Wednesday, January 28, 2009

The state of "I don't know"

There are a few recurring themes (if I may go all musical on you) which I've noticed in my work with Bc.  One is that sometimes he shows up, and sometimes he doesn't.  Another is that sometimes he seems very interested in what we're doing- all involved, playing music, engaged, and sometimes he doesn't. Yet another is sometimes he's very groggy in his sessions (and sometimes so am I), and sometimes he's not.  

Okay, so maybe there's actually only one theme here:  sometimes yes, and sometimes not so much.  

I haven't worked with Bc all that long (comparatively speaking).  I'd say it's only been, maybe, three or four years. I've often found, having worked in an institution for almost (gasp!) twenty-one years, that it takes more like six to eight years to start to get a sense that maybe we have a relationship happening here.

On two separate occasions, in the past month or so of working with Bc, I've had this very strong sense of feeling bothered.  Not exactly bothered, really- it was more a wondering, "Does this man really want music therapy? Am I just getting on his nerves?  I have to work so hard to get his attention, and even when I may actually have his attention, I'm not sure that he's interested in this.  Do I even exist as something or someone who matters to him?  I just feel like he's avoiding dealing with me, and I'm constantly trying to get a sense of 'does this matter?  Do I matter?'"

So there I was, pondering these things, and it suddenly hit me. "Is this how Bc feels in his life? Like he has to work so hard to get people's attention, and then maybe they'll be interested in paying attention to him, and maybe they won't. Maybe Roia will stick around, maybe she won't. Is it worth the effort to trust someone who's probably going to disappear anyway?"  

It has occurred to me that it's possible that my clients spend a large amount of time experiencing uncertainty. And I, by extension, as their music therapist, spend an equally large amount of time feeling uncertain. I've written (well, I've made mention of) ambiguous loss in two previous posts (here and here). Families disappear.  Staff comes. Staff goes.  The thing is, I think it's connected to this constant state of "I don't know" that my clients and I seem to co-experience in our sessions.

If you've ever been in an institution (for whatever reason), then you start to notice that, in spite of all the schedules and the "you're supposed to be here at this appointed time" and the regimented this, that, and the other thing, the menus, the activity schedules and so on...there is still a strong sense of uncertainty in the experience of being there.  

By uncertainty, in this instance, what I mean is, "Which staff is on today/tonight? What kind of mood is s/he in? What is that going to mean for the kind of night I'm going to have or not have? Is this person still my staff, or has s/he moved on to work in another building? When will my family be visiting me? Do they know I'm here?  Do they care?" You get the idea. 

As a music therapist, I'm called on to hear this somehow and translate it to music.  To give it a voice.  To acknowledge it. This constant state of "I don't know."

Sunday, January 18, 2009

A lot of ways to say "goodbye" (or-er- not)

I keep meaning to go back to the series on Paying Attention in Music Therapy (and I will), but the thing is, my clients always seem to provide me (and, by extension, you) with a whole host of examples of how to pay attention and why it's so important and helpful.

Before I even begin, I want to add a disclaimer and say that I realize I could be absolutely off the mark in any and or all of my interpretations with regard to my clients' actions and interactions. The reason I give so many details is that it's helpful to note that, when they're ready (and when I start to make sense to them), my clients (many of whom have autism) really do make a major effort to let me know, through all my insistence on paying attention, that I sometimes seem to get it right. 

Now, on with the latest...

Yesterday was a pretty intense day with B.  He took a lot of risks this past week, and he allowed himself to show me how strongly he feels about his time in music therapy with me (it's not as if I didn't know it, but I think he was feeling it more acutely this past week). 

If you've ever read this blog, then you can't possibly have missed the fact that goodbyes (and endings) are not my clients' favorite time of the session. 

Well, having taken all kinds of risk (and having felt all kinds of rejected), B was quite clear in letting me know he was not pleased with our having to stop for the day. On Wednesday he kept putting his coat on halfway and then taking it off and handing it back to me (along with the mittens I so painstakingly attempted to get over his rather uncooperative thumbs- argh!).  Then he kept indicating a need to use the bathroom (um, he didn't need to use the bathroom).  

