Sunday, April 26, 2009

More on "not knowing"

I have been slowly making my way through Mindful Therapy: A Guide for Therapists and Helping Professionals by Thomas Bien. I have mixed feelings about the book, but every so often I come upon some passages that seem quite relevant to me. This is one of them:
An attitude of not knowing is, I believe, extremely valuable for the mindful therapist, as it is in Buddhist practice. When you think you know, you stop being open. Not knowing helps us remain open to the patient before us, seeing this person as a unique individual in a unique situation rather than another 'case' of depression, or anxiety, or marital difficulties. Not knowing, while the opposite attitude from what we learned in our education, is our best friend in the therapy room. The wise therapist respects not knowing, is comfortable with it, and even cultivates it. We cannot understand if we think we already know. And to know you don't know, taught Confucius, is the beginning of knowing. (p. 138)
I write a lot about uncertainty. It seems an integral part of my work. I've also written about the state of "I don't know" and about getting lost

I suppose it all boils down to different ways of acknowledging, with some humility, that we music therapists often don't know, in a session, what's best, what's going on, and how to proceed. But we are present, and we trust the process and the music.

Sunday, April 12, 2009

What autism "awareness" really requires

The thing is this: if we as music therapists are going to be of any use to the folks we serve who are autistic, then our level of awareness must include (from the beginning) paying attention to what autistic people have to say. 

Yes? 

Of course, yes!

Here, for example, is what Asperger Square 8 (aka Bev) has to say:
Asperger Square 8: Autism Awareness!!!

Thursday, April 9, 2009

This piano's got some kind of vibe!

At long last I was able to get LR to the Music Room! 

From the minute I started working with her I knew she'd love it. The difficulty, though, was in getting her to leave the cottage with me. But today the weather was gorgeous (about time!), and I know she recognizes me now, so she feels a little safer getting out the door with me. 

After some fidgeting (on her part) and waiting (on my part), she took my hand and pulled me to the closet to get her a coat. I explained to her that it wasn't that cold, and she agreed to put on the sweatshirt (a puffy blue thing) I'd fished out of her room for her. 

We ran into T on the way out the door (T's the food service worker, but she also sometimes pitches in when they're short on direct support staff), and she offered to walk over to the Music Room with us.  

Yes. Please do join us.

We did it! We got there, and LR went straight to the piano (it's a Clavinova) and started to play. 

LR loves (no, really LOVES) vibrations. She totally digs the guitar, and she'll try to tap absolutely anything to find out if it has any sort of resonance. (I've always wondered whether she likes the vibrations that come out of people. You know how we have our own resonant qualities. It remains to be discovered.) 

I took her on a quick tour of the room. She tried out the metallophone (the low notes are particularly bong-y when tapped), the tubano, the bongos, and the doumbek

But she really liked the piano. And the guitar. She tried playing both at once. It was very creative, I must say. She assembled herself so she had her right hand on the piano, and her left hand was tapping the guitar. 

She used a pretty consistent rhythm in the clusters she was playing on the piano. But, being LR, she was largely focused on how it sounded with her ear glued to the piano.

And I was largely superfluous to her experience. 

Well, at least we got through this major step.

Wednesday, April 8, 2009

"After you've gone and left me crying..."

B jumped up (jumped, I tell you) to come over to me when I showed up in his group (I was feeling guilty, because I was a little bit late). He barely let me get his jacket (um, it's April, and there were snow flurries happening off and on today). Anyway, he barely let me get his jacket out of the closet and on to him before we stopped to get his meds. Then we were on our way.


He got to the Music Room, and somehow we missed the door to actually go in. Don't ask me why. We just kept turning around the corner and walking and heading in the wrong direction. Then when I got him back in the direction of the door, we missed it on the way back again. 


Okay. What?! Already! 


Somehow, I managed to veer him in the direction of "please get in to the Music Room, or I won't be able to pay attention to what you're apparently trying to tell me!" 


Alright. We are now inside the Music Room. Now I can focus. 


B was very upset. To the point where he was actually crying (I think). It was very sad. I decided the best thing I could do was to simply sit with him and wait it out. Try to give him the space to feel lousy, since that seemed to be how he was feeling today.


[Actually, his distress was a continuation of our previous session where there was a lot of instrument throwing, occasionally aimed at me. I reminded him that I would not be able to hear him very well if I was having things hurled at me, so he "agreed" to stop, but made sure to get in an obscene gesture to make his point. Got it. F--- you, Roia!]


When B is upset, there's a lot of moving. When he's more mellow, there's a lot of sitting. Today there was a lot of moving. He speed walked over to the office area, sat in the other music therapist's chair, whimpered, then dashed back over to the music part of the room.


Every so often, after he sat briefly on the couch (his usual hangout), he hopped up and went to look out the window, rocking from side to side as he did so. I noticed his rocking was kind of gentle and not all that fast, but everything else about him seemed to be in high speed.


I tried to figure out whether I should musically reflect the rocking (maybe it was a way for him to self-soothe?) or the agitation or both. I opted for a bit of both, and I think it ended up sounding like a bit of a mish-mosh. 


