is it a way to connect with me physically?- which I wondered a few paragraphs ago- Or is it a way for him to say "I'm angry"? Or a way to say "you left me, and now I want to leave you" by trying to push my way out the door?)

-Was the fighting and struggling with me a way to cover up deep sadness?  I asked him "Is it okay to allow me to see your sadness?" (I think I was aware of a sudden sense of sadness, so that's why I asked.  He responded by sitting and making some pointed eye-contact.  Hm.)

-He also kept tossing instruments- even kicking them once or twice. (I use about four instruments to help him say some broad, general things- since he doesn't use speech to communicate.  The maraca is to say "I'm frustrated/angry", the tambourine "uncertainty/anxious", the cabasa "sad/disappointed", and the tube shaker "I'm okay today".  Interestingly, he hardly ever even touches the tube shaker.  Anyway, he had tossed the instruments- as usual- and on this particular day, while he was up and encountering them on the floor, he added a kick to them.  I'm guessing there was some anger, yes?)

-A couple of times, since he was really pushing at me to get out the door, and I didn't want him to have a toileting accident in case he actually needed to go, we went and walked down the hall.  He didn't need the bathroom, but he didn't want to leave either, so we ended up walking back to the Music Room. (I asked if he wanted to go for a walk to get some air/exercise- didn't seem to want to go- that, of course, was when he went and sat down.)

-When it actually was time to leave he didn't seem to be too happy about it. (I had taken him- yet again- down the hall and this time he did use the bathroom, and when we got back he didn't want to go in the room. I think it was because it was time to go, and he didn't really want to go back to his building. I had to go in the Music Room and get our coats.)

-When we got to his building, he paused on the way back in, and he let me open the doors this time. Usually he dashes in ahead of me and gets all the doors himself. (I got the sense that it was simply hard to let go at the end of the session. I realized how heavy my heart had gotten during the course of the session, so I also felt the sorrow of having to end for the day.)

So that's how I process a session.  Most of my thoughts happened during the session, and I wondered some of them out loud and some of them I couldn't quite fully form.  I still couldn't tell you for sure whether he was upset about our missing a session due to my vacation, upset because it was Thanksgiving and the holidays bring him sadness, or he was simply overloaded from day after day of noise and needed to vent to me in the quiet of the Music Room.  Or something else entirely that I would never occur to me to think.

The whole point of calling it a process is that we look at what happens over a long period of many sessions, not just one single day.  But this is what happened on a particular day, and I put it into the context of our entire period of work together (it's been eleven years of work, as it happens).

Wednesday, November 26, 2008

Paying Attention in Music Therapy Series- Part 1: How to Process a Music Therapy Session

I've written before about paying attention in music therapy. It's such an important aspect of our work (made even more so by the fact that many of us work with people who don't use speech), I decided to do a series on the subject.

The first thing I learned in clinical supervision was how to write a process paper. Appropriately enough, it helps you process (in other words, think about and examine) the session by looking at what you were hoping to do, what actually happened, and how your client(s) reacted and how you reacted. It's an intensive exercise, but it's worth it, because many music therapists are used to doing activities and focusing on the product of therapy (the goals and getting to the goals by using specific activities). As such, it's a very new experience to pay attention to the process (looking at relationship and the development of the relationship and how it's manifested in the music). Furthermore, when you aren't sure what's going on- maybe therapy isn't progressing, or maybe you feel uncertain as to how to proceed, or you find yourself having strong reactions to a particular client- it's a way to dissect the session into its smallest parts, thus (hopefully) slowing the whole experience down enough to be able to see where, why, and how the therapy is getting stuck.

Create two columns next to each other on a piece of paper. Listen to and/or watch an audio or videotape of a session (if you have neither audio nor video, you'll have to do this from memory). In the first column right down exactly, in the order that it happened, what you did and what happened (what music you played, what you said, how your client(s) responded, etcetera). In the second column write down (opposite of what you did or what your client did) what you were hoping to do, why you chose to make a particular intervention, and how you felt about your client’s response(s). For example:  

(Column 1) I went in to the building to pick up my client, Joan, for music therapy. She was waiting for me at the door, because she can see through the door when I come in. We walked to the Music Room. She waited for me to help take of her coat. I sat at the piano, and I invited her to join me in the chair I had set up next to me. She walked around the room, touching different instruments. I sang the greeting song I usually sing to her (and so on). (This is your objective experience. Just the facts)  

(Column 2) I was excited about going to get Joan. I really like her, and I was looking forward to doing our session. I was surprised but pleased that she seemed so eager to come with me today. When I helped her take off her coat, I wondered whether she really needed my help, or if she's just used to other people helping her with it. I found myself feeling somewhat frustrated that she continues to walk around the room and ignore me when I sing a greeting to her. I wondered if other people feel frustrated with her as well (and so on). (This is your subjective experience.)