Yesterday he got his coat on and such, but when we got back to the cottage he looked like he wasn't quite finished with me.  He actually followed me right through the day area to the hallway where we hung up his coat (well, where he held on to his coat and then handed it to me to hang up).  Then he rushed over after I signed him in and was set to follow me right back out the door.

His staff person offered him a snack, and, after a pause, the crackers won, and he decided he needed sustenance (I'm totally down with that- I am, after all, a great big fan of food). I reminded him I planned to see him on Wednesday, and, had he had the dexterity, he might have given me the "yeah, yeah, you do that" wave while he indulged. 

As I was walking out the door, not one but two separate countertransference songs swirled through my head.  Countertransference songs are those that start playing in my head when I'm doing music therapy with an individual or a group. 

The first was "Don't Leave Me This Way" . I know other people sang it, but I remember the Thelma Houston version from back in the mid 70's- which wouldn't be an issue, except that, in this case, it's of interest- to me anyway- that the version I know is sung by a woman.  More on that in a moment. 

The second (and almost simultaneously occurring) song that my mind started singing was "Please Don't Go" (which KC-of the Sunshine Band- wrote and sang in a sweaty state in the YouTube video to which I've added a link). 

Both songs are pretty impassioned, and the feelings expressed within them are rather intimate (which, I believe, were the feelings B was trying to express in his session).

Now to the fact that one of the songs was (in my memory anyway) sung by a woman.  Bear with me, this may get a bit confusing:

A number of times in my work with B I've come up with countertransference songs which were sung by young girls or young women.  It struck me as something I ought to take note of, and I did give it some thought at the time, but it's mostly been lying quietly in the back of my mind for a while, waiting perhaps for just this moment.  

Last Saturday (not yesterday), after a very difficult and puzzling session with B, I left, and (as I expressed to my clinical supervisor) I found myself feeling emasculated.  Which was a very odd feeling for me to be having since-er- I'm not a guy.

I realize there could be a lot of reasons why B seems to somehow summon up so many songs in the feminine voice, but in this particular case (back to yesterday's session and the two "don't leave me" songs I heard in my thoughts), I wondered if my having set a limit ("B, we don't have that kind of relationship.") made him feel rather emasculated.

I extended the thought further in my mind, and I wondered if he struggles, in general, with his identity as a man (i.e., What does it mean for him to be a man?  What does it take for him to feel like a man? Does he feel like a man? and so forth). 

This isn't easy work, but how can you deny that it is so fascinating?  

Friday, January 16, 2009

Listening to the difference

Last Saturday, D and I waded slowly through the snow (since we were both fairly well-bundled, it was actually a pleasant and pretty walk), and we managed to get ourselves to the Music Room. 

Lately, he has been a lot more vocal during his sessions, and it's been exciting to hear his voice at long last, mixed in with his chuckling and rocking. 

Before I went on vacation for two weeks, I'd been using a lot of dissonant sounds on the piano with him, and he was quite responsive. So we had been playing back and forth, with D vocalizing, smiling, and tapping at the tubular shaker.  

This past Saturday was the first session after I'd been away.  What I began to notice as we made music together was how different my music sounded from what I usually play with D. Instead of the playful dissonance, I found myself using a ground bass. Very consonant. Very settled and very settling. Also very consistent.  I found myself using a lot of I-IV-V progressions- nothing particularly unexpected. In fact, it was downright predictable.

I usually ask my clients whether they have any feelings with regard to my absence that they want me to know about. Of course, since the majority of the folks I work with can't tell me with words, I am usually left to figure it out. Somehow. Well, "somehow" usually involves paying attention to the music. And how people are interacting with me (or not).  Mostly I try to notice what feels different.