Even I was up and down a lot. I had decided the guitar was a better option for improvising than the piano, because I could follow him more easily if he happened to run out the door. Also I could turn and see him while holding a guitar.


B was also humming. It was actually a very beautiful and poignant hum, and I tried to follow along with the guitar and, at points, with my own voice. He'd hum at a particular pitch and then drop down an octave as he came to the end of a phrase.


Eventually, his movements came to a gradual settling down, and he (mostly) managed to assemble himself on the couch to catch his breath. I breathed in and out quietly with him.


"I guess underneath all the silence we were exploring two sessions ago you had a lot to say, B."


We sat together, back in the silence, and the lyrics that sang into my mind were: 


After you've gone, there's no denying..."


I have learned over the years to pay attention to the lyrics that pop into my thoughts when I'm with a client. To me they're like messages sent from their consciousness to mine. 


These were the only lyrics I could remember, and I wondered if he was trying to let me know how hard it is for him to have to wait in between our sessions. 


Now, it may seem as if I came up with this from out of nowhere, but that's actually not the case. He has a very difficult time leaving sessions, and there is usually a lot of dawdling and trips to the bathroom and long pauses before the jacket gets put on when it's time to go. 


Also, as I noted, he had been quite distraught in the previous session as well, and we had explored his frustration with me, because I'm not able to fix his life for him (which, I'm thinking, would take the form of my taking care of him outside of the institution). 


In the past month, we've been talking a lot about feeling abandoned, and I also used the Billie Holiday song "Left Alone" in one session (this version is sung by Abbey Lincoln).


When I commented to him that music therapy can be a mixture of deep gratification (it feels so wonderful to be listened to and acknowledged) and extreme frustration (because it's still therapy- it's not life) he immediately picked up the maraca and tossed it across the room (the maraca is the instrument we've designated to express anger and frustration). Score? I think so.


Heck, I sure wish I could tell you I had some brilliant piece of advice to offer him, but let's face it. The truth is, living in an institution is the pits. He knows it. I know it. I can't fix it for him. And, yes, it is frustrating. Insane-makingly so! On a lot of levels and in painful and never-ending ways. It's frustrating for him, and it's frustrating for me too. 


What to do? What to say?


He'd stopped running around by now, and he only got up every so often to punctuate a point I made (I think that's his way of saying, "you're getting it, Roia," but I'm not 100% sure; I never am). 


I told him I was glad he felt safe expressing his feelings to me, and he was welcome to keep doing so in music therapy. To be honest, I felt very honored and humbled by his trust in me. People don't expose that much emotion and pain in front of just anybody. 


I guess the best description of what I did today was to stick with B. I validated his feelings. I kept caring about him. I invited him to keep using the music as a container. I reminded him of when I'd see him next.


I noticed (in myself) how hard it was to end the session today. I knew we needed to go, but I felt awkward insisting (especially given how much emotion happened in the space), and when I tried to play something quiet about breathing, he started hitting his head. 


"Hurting yourself is not a solution, B. Showing up in music therapy every week [I actually see him twice a week] and using sound and movement to tell me how difficult this is for you is a better alternative."


He didn't look like he was buying it, but I had to get up and get the coats already. It was getting late. 


I put my coat on and held his out to him. He paused as long as he could, and he finally got up, took it from me, and put it on. 


When we got back to the cottage his staff greeting him warmly, and he went to sit down. He watched me as I hung up his coat, left the room to sign him in and then walked back through to wave "goodbye" to him. 


The lyrics were still floating through my mind as I walked back to the Music Room to tidy up and go home: 


"After you've gone, and left me crying
After you've gone, there's no denying..."


Sometimes being a music therapist feels like being one of the meanest people in the world. 


Tuesday, April 7, 2009

Listening

I was reading a book called “Practicing the Sacred Art of Listening: A Guide to Enrich Your Relationships and Kindle Your Spiritual Life” (by Kay Lindahl of the Listening Center) this morning, and I was thinking how odd it is that so many music therapy training programs seem (in my mind anyway) to spend way more time helping students learn to lead the group by coming up with effective activities to change behavior and meet goals than they spend in helping students learn how to listen. 

This seems sort of ironic, given that we’re music therapists. Ideally, much of our work consists of listening and responding and then making music in some way. Listening (if I may state the obvious), is probably the most crucial aspect of the work of being a music therapist. 

In retrospect, it occurs to me that my teacher did actually try to teach me to listen, but I was too young and self-absorbed (in the sense of worrying about what I didn't know) to be able to- er- listen to him at the time. Sigh.

One of the (many) things that, I think, creates a lot of anxiety for the music therapy practicum students who come to the developmental center where I work is wondering how on earth to go about listening to people who don't use speech to communicate. It's certainly a legitimate concern, and it doesn't have easy answers. 

It's a complicated enough subject that Herb Lovett (one of my heroes) wrote an entire book about it. He's not the only one who has addressed this issue, of course, but his was one of the first books I read which advocated paying attention and listening to people who don't have access to the usual means of communicating.