Tuesday, November 18, 2008

"On the right track" versus "trying again"

I was just reading an interesting post by Dinah in the Shrink Rap blog about "What People Talk About in Therapy".  I had to click on it, because, as you know (if you regularly read my blog), I do music psychotherapy with people who don't use speech as their primary means of communication.  As you would imagine, I'm always wondering what my clients (many of whom are on the more involved end of the autism spectrum and all of whom live in an institution) would talk about if they could.  Of course, I also try to read what autistic people have to say (knowing full well that what one person has to say isn't what every person has to say) as well, since the internet has become a rather handy resource in that respect.  

I am, however, always curious to know what it's like to do psychotherapy with people who talk out loud.   

Here's a particular part of Dinah's post that I wanted to ponder:
Psychotherapy is often about finding and elucidating patterns for people. Have you noticed you always feel badly at this time of year? That you've been feeling worse since we stopped the medicine? How you talk about your boss the same way you talk about your mom? How you make assumptions about the reactions of strangers that keep you from even trying to get what you want? Maybe it resonates, maybe it doesn't, I can always try again.
Even though the folks I work with don't use speech, they certainly have very clear behavioral patterns and styles of interacting.  And I find I do the exact same thing (noticing and pointing out patterns) in my sessions. Of course, because it's music therapy we also have the added opportunity to notice patterns in music-making (or music-avoiding, or instrument-throwing, or dead silence, etc.). I also tend to pay attention to my own typical patterns of reactions to specific clients. Between the process of taking note of my issues and the "miracle" of projective identification, there is usually some illuminating moment somewhere (even if I'm not always sure which way to go in my work with a particular person).

The challenge, as always, is that my clients' behavioral patterns can just as often be related to motor planning difficulties, and they may not reflect what is actually going on in that person's mind. And, yes, just because someone is able to tell you what's going on for them, it doesn't mean that s/he is going to be accurate, talk about the "real issue", or be aware of what's going on internally, and so on. 

What I specifically appreciated about the above quote, however, was that she notes (with regard to her interpretations and observations):   
Maybe it resonates, maybe it doesn't, I can always try again.
Many people who come to watch me work (most of them are music therapy students sent to do observations or doing their practicum with me), or those I to whom I describe how I work, ask me "if your clients can't talk to you, how do you know you're on the right track?"

Well, the most obvious answer is that I don't always know whether I'm on the right track. I may be on the absolutely wrong track. And, as Dinah kindly points out above, "I can always try again." As I've continued to do this work I've discovered over and over again that therapy isn't usually about being "on the right track" as much as it is about "trying again."  Going back to Dinah's blog: 
In my past ramblings on psychotherapy, I made the comment that sometimes people seem to talk about trivial things that happen in their lives --I think I used the comparative price of beef as my confabulated example for my confabulated patient-- and they still find therapy helpful. I noted that therapy can work even if the patient doesn't come every week: help is where you find it and people have different needs and extract comfort & cure in different ways.
I may, at the end of a session, think, "wow, that was a whole lot of not much happening," and yet it's not unusual to have the following happen: I prepare to leave the client's cottage where I just dropped him off, and he suddenly comes running back over to me and wants to leave with me. Obviously, something in that session touched him, and he found some meaning in being there with me. Maybe it's because I generally do "try again" when I get it wrong.  Maybe it helps my clients know that they can try again too. 

Tuesday, November 4, 2008

"That was so much fun!"

"That was so much fun!"  Well!  I don't usually hear that from the direct support staff who take part in music therapy groups with me.  Actually I don't usually have any staff with me when I'm doing music therapy.  Long ago I decided to work alone when I do sessions, because the direct support staff and I tend in very different ways.  Ahem.  

As such, you may be wondering why I actually decided to include the staff when I started a new music therapy group with the women in Group 2.  Well, for one thing, this can be a pretty rough crowd- I've seen one of these women tear apart an entire bathroom, ripping down shower curtains, tossing clothing and bathing items asunder, and then shred her clothing in a matter of seconds (let me tell you- that's a talent).  Another woman tends to yank hair, scratch, and bang her head on the floor.  As you might imagine, having their support staff around could be a very good thing.  

