Thursday, May 28, 2009

Is change a good thing?

The first good thing about last Wednesday was that J decided to go with me to his session. 

That may not seem like a big deal but for him it is. We've had a year and a half (maybe a bit longer) of his hemming and hawing about being in music therapy. Since he doesn't use words to communicate, "hemming and hawing" looks like his walking with me (for all intents and purposes looking as if he's planning to come to his session) only to get completely stuck and not move- unable to move toward the session area and unable to walk back to his day area. (Insert long pause here.)

Sometimes his "hemming and hawing" looks like pulling me (yes, literally) in various directions and not really going anywhere. Sometimes it involves my suddenly noticing that he didn't let me know he needed to use the toilet. (Insert more pausing.)

We had been using the Music Room for sessions.  I've worked with J for quite a few years now, and it had taken us a long time to get to the point where we could safely leave the cottage, walk to the other building, and get to the Music Room, not run out the door in the middle of the session without letting me know he needed to stop for the day (that also took some practice), and get back to the cottage without anything too dramatic occurring. 

A little over a year ago J got to the point where, when he walked with me to the Music Room, he flatly refused to go in, opting instead to pull me around the building, pull me around outside, and pull me to the canteen (never to the cottage). I finally had to say "enough. We need to go back to working in the cottage!" J is a good two heads taller than I am, and, frankly, I need the use of my hands and arms, Furthermore, if I wasn't feeling safe, neither was he (or maybe it was the other way around). 

So there we've been: in the cottage. 

J is clear that he doesn't want to stop music therapy. Even when he doesn't want to actually go to his session, he holds on to my hand tightly and pulls me to sit with him in his day area.

"See Roia? This is where I live."

It has felt frustrating, confusing, heartbreaking and maddening at various points.

Last Wednesday (which is where I started this blog) I found myself, again, wondering out loud to J about his intense ambivalence (a.k.a. "hemming and hawing") with regard to his use of the music therapy process. (Mind you, J has been ambivalent from the beginning, but we had at least worked to a point where he was decidedly certain of his wish to get himself to his sessions.)

I noted that one of the hardest things about going to therapy (any kind of psychotherapy), and I say this from my own experience as well, is that as we get healthier the people and situations in our lives sometimes look, well, a lot sicker. It's a lot harder to tolerate boundary violations, drama, and generally obnoxious behavior when you've made an effort to be more mindful in your interactions and to get your own dramas under control.

The average person can decide for themselves, "I no longer wish to be in this relationship" or "I need to make some life choices so I don't find myself frustrated by being in jobs that are not challenging to me" or some act that requires a sense of agency.

But a person who lives in an institution, whose life is basically organized for him by other people in so many ways, who doesn't have or see any real prospect for getting out of the institution may not be able to do that. 

Even if he makes a monumental effort to convey what is important to him (and many of my clients do!), most institutions don't have the capacity to listen.

To know this, to live this, is nothing short of tortuously frustrating. 

In effect, I could see that J may (quite legitimately) feel as if I have offered him a taste of something that he could only have when he was in his music therapy session. And he may feel angry, resentful and hurt by that. And, yes, he may feel quite ambivalent about wanting to continue this kind of work.

In effect, I feel as if I have supported him to grow within a system that isn't willing to grow. 

As I acknowledged all this to J, he listened, quietly walking around the room where we worked, the noise of television sets, blaring music, and people's voices forming a constant background to our makeshift therapy space.

J walked over to me with a sort of wailing sound (a sound he often makes) and pulled the guitar carefully over my head (it's attached with a strap), waited for me to put it down, and pulled me gently out the door and back over to his day area. 

He sat down in a chair and just watched me as his staff, mostly ignoring him except to verbally acknowledge his return, began to chatter with me. 

"See, Roia?" his eyes seemed to ask me.

Yes, J, I see.

I'm sorry.

This past Wednesday, he got up and came right with me to his session.

Tuesday, May 19, 2009

"I'll Fly Away"

The last thing I remember about K is how worried I was about his health. He had been coming to music therapy and literally crying, "ow, ow, ow". I'd gone straight to the nurses and told them (again), "there's something very wrong with K. I've known him for 20 years, and this is not a sound I have ever heard him make." They assured me they were looking into it.

It was heart-breaking to listen to him. It was difficult to focus when I knew something was wrong. I felt powerless to help him and angry because I had been expressing concern about his health for at least a year.

