Monday, February 15, 2010

What's that you say? No clothes?

Self censored - SelbstzensurImage by gynti_46 via Flickr
Periodically, when I'm minding my own business and doing a music therapy session, I will have the experience of one or the other of my clients suddenly deciding that removing his or her clothing would, at that very moment, be the most effective means of communication. 


I mean. Really. Must you? 

I don't know about you folks, but I am fairly certain that this particular topic was never covered (if you'll pardon the accidental pun) in music therapy school. 

As long as I've been a music therapist (and, let's face it, it has been quite a long time), I've never quite come up with a response that I could really say I'm happy with when I'm faced with a naked person in one of my sessions. 

Obviously, my usual response (did I say "response"? I meant "reaction") is to remind the person that we keep our clothes on in music therapy, because it keeps us all safer. And, if the person is not actively attempting to get his/her clothing back on, I do tend to offer to assist. 

All of which  may or may not be the "right" thing to do, but that's how it usually plays out.

Okay. So we all know I'm not a behaviorist. And I don't do activities. And my approach as a music therapist is generally to try to understand what the heck is going on when my clients are using whatever action they're using in order to make their point (presuming, of course, that they have their own personal reasons for choosing this particular action) (thank you very much). 

And, being me, I try to pay attention to my own emotional responses, because my experience has been that people who don't use speech will often try to get me to feel what they're feeling so I "get" what they're trying to convey to me. 

In the past two weeks I've had one man yank down his pants and underwear mid-session, and I've had a woman remove her shirt and bra (several times) in her session.

And I'm trying to make sense of these things.

So, if you don't mind, join me as I stumble along through my thought process, trying to understand what all this nudity is about.

Generally, I start with: what is this person trying to say to me?

Sometimes it's "I need a bathroom, and you weren't picking up on any of my other cues." (That's usually the first thing I ask about, because it has to be the worst thing in the world to need a bathroom and to not be able to say, "Hey, excuse me, but I've gotta go. Now!")

It could be sensory discomfort. Reasonable enough, I suppose. But if the person wasn't trying to get naked every other time s/he was in music therapy, or wearing clothes...Well, it's hard to say. 

It could be anger. 

It could be a way to say, "I feel exposed in front of you, Miss Music Therapist, asking me all these questions and paying way too much attention to me!" 

Or, in other words, "You're making me uncomfortable with all this music therapy, lady! Now I'm going to make you uncomfortable. How do you like me now?"

I suppose it could also be a way to ask me a question, such as "how safe am I if I expose myself to you, Roia? Will you hurt me? Shame me? Ridicule me? Violate me?"

Or "how will you act toward me if I do something considered taboo (since I can't tell you with words about the difficult things that have happened in my life)?"


As it turned out, with the woman, she did need to use the bathroom. But I still think there was more to it, because I'm still quite new to her (we've only had three sessions). I know she has sensory issues, but she also may be trying to learn something about me.

I'm not so sure about the man's motivation for pulling down his trousers. He didn't need a bathroom (I asked). He doesn't like leaving his session when it's time for us to end. He does have strong feelings toward me. I know I frustrate him because I can't fix it all by taking him away in a car. 


As is often the case, I'm left with "I don't know." Sure, I have ideas, but I don't know.

And, as always, I tuck the latest bit of information into my head (along with all my interpretations) and keep on going. 

Until maybe someday when another action occurs, I'll have another tiny piece of the puzzle to add to my understanding of the person standing in front of me. Exposed. 

Friday, February 12, 2010

Are we willing to make our clients the "star ingredients" in a session?

Cooks at work.Image via Wikipedia
I knew someday I'd find a way to link cooking and music therapy! (Can I get a "huzzah!"? Anyone? Anyone?)

Well, actually, Joanne Loewy, a fellow music therapist- who was one of my grad school teachers at  Hahnemann- always used food as a metaphor when she talked about music therapy. 

And this is sort of like that. But different. Follow me here. This gets a bit twisty. 


There I was dozing off on the couch with the television tuned to a PBS station, and I somehow woke up just in time to see the last ten minutes of Avec Eric, which is a foodie cooking show (we love food!). 

Eric, for those of you who are wondering, is a chef in New York, and he has a show on TV where he travels around and talks to other chefs and then shares his own recipes. 