Another reason I wanted the staff in this group to come with me is that they are consistently with that specific group on Monday evenings.  Most importantly (to me anyway), these three group leaders (as they are referred to in our facility) really seem to like the ladies they support (I'm not being nasty here- sadly, I don't always see this attitude in this line of work).  They were very enthusiastic when I asked them if they were interested in our doing a music therapy group.  

We agreed to move the ladies from their usual living area (a room with no outside windows, in the middle of the cottage, surrounded by a lot of noise from neighboring day areas) to a room across the hall where the recreation staff works.  It's generally a quiet room, it's contained, it has chairs (even though various members of this group like to be mobile or recline on beanbags), and we can use fewer lights (the fluorescent lights are quite horrible) because it has windows.  

I also wanted the staff to understand the point of music therapy- give them a context within which to interpret what they might experience in the sessions.  I wanted to give them an idea of what I'm doing, why I'm doing it, what I'm watching and listening for, and how I'm going to do what I do. So I gave each of them a copy of a detailed memo I wrote a long time ago for supervisors who periodically come to observe sessions.  

I also gave them the Music Therapy Observation Form I've been working on for quite a while.  It's a complex form which I usually have my practicum students fill out  on a weekly basis.  It asks a lot of questions meant to provoke thought with regard to what the music therapist is seeing, sensing, hearing, and musing about during the group.  It also encourages attention to the relational qualities and dynamics within the group and how these might be expressed (or avoided) in the music.  It also notes some of the elements which might be going on (or ongoing) for clients in addition to the experience of being in the music therapy group (illness, sensory issues, motor planning problems, traumas, family stuff, etc.).  

We've had three sessions so far.  If all of the group members (minus their staff) show up we have seven women- which may end up being a lot, but we'll see how it goes.  The best we've managed so far is to have six women and two staff people. Sometimes the ladies decide to go to bed early, sometimes they head out with the teachers, and sometimes they need a break from the group and want to do their own thing.  

All but one of the women in the group are somewhere along the autism spectrum.  And, again with the exception of the one woman (who is dealing with mental illness along with her developmental disability), none of the ladies use speech to communicate.  They are, however, women with voices.  Quite a range of voices, I might add.  From low and gruff to high and sweet.

One of the things I noticed with regard to the group leaders is that they tend to chatter almost constantly with the women in their group.  This is actually, in many ways, a very good thing.  So I didn't want to discourage their natural tendency to want to interact, but their conversation, while animated and pleasant for the most part, was making it awfully hard to actually hear the group members.

Last night three of the women were present in the group.  I gently invited their support staff to listen- reminding them, "this is your opportunity to hear the ladies you work for in a completely different way."   They were quiet, and they listened. And it was great!  

I offered V a maraca.  She had come in to the room using her wheelchair, because her staff, M, was concerned she'd grab at and scratch everyone (and, indeed, she did seem headed in that direction as she began to pull roughly at M's shirt).  V held the maraca, evidently curious enough that she was able to settle herself down. In fact, she didn't grab anyone else for the rest of the session.

K was awake (last week she slept on a cushion we had brought for her- this time she had a big long beanbag and a blanket).  K is often asleep during the day, because, from what I can gather, she doesn't sleep well at night. I sang a greeting to her (and to her housemates). I invited her to turn toward each woman in the group (she is also visually impaired), asking them to alert her as to where they were located in the room by making some form of sound (her staff included).  She listened quietly as each of us made a sound or greeted her with a "hi, K" and turned her head to acknowledge that she had heard us.  

M switched chairs a number of times, making sure to stay near me, even maintaining visual contact.  She sang through much of the 30-minute session, quietly, a high-pitched and delicate collection of short little four and five note melodies and bursts (for lack of a better word).  

At one point, L agreed to come in to join us.  She still had a cold, but she accepted the tube shaker from T (her staff), and she shook it vigorously for about 30 seconds, set it down, picked it up to give it one more good shake, and handed it back to T and left.  

V eventually decided she wanted to get out of her wheelchair and sit on the beanbag with K (apparently they like each other well enough and are used to sharing this space).  There was no scratching or grabbing.  K decided to stand and move to the music (I too got up to sing and rock across from her while I followed her rocking on the guitar).

It was hard to have to sing "goodbye" to them all, because it truly was enchanting to watch the group transform into this lovely music-making collective.  T was astonished and excited (having assured me when we began that she had read all the papers I'd handed her the previous week and found them fascinating).