When I got back to work last Wednesday after a week-long vacation, I heard he was in the Intensive Care Unit at the local hospital. I made plans to go and visit him on Thursday.  

It was too late.  K died Wednesday night.


P, one of his regular support staff, also devastated, asked if I would sing the song "I'll Fly Away" for his memorial service. I didn't know the song, but I found the music and started to learn it.

D was a bit draggy when I went to pick him up for his session this past Saturday. But he got right up to come with me. 

As soon as we got to the Music Room he moved all the instruments off the couch and parked himself there, in a reclining position, facing me. 

He looked sort of glum as I sang a greeting to him, and we spent some time just breathing quietly together. D stared out the window, as he often does, and as I watched him, my mind started to sing, "I'll Fly Away".

I played it for him- painstakingly, since I had only barely begun to learn the song. It seemed to offer a powerful message for him.  He turned to look my way, and he listened intently as I sang.

Some glad morning when this life is o'er,
I'll fly away;
To a home on God's celestial shore,
I'll fly away.

I'll fly away, Oh Glory
I'll fly away; 
When I die, Hallelujah, by and by,
I'll fly away.

When the shadows of this life have gone,
I'll fly away;
Like a bird from prison bars has flown,
I'll fly away

I'll fly away, Oh Glory
I'll fly away; 
When I die, Hallelujah, by and by,
I'll fly away.

Just a few more weary days and then,
I'll fly away;
To a land where joy shall never end,
I'll fly away

I'll fly away, Oh Glory
I'll fly away; 
When I die, Hallelujah, by and by,
I'll fly away.

(written in 1929 by Albert E. Brumley)
The best way I can think of to describe it is that it seemed as if D's eyes, gazing out the window, were singing this song.

A thought crossed my mind as I shared "I'll Fly Away" with D- a song I will be singing for K's memorial service in a couple of weeks. K taught me, as well as many of my practicum students, about being a music therapist (he was a part of the "Sick and Tired" crew I described in my last post). As a result of his death, I've now had occasion to learn this powerful song, and what's more, to share it with another of the people I support.

So, in a way, K remains present, and he continues to share his gift. 

I hope it's true for you, K, wherever you are...that "like a bird from prison bars [you have] flown" and that you're in a state of being in which "joy shall never end".

Friday, May 1, 2009

Sick and tired

Lately I've noticed myself absolutely dragging through my sessions with a group of guys I've been working with for a long time. There are five men in the crew, and they range in age from their late 40s to mid 60s. None of them use speech to communicate.

Now, what you need to know about this group is that, when we started to work together (it's got to be almost 15 years now) they were horrible. No. Really. Horrible. They'd all take turns throwing their hands in their pants and were merciless in their teasing. They'd vocalize so frequently and so loudly I couldn't get a sound in edgewise.

I used to leave their sessions in tears. Sometimes I didn't even make it to the end of the session before I found myself about to bawl in frustration.

What finally helped?

Well, after I spent a long time (a. very. long. time.) singing about what they were doing- and nothing seemed to change ever- I asked them one day if maybe they felt as if they were being tormented and teased in their lives and wanted me to understand how powerless and futile they were feeling about it.

The usually noisy group was suddenly silent.


That moment changed everything. From that day on we were a music therapy group.

We slowly worked up to being able to use the music so the guys could express their hopelessness and rage, and I was able to help them contain and frame the feelings within the music.

These gentlemen have become "the teaching group" when I have music therapy students from the local university. They take their role as teachers very seriously, and together we've taught our practicum students a lot about building relationships, paying attention, and how people who don't use speech and have trouble playing instruments use music.

But, as I said (way back when I started to write), lately I find myself experiencing this heavy, leaden feeling in the group.

The other thing to know is that, of the five guys, four of them have had some serious health issues in the past month or so- pneumonia, the need for a colonoscopy, unexplained weightloss, repeatedly falling (leading to cracking of one's head)- not good stuff.

I sat with them on Monday, wondering why I was suddenly feeling like I needed to take a nap. R accepted the tambourine I offered, apparently only to toss it unceremoniously to the side and look at me. Thanks.

A thought that came to me was: they feel sick and I feel tired. Hmm. I wonder if they might be feeling sick and tired...

They'd all been dozing off or watching me quietly.

I started to improvize the "I'm feeling so sick and tired" blues. I invited them to find a way to let me know if this made any sense to them. If this might be how they were feeling.

They sang with me. Boy, did they sing with me.

Poor guys.

If you think of it, send along some good vibes their way.