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. 

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