As we sang "goodbye" V, who had been holding the maraca so quietly, decided to join in with her voice.  Indeed, "that was so much fun."


Tuesday, October 21, 2008

Thinking about acceptance

I was just reading Asperger Square 8's blog where she posted a video made by the mom of a child who is autistic (you should go watch it- it's thoughtful and has a message worth hearing). The mom referred to herself as a former "warrior mom"- in other words, a mother who did everything she could to "cure" her child's autism.  Her child is now ten, and she has changed her focus from trying to "fix" her kid to loving and accepting him as he is (and inviting the rest of the world to do the same).

I commented that I have stopped trying to fix my clients and decided it would be more helpful to get to know them and to enjoy making music together.  Then I re-read my last blog post.  It wasn't a shining example of me being particularly accepting.  Well, I guess if it was a shining example of anything it was my difficulty knowing when to say "enough is enough."  (I did finally have to discontinue music therapy with that particular client, by the way.  It was, in large part, because I was getting kicked and pinched way too regularly, and it really needed to stop.  But it was also because he really doesn't seem able to make use of music therapy right now.  Maybe someday.)

I did, at any rate, want to give some thought (well, more blah-blah) to whether the folks I work with need "fixing" or acceptance. When I stopped doing music-making "activities" (back in 1994 or so) and started using the music to build relationships with my clients, there was a huge sense of relief. My clients were relieved, because I was finally paying attention to them (and not to my concerns as to which activity we'd be doing next and how on earth I was going to get them to do what I wanted them to do).  I was relieved, because I felt as if I'd finally learned how to be a music therapist (versus doing music therapy to my clients).   I also didn't have to come up with bigger and better activities any more (which was especially nice, since I never could get my clients to do any of them anyway).

More importantly, I got to enjoy the work for the first time (hence, my undying gratitude to my clinical supervisor, Janice Dvorkin), and I got to know my clients and to like them in an entirely different way- as people who were worth knowing and not as blobs to be molded through planning and organizing specific interventions to- okay, I admit it- "fix" them.   

If I'm going to be truthful (and I may as well be), it's only been in the past year or so that I have had the conscious thought:  "My clients don't need me to fix them, and they don't need me to fix their lives for them.  What they "need" is for me to be here, and be an ally, and like them for who they are, and help them like themselves for who they are.  Period."   Recognizing this has provided me with even more relief.

It still bothers me when I can't fix life for the guys (it's an institution, and, I'm sorry, but institutions are inherently the pits), and it's hard when it seems as if some of the people I work with can't seem to move beyond a very difficult way of being.  But, if I'm going to be accepting, then it goes beyond not seeing my clients as needing to be fixed in some way.  It also seems to mean that I have to get to a point of being okay with the fact that people are who and where they are, and if they don't choose to make use of the therapy I offer, then part of that acceptance is moving on and supporting someone who is ready to receive my services.

Thursday, September 25, 2008

Is failure an option?

Oh. My. God.  Today was long.  It was annoying.  It was frustrating.  It made me wish I did anything but music therapy.  

As guilty as I'm going to feel, I have to say it.  Sometimes I hate my job.  Okay, so now you know. I felt like a complete failure by the end of the day anyway, so I may as well publicly (yes, publicly) admit that sometimes it sucks raw eggs to be a music therapist, and I entertain evil thoughts about some of the guys I see for music therapy.  

Initially, I was just having a boring day, because a lot of my clients seemed to be out and unavailable.  Then, when they were available, they were exhausted (yes, I am rolling my eyes heavenward, why do you ask?).  

Well, okay, the real problem was one particular client who has been challenging me for...let's see how long have I worked with him? Almost five years maybe? Let's just say there has never been a time in our work together that didn't make me wonder "why the hell am I still doing this? Why is he still getting music therapy?" (or, to quote a wonderful bumper sticker I bought many years ago, "where am I going, and why am I in this hand basket?"). 

Yes, there's something wonderful and likable about him, but, for pity's sake!  I am tired of asking him to stop licking the walls, the table, the dirty clothes bins, etc.  I am ready to claw out my own eyeballs from asking him to stop writing all over his face with the ball point pen.  And, for crying out loud, enough with the kicking, punching and pinching at me!  

I think I'm most upset, because I have sincerely tried and tried, and the reality is I can do no more for this man.  I just don't have the energy to keep arguing with him.  If he doesn't want to change, then he doesn't want to change, and I'm wasting both our time trying.  

