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.