I think a lot about how to listen to my clients. Well, I should amend that to say I think a lot about how to hear my clients. After a lot of years of practice (No. Really. A lot of years!) I would say I've gotten better at listening (and also better at noticing when I'm not listening and think I have been). It's still awfully hard to know for sure whether I've heard my clients properly. 

Most of the people I work with let me know I'm on the right track by changing something they're doing. For example, I may be working with someone who is throwing or pushing instruments around the room. What I often do in response (as long as instruments and people aren't getting hurt) is to hypothesize out loud as to what's going on (as in, why the need to use this particular way of communicating and why now?). 

What I'm doing is trying to find a way to verbally (and/or musically) state what my client may be trying to "say" to me with his action. "Are you telling me you're not interesting in music therapy today? Perhaps you are frustrated about something. (Some people don't respond as well to questions, so I try to re-phrase it as a statement instead.) Maybe something or someone has frightened you."

All the while I pay attention to my client's responses. Meanwhile, I monitor my own reactions and thoughts (simultaneously). I try to be aware of how I'm reacting to my client's action(s): with anger? With anxiety? With sadness? Frustration? Humor? Uncertainty? My reactions give me information about the interaction so that I can do the work of helping my client "talk" to me. 

In my work, the relationship is the focus, so whenever something is going on in the session, I relate it back to what is happening between my client and myself. As such, it makes sense to notice how I'm feeling in relation to what my client is doing, because, more than likely, s/he is trying to help me hear him/her in some way (granted, it's not always in the most helpful way, but I believe the intent is there).

So, back to how do I know when I'm getting it right: well, I don't always know. In fact, I will never (and have never) 100% Known.  This is what makes this work so difficult (as I've said before). The not knowing for sure. Ever. 

But when someone suddenly stops throwing things around when I ask if he's trying to tell me he's scared (and I never said "stop throwing things around" to him), I can at least start thinking about what might be making him scared and have a place from which to start hearing him. 

And, at the very least, I know he knows I've been listening to him.


Sunday, April 5, 2009

Music Therapy Defined (Take 2)

D helped me to clarify a part of my understanding about music therapy today. During our session I found myself reflecting his music and his general way of being, noticing that I had to keep starting and stopping. When I played quietly he seemed impatient with it (even though he was barely moving and there was very little to even reflect). When I put more energy into the music, he had a brief burst of energy in response, smiling, playing the tubular shaker, and then setting it down again.  Just as suddenly, his facial affect changed again, and we were back to the quiet, almost non-existent music again. 

I invited D to listen to the sounds he was making and tell me more about his music. Then I revised the question and I wondered (out loud), “what do you think your music is telling me about you? If you were listening to someone playing the sounds you just used, what kind of information do you think you’d have about the person playing it?” 

I liked the idea of D learning to listen to himself via his music. It occurred to me to use this as another way to explain what I do when people ask me (the ever present question): "what is music therapy?"

I started to think about this, and I found myself focused on the fact that we don’t always tend to listen to ourselves. When we do listen, we get anxious, and what we have to say about ourselves is usually not all that kind. Or enthusiastic. Or loving. I think we call that: resistance. 

I think this is an integral part of improvisational, dynamic music therapy in the sense that we, as music therapists use the music to teach our clients to listen to themselves. “What do you hear yourself saying in the music?” is what we ask. “Tell me more about how you’re saying it," and "what's it like for you to say this?"

Of course, as I already said a couple of paragraphs ago, being human and all, we have a tendency to resist listening to ourselves. This takes a lot of forms where I work. Beside plain old not paying attention, I also hear it as “oh, I can’t play music; I have no talent” and “no, you’re the therapist, you're the musician- you should play.” (Cue the "working with resistance" music here.)

Once people are actually willing to use the music, there are a lot of directions to take. A music therapist could invite a client to consider things such as: What’s it like to listen to yourself? Do other people listen to you? Do you notice that there are times when it’s easier and times when it is more difficult to listen to yourself? At what times is it easier, and at what times is it more difficult? Describe your sounds at those times. Do you think other people hear that in you as well? 

But let me go back to this idea of music therapy giving us the space to externalize our internal dialogue (so to “speak”- tee hee). When we are able to do that, when we pay attention to and are present to ourselves (in terms of listening to what and how we talk about or perceive ourselves) isn’t that, in itself, a sign of growing emotional/mental health? 

I mean, to be able to listen to our self (as in, to get beyond some of our resistance and concerns about being judged) is an act of courage by itself. To take it a step further and to act on what we hear (either by changing what we’re doing or thinking or changing how we see and experience our self, etc.) is, ultimately, what we’re going for in any kind of therapy (at least that's my understanding).

When we become aware of our characteristic ways of being and interacting, then we’re in a position to change it (when change is warranted). We also have the opportunity to come to a level of self-acceptance- even self-love- as we gradually become familiar with our own sounds, rhythms, melodies, harmonies, timbres. 

So, how did D respond when I asked him what his music was telling me and showing him in his session? I’m not sure yet. He paused a few times and seemed thoughtful. When we ended the session though, I felt as if bringing up the idea of listening to himself seemed like a wise (and long overdue) suggestion.