The distress part for me (until now anyway) has been that, to my way of thinking, I have to keep trying.  See, now this is why I needed to take a break from working for a little while- so I could finally recognize that my thought process was ridiculous.  It is now glaringly obvious to me that "trying" in this case is more about my need to not fail than about his need for music therapy.

I wonder if other music (and non-music) therapists go through this madness.  Or am I just insanely Don Quixotic about it all ("to fight for the right- without question or pause- to be willing to march into hell for a heavenly cause...etc.").  Clinical supervision anyone?

*Heavy sigh.*


Tuesday, September 16, 2008

A visit to the cemetery

On my way to rehearsal last night, I decided to stop at the library.  Well, as it happened, the library had just closed, so I was too late.  While I was waiting to turn out of the library parking lot, it started to occur to me that R was buried in the cemetery across the street.  On a whim I pulled in to visit him.  I couldn't remember whether there was a gravestone, but I had some idea of where he was buried, because he's toward the back by the trees.  

I got out of my car and went to look at the gravestones.  No luck.  I noticed a little metal grave marker, and when I looked closely I saw his name on it.  Then I realized that someone who knew and loved him had placed a little metal smiling bee next to it to mark the space as belonging to R.  I started to cry, because I was very touched.  Back in February I wrote about how R used to come up to me and yell "BEE" at me and want me to yell "BEE" right back to him in his ear.  When he was younger, bees would sit gently on this man's finger- this man who, for a large portion of his life, yelled and slapped and kicked at people (often because he was likely in a lot of pain).  

Now he has a little smiling bee watching over him.  I think the other thing that made me cry was knowing that it meant someone else, probably from the institution, has been visiting him and is missing him. I don't know about anyone else, but I think it's comforting to know that, even when we mess up some things in this life, even if we yell and lash out at people because we're in pain of some sort (emotional, physical, spiritual) or we're scared- there's usually someone (or several someones) who still love us and will miss us when we die.  

Saturday, September 6, 2008

Beautiful voices

One of the things I didn't know I missed when I was away from work for the summer was the collection of little and big sounds that go along with my music therapy groups.  When I hush and listen (and sometimes I have to give myself a mental nudge to remind myself to do so) I can hear the voices and sounds made by the people who don't use speech to communicate.  

On Thursday afternoon, we had quite a crew gathered (I honestly don't know how so many people keep ending up in our group).  There were at least ten men, and we were all sitting (or standing) in a sort of long circle in various forms of chairs.  Everyone who wanted to use an instrument (well, all three guys) had their preferred objects to sound, and even though we looked (more or less) prepared for action, we couldn't seem to get any kind of a musical improvisation going.  

To be truthful, there was some unrest.  T, who was sitting next to me, was a bit agitated, and he was up and down a bit- biting at his hand and then taking my hand and pumping my arm up and down a few times.  The recreation person came in and asked if he could borrow one of the guys, so they left together.  B wanted to sit in the windowsill- which, on principle, I'm not against, but his staff have asked that I not let him do that, because he tends to urinate all over the windowsill area, and, well, you get the picture- so I usually ask him to not sit there.  P, who usually wants to be in the session before anyone else and stays longer than almost anyone else, decided to return the tambourine he likes to use and left the room entirely.  

I think it was in between dramas that I finally quieted down, uncertain as to how I should proceed, and that was when I noticed the sounds:  R's quiet, breathy "hah, hah, hah" (accompanied, as always, by his quick forward rocking motion), B's- also quiet- melodic humming (he usually uses a very small range, and it's often in a minor key), and S's consistent, somewhat higher pitched, "ee-mmm-aaahh-mmm-eee-aaah", punctuating his sounds with gentle clapping sounds placed at various intervals.  K had the seed pod rattle, and, as always, he held it tightly in one hand, making it difficult for the seed pods to actually rattle, and he used his other hand to tap at it very softly.   

I listened with such pleasure, suddenly aware of how much I'd missed these sounds and these moments.  I tuned my low and high E strings down to D (the sounds felt very open and D-ish to me), and I joined in with my quiet sounds too.  The energy in the room shifted, and we were all able to settle down and play together.   

Monday, September 1, 2008

Walking slowly together

On Saturday (I work on Saturdays) I went to pick up D from his cottage.  I hadn't seen him for two and a half months, and I wasn't sure how he would react when I showed up after all this time. I mean, I told him I'd be on a leave of absence, and I explained that I would be returning at the end of August, and we would resume music therapy.  Since D doesn't use speech, and he's rather a quiet man (at least he is when he's with me), I wasn't sure how he had experienced my announcement.  

