Sunday, October 25, 2009

When we are injured by our clients

One of the scarier things about being a music therapist is that sometimes we get hurt on the job by our clients.

This is something I've been meaning to write about for some time now, but I've been procrastinating. I mention it now, because, recently Todd Henry, a man identified as a music therapist, was actually killed by one of his students.

It's a real issue when we provide services to people who are not always able to control their behavior. Or those who have gotten used to using violence as a means of communication. Or who have serious mental illnesses and aren't able to distinguish between what is reality and what is generated in the mind.

I've been hurt at times by my clients. I've been smacked, bitten, scratched, had my hair yanked, my fingers squashed, I've been head butted, grabbed, in a headlock, pushed, kicked, and pinched. Depending on the day, the situation, the context, and how violent the situation was, I've felt varying levels of distressed.

In general when I get hurt, my immediate reaction is that I feel uncomfortable, angry, frightened, ashamed, uncertain, violated, powerless, and with a general sense of not being sure how to proceed after it has happened (other than to say, "we need to stop the session for today.").

Because I work the way I do (using an object relations approach), I absolutely believe that the feelings I experience in reaction to getting hurt are more than likely the feelings my clients either are, or have, experienced in their lives (hello, projective identification).

As such, part of moving forward with my clients after violent behavior is addressing what happened in the following session(s), talking about how it impacted me and what I think my client may have been trying to communicate to me (i.e., that s/he was feeling powerless, ashamed, angry, frightened, etc.).

I work with people who live in an institution. By that very fact alone, they have experienced trauma. Never mind the many other forms of physical, sexual, emotional trauma they've likely endured over the years. When a person doesn't use speech, and doesn't feel as if s/he's being listened to, and s/he is fresh out of coping skills, violence is sometimes the result.

This issue isn't talked about much, if ever, when we're in school and learning to become music therapists. It's also not a topic that I see coming up in music therapy conferences either.

One of the reasons I don't usually bring it up is that it scares people. Another reason is that I don't like the idea that people see my clients' violent behavior as being a factor of their disability. I don't think most of my clients are violent (and not all of them are) because they have autism or some other intellectual or developmental disability. I believe it's usually a result of their life and not having learned better ways to cope with extremely challenging situations.

So I'm bringing it up today. And I'm wondering what your experiences (whether you're a music, creative arts, or other sort of therapist or supporter/caregiver) have been with this issue.


K. Suzanne said...

Perhaps you could be the first to present at a conference on this issue? Just a thought.

Roia said...

It's actually a very good thought, and I've been thinking about doing a presentation about "taboo topics in music therapy" at some point. Thanks for the thought!

Kimberly Sena Moore, MM, NMT, MT-BC said...

Wow, I had not heard about Todd Henry. Sad.

I also have situations where I have been hurt. I think anytime you work with clients who have difficulty self-regulating (calming)--autism, trauma, EBD, dementia--there is a risk, whether you are a music therapist or not.

This is also a very important topic. It's one that individual facilities address, but I don't think I've ever seen it in a music therapy forum. I agree with the first comment--I think it would make a great presentation.

Nikki Belshe, MT-BC, NMT said...

I would attend that session!

Great post - lots to ponder.

Roia said...

Thanks, Kimberly and Nikki, for your comments.

In terms of it being addressed in facilities, I'm not sure what it's like in other facilities, but in our institution it's usually just seen as "well, it goes with the job". We do, of course, have a very efficient medical response. For instance, when I was bitten, I had to go and have my blood tested repeatedly (which has its own drama with three-part harmony), and all that was covered by the facility and such.

But there really isn't any formal support process for staff who get hurt. Of course my co-workers check in with me to see if I'm okay, but I wonder if it would behoove facilities such as ours to have some sort of emotional support system in place as well.

I think NOT addressing these issues can lead to abusive behavior by staff who are frightened and don't have good coping skills of their own (see the blog on "Violence in the lives of people with disabilities").

Michelle Erfurt said...

I've been hurt by clients too. My employer at the time... an institution just like where you work Roia... had the same 'it goes with the job' attitude. I think they are right, it really DOES go with the job but that doesn't solve any problems that come up. I had one particular client who attacked me and I was seriously afraid of my client afterward. (Don't worry, I was hurt mentally more than physically) I loved my job but just didn't want to work with this client anymore. I was also afraid to tell my supervisor this because I was worried that if I appeared that I didn't want to work with clients I would be fired. I don't know if this would have really happened but I didn't want to try and find out.

Roia said...

Thanks for sharing your story, Michelle. I can imagine, as a young music therapist, that you would feel as if you had to work with someone with whom you felt so uncomfortable.

I had a client bite me quite a few years ago, and I was so clearly distraught from the event that I simply couldn't work with him. I had a stomach ache every single Tuesday night because I knew I had to deal with him on Wednesday mornings. It was awful, and I finally had to take the risk of being seen by my co-workers (this is what I perceived anyway) as somehow being inadequate and end music therapy with him.

Years later we were actually able to work together again (apparently, there's something to be said for that whole waiting around long enough and you'll eventually get past it thing) and we had a pretty good therapeutic relationship.

I think, ultimately, if we're so uncomfortable with or scared of or furious with a client, we owe it to ourselves to think about how well we're able to serve him/her under the circumstances. Sometimes it's possible to move beyond the situation, but sometimes we can't. And I think it's important that we know it's okay to not be "the perfect music therapist who can handle everything."