I wondered (to myself first, and then out loud to D) whether he was feeling a need for me to be predictable in the music, because I had been away (which, in spite of my reminders, probably felt somewhat unexpected to him).  Perhaps he needed me to be more trustworthy, or simply present, within the context of the music.

Interestingly, consonant music usually comes back to the tonic chord- the I chord out of the I-IV-V progression. Maybe he simply needed to have me musically express that I had come back.

You see how it's sort of difficult to put the musical experience into words.  This is what makes music therapy so powerful.  It doesn't rely on words. 

Well, I wasn't sure whether I was on the right track or not.  D doesn't usually seem to be too bothered by my being away.  But here I was noticing that my musical interactions with him were different- even though his responses seemed pretty much the same as usual to me.  

So I waited and tried to pay attention.  There we were: D was doing his singing and tapping thing, smiling as I played my consonant chords on the piano, and we were going along just fine until I let him know we had about ten minutes before we had to say "goodbye".  His whole face changed, and the vocalizing sort of stopped. Hmm. 

"Roia, we were going along just fine in music therapy, and suddenly you weren't here."

I wouldn't have thought much of it, because he does do this sometimes, but it was so obviously connected to my saying it was nearing time for us to go.  And I did just get back from a vacation. And there was that whole playing different music thing.

It may not have been a perfect answer- or even a great interpretation, but it seemed pretty clear to me. I reminded him that I planned to be back the following Saturday.  Gradually his good humor (and voice) returned, and we finished the session peacefully. 

Guess we'll see what tomorrow brings... 

Sunday, January 4, 2009

Of Vacations and Interpretations

It's Sunday evening, and tomorrow I go back to work. I'm always a bit nervous about how sessions will go after I take a vacation. Since my clients don't use speech to communicate, it's always a bit of a challenge to figure out whether or not there are any possible abandonment issues (which usually seem to present as anger- which, for my clients, generally appears in the form of being just plain difficult) which may have emerged during my time away from work (or, perhaps, as a result of my reappearance). 

I've found it's a delicate process- trying to interpret my clients' actions and reactions during the session or two following my absences.  In case you're wondering, I do prepare my clients for any expected vacations, holidays, changes, etc. I figure I'll give them the details, and they'll understand what they understand. The reason it's so "delicate"  though is that I'm never sure whether I'm misinterpreting someone's actions as distress with regard to the therapy relationship when it could be something else entirely.  

As an example, one of my clients may be a bit "off" when I get back after having been on break There are, of course, a whole lot of interpretations that I could be making with regard to his seemingly "off" behavior.  He could be experiencing any number of sensory or physical distresses, or he could be depressed from the holidays, he may have had a visit from family members (or not), his staff may have frustrated him, his housemates may have been invasive in some way, he may simply be trying to get back in the swing of things after having his schedule interrupted by a lot of his staff being on vacation.  Or any other number of things that I could never guess, because they're internal, and he can't tell me them (or, if he could, he may not choose to do so).  Or, I suppose, he may have felt sad that his weekly bit of connection with me was missing.  Or it could be various combinations of the whole lot. 

Often it's the "being just plain difficult" business that starts to make me wonder (out loud- sometimes musically- to my clients) whether they might be doing the opposite of what I'm hoping because, perhaps, I did the opposite of what they were hoping.  In other words, I wasn't there for them when they needed me. 

Oddly enough (or maybe it's not so odd), the other thing that sometimes happens after I return from a holiday is a client trying to run out of the session.  I have gotten to the point where I almost automatically ask if maybe they're trying to say, "How dare you run out on me, Roia!? See how you like it...damn it!"

Imagine the frustration and embarrassment on both our parts when it turns out that the rush to the door ends up being a need to go down the hall to use the toilet, and I miss the cue entirely.  Not that the folks I work with don't make good use of toileting accidents to let me know they're "pissed". 

So, um, as I said, I'm a little nervous about tomorrow, particularly because I have a number of new clients whose "languages" I've yet to learn.  I'm supposing that I'll be getting the opportunity to do just that during the coming week.