Anyway, he smiled when he saw me this past Saturday, and I must admit I was glad to see him too.  He pulled me to the door, and we were off.  It was a quiet morning, and D tends to walk- more like an amble actually- very slowly and deliberately.  His heel always goes down firmly first and then the rest of his foot follows along in sort of a rolling motion, his toes always pointed out. He holds on to me- to my hand- with his right hand, and his left hand usually goes up and rests gently on his chest or on the drawstring from his jacket (or the drawstring on his shorts).

A good word to describe D's pace, I'd say, is "leisurely".  Very.  I have often found it difficult to walk with him because I have to slow down quite a bit in order to not end up dragging him along. The thing about this particular day was that I had just returned from taking my own "leisurely" break.  As we walked slowly together, I immediately noticed how much less hurried I was, and how it was so much easier than usual for me to adjust myself to D's gentle rhythm rather than indulging the tendency I have to move along at my usually frantic trot.  

As we strolled along D hummed quietly, and I enjoyed listening to his singing- not a particularly wide range, but he was very present and lovely to hear.  Nice... to slow down and pay attention.

Saturday, August 30, 2008

Reflecting on a quiet summer

I'm finally back to work.  Only problem?  I got a cold the day before I started. Sigh. So I've been coughing and sniveling through the last three days. Nice.

I've done a lot of thinking about whether my decision to take a leave of absence from being a music therapist for two and half months has been helpful.  A lot of people have asked me, and here's what I have to say about it:
1)  I am absolutely shocked that I didn't spend the entire summer feeling guilt-ridden about having "abandoned" my clients.  After all, I am responsible for their happiness and their very lives, am I not? (Now... you see why I needed to take a break?)  This fact alone indicates to me that I was correct in my recognition that "it was time."  
2)  Toward the middle of August I realized that I couldn't quite remember my schedule.  I know this sounds like kind of a weird thing, but when you work in an institution (heck, when you live in an institution) your whole life revolves around your schedule.  There are a lot of people who need services, there are a lot of people who provide services, and somehow or another we all need to show up, be available and have space to do our thing in some orderly way. Hence, schedules.  
Even though my schedule has changed many times over the last 20 years, I have always been fairly certain I'd be thinking through my schedule daily for the rest of my life (well on into retirement).  It felt that indelibly emblazoned in my mind.  I actually had to go in to work this past Wednesday (my first day back) and ask our secretary if she had a copy of my most recent schedule.  Woah.  That was unexpected.
3)  And, speaking of retirement (well, sort of), I actually have gotten to the point where the idea of retiring, eventually, from the institution sounds good to me.  In fact, I'm even eager to get there.  Can we say, "enmeshment problems"?   Who knows? Maybe I'd even consider moving on and doing different work before I retire (as in, I'd still be a music therapist but with a different group of people).  It would never occur to normal people (I am not one of them) that this would not be an option (leaving one job and going to another, I mean).  For me, it took an actual leave of absence.  Hm. 
4)  This realization happened after my return:  The first three days of work have been exhausting!  Okay, yes, I've got a cold, and that isn't helping at all, but... I'm saying... exhausting!  Walking around from building to building with a guitar on my back and a bag of instruments slung over a shoulder, doing session after session, chasing after clients who head off to parts unknown, dodging clients who suddenly decide to freak out while I'm walking through their day area, trying to cram in paperwork time, preparing for a whole bunch of memorial services and monthly religious services, and figuring out what I've missed in the two and a half months since I last showed up for work... I just get home at the end of the day, check my email, brush my teeth, and dump myself into bed!  
Until you take time off from the perpetual motion that comes to be your daily life, and then go back to it, you don't know how hard you work!  I guess I just got to be so used to doing my usual routine (and what I described above wasn't even usually my whole day, because I've had private clients as well) to the point where I didn't even notice how much constant effort I was putting in to just getting through a day.  Wow.  Just... wow.  Definitely eye-opening.
5)  I'm noticing that I feel calmer in my interactions with my clients.  I'm always going to be neurotic about safety issues, but I feel less compelled to do something when it seems as if nothing is happening in a session.  Before my leave I knew that I didn't have to do anything, but I felt the need to do something.  Now that I've given myself the time I've needed (boy, have I needed) to listen to my own thoughts, face a lot of feelings, slog through so many issues around how I relate to people and such, I'm more willing to simply be with and wait for my clients to get where they need to go when they're ready. 
So, was it worth taking time for myself?  Absolutely.  Am I glad to be back at work.  You bet I am.