Tuesday, November 24, 2009

Isn't that kind of messed up?

Those of you who regularly read my blog have probably come to realize that I'm not exactly someone who focuses primarily on behavior change as a goal of music therapy. (And, truly, I'm not trying to bash behaviorists here.)
Not Different Just SpecialImage by nickwheeleroz (on holiday) via Flick

My usual focus is on building the therapy relationship  and learning about my clients through interacting with them. Behavior change, I believe, comes about naturally because the person wishes to maintain relationships with other people.

As such, I spend a lot of time thinking about and trying to come up with some ways of understanding why certain "behaviors" (or ways of being) are so indelible and resistant to change. (Mind you, this is something I regularly try to hash out in my own life as well. But I digress.)

So I started to wonder whether some of my clients have gotten so accustomed to playing the role (in their families, in the institution, in their lives) of "the messed up one" or "the problem" because, on some level it affords them the opportunity (perhaps, from their perspective, their only opportunity) to be special? 

I'm not saying this in a mean-spirited way, believe me.

Here's the thing: a good large portion of the folks I work with often don't stop "doing behaviors" that get people grumbling at them (this in spite of years of behavior modification programs and, the ever popular in institutions, active treatment).

And it made me wonder. Why?

I know my clients always have some reason (whether or not the reason is obvious to me or to any of their other supporters) for choosing the actions and interactions that they choose. 

Okay. So.

In the absence of a clear or obvious reason as to why someone is acting in some unusual or less than sociable way (a reason such as physical discomfort that hasn't been discovered or addressed, or a reaction to something we may not yet know is happening- like hidden abuse), I ask myself (and my clients): 

What's preventing this person from moving beyond this behavior? What is it about this particular way of interacting, this way of being in the world, this way of behaving...that is working for this person in some way? Why might s/he be loathe to give it up?

So I come back to the question in my mind: what if this adopted behavioral style, or interactional style, is in some way fulfilling a wish to be "special"? 

And whose wish to be special is it fulfilling? Is it my client's wish? Or is it the wish of his/her family? By not playing out the role of "special" will s/he be disappointing her/his family? Or believe s/he will disappoint her/his family? 

Is it a way to be noticed at all? In an institution, unless you act out in some way, you run the risk of pretty much sitting quietly by yourself and not having much interaction with anyone, because you're essentially not getting on anyone's nerves. That's fine if you're not all that into interactions with people, but what if you're lonely. And your choice is to not be noticed at all or to be outrageous? Which might you choose?

Right about now you're probably thinking, "No wonder that girl doesn't get anything done all day, obsessing all over the place as she tends to do."

And you'd be right. 


Wenchzilla said...

I really think there is something to this. It occurred to me while reading this that I have a quite difficult client and when interacting with him, all the providers kind of "hold their breath" until we see what kind of day he is having and we prepare ourselves for being the focus of his anger. When he has a good day, we don't say to him, "wow, you're having a really good day. It was very pleasant to be with you today" and maybe we should. He has been that way for so long that it may not change anything but it may just tip the scales the other way, right? Most interaction now is re-directing his behavior and anger and that's where he gets his attention from staff and from his family so not much positive there. I know we talk positive reinforcement all the time, but I know that I get caught up in the fact that he is lashing out at me and forget that I need to reinforce the positive. Thanks for reminding me!

Roia said...

Thanks for your comments, W. I'm glad you found it to be a helpful reminder.

With regard to your person with the anger management issues (shall we say): I sometimes find it helpful to pay attention to my own reactions to clients who are having a time of it (i.e., with some people I feel angry, with others I feel anxious, with still others I find myself feeling powerless- sometimes all of those things at once).

Then I ask the person (my clients don't use speech, but I ask anyway) if maybe s/he might be feeling that way and not really knowing a better way to tell me (i.e., s/he may be feeling scared, powerless, angry, etc.).

It may take a few times of doing it (really thinking out loud with the person about his or her behavior). But, if you're on the money, you'll often notice some sort of a shift in the interactions. That's when you can try to help the person learn some better ways of letting you know s/he is upset and needs support.

A lot of times, we're so busy reacting and trying to respond to people's wilder ways of doing things we forget to just talk with them about it (even when speech is not their primary mode of communicating).

Good luck (and stay safe)!

Gijs said...

What's preventing this person from moving beyond this behavior?

A good question. If I had the answer every therapist would be out of a job.

I'm not sure if the word "Special" in your story fits the reason for the behaviour. I think it's more a way of saying (on maybe a subconcouis level): Here I am! I have a right to be here!

Don't we all want to be seen?

In my work I see people who cut themself, who do suicidle actions (wich don't work, 'cause they don't want them, to work). Some times this is also a way of saying; Look at me! There is something I'm trying to say!
A way of grasping some ones attention.

And sometimes; People just learnt to behave this way and found that it worked in that particular time. So they kept using it without noticing it was difunctional.


Roia said...

Thanks for taking the time to comment, Gijs.

I think you make valid points. Continuing to use less than pleasant actions is, I'm sure, a way to say, "hello! Something to say here!" For folks who don't use speech, that's pretty important.

I think by using the word "special" I was getting at the need to stand out- to go beyond being just plain noticed.

I'm not sure that I actually said it in the blog, but I was also looking at the element of playing out a particular role that has been "assigned" (unconsciously) to that person. And by that I mean that we all play a specific role in our families, in our groups of friends, in our communities, etc. And it takes some self-awareness for us to recognize that we're doing that and even more effort to move beyond that role, which becomes a very comfortable and familiar way of being- hence, the resistance to change.