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).

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