Okay, are you with me so far? Good.

Well. I was half listening to the conversation between Eric and the chef he was interviewing for this particular show, David Kinch. David had made some fabulous food thing for Eric, and they were eating it (with great appreciation, I might add) and discussing what made it wonderful.

Here's where my ears perked up, and I thought, "Hunh!"

Eric had complimented David because he said he could really taste the vegetables he'd used in the dish. And (here's the really neat part) David responded by saying how, when he was a young chef, he was always looking to add one more  ingredient to the dish. As he's matured, he noted, he tries to keep the dishes as simple and basic as possible, always wondering what he can take away so that he can retain the essence of the main ingredients he has chosen. Eric agreed, saying it was indeed important to have "star ingredients".

"YES!!" (I thought loudly). That's exactly the process I experienced as I matured as a music therapist! 

When I was a young music therapist I was always looking for bigger and better activities. I remember having session plans with lists of things: first we'll do this, then we'll do a bit of that, then we'll work on this, then we'll look at that... On and on. It was a never-ending quest to come up with the perfect activity that would finally motivate my clients. If this activity didn't work, surely another one would.

All to no avail. 

Then, when I started to receive clinical supervision, I learned that my clients are the "star ingredients" in a session. And I didn't need to focus on (or even do) activities. I just needed to learn as much as I could about the primary "ingredient" (my client) and to figure out which gentle seasonings (if you will) this person might need in order to truly emerge and shine.

Now I no longer do activities. Instead, I engage in the process of getting to know the wonderful flavors that make up the person sitting in front of me in a session. I use the music (as opposed to kitchen tools), sparingly at times, copiously at others, depending on how much is needed at a given point.

I have finally learned that it's not about how much I do in a session, but rather whether or not I was able to provide my client the space to be

Here's a link to the actual show if you'd like to see it and be inspired as well. 

Wednesday, February 10, 2010

People in pain

Chronic Pain BarbieImage by Migraine Chick via Flickr

I don't know what it was about this past Monday, but it seemed a day of pain for some of the women in my sessions.

Lately, having experienced a medical situation myself that causes a lot of physical discomfort, I've developed a far greater appreciation for the deep frustration and futility that goes along with chronic pain.

Both women were crying, each doing her best to cope with her body in the best way she could.

The first woman, C (I saw her first thing in the morning), is still fairly new to me. Some of her staff seemed to think the fact that she sat on the floor on her behind and scootched herself forward was (aside from being odd) because of my being someone new and unfamiliar.

OK. I guess the fact that C screamed and cried through much of the session, after throwing her shoes at me (boy, did I have a flashback to George W. Bush and the shoe throwing incident. But I digress.) but didn't try to leave may have been because I was new as well. But she certainly seemed to be hurting from what I could tell.

I sat with her and nearly cried myself as I musically accompanied her frustrated tears and sounds. She reached her hand out to me once or twice, and I did my best to move over (we were sitting on the floor) to be within her grasp.

C then went back to stripping off her clothes. Of course, she first made a sign that looked like "toilet" with her right hand. We managed to limp out the door and into the hallway (where she sat down and proceeded with the stripping process again). I managed to get her dressed and we hobbled into the bathroom area where she completely stripped down. At which point I got someone a bit more familiar with her to get her dressed again.

She then went to sit at the table and seemed mellow and cheerful. That was when her staff let me know that C was just messing with me because she doesn't know me. "See? She's happy!"


In the second situation, V, when I arrived was restrained because she had been thrashing her head into various hard objects (the floor, the wall, the door, the wooden sides of the chairs...), and her staff felt freaked out (who wouldn't freak out seeing someone do that to their body?). 

One look at her, and it was clear (to me anyway) her sinuses were bothering her. A lot. Her nose was running furiously, and her eyes were swollen shut. (This is a person I've known for a few years, and she is always stuffed up and particularly unhappy when allergy season is in full swing. I also had had a headache the entire day from the shifting weather patterns, so I didn't come up with this thought out of the clear blue, as it may appear.)

Anyway, she came out of restraints in time for the music therapy group to start (thank goodness). We were attempting to make the trip from the day area to the room where we have our session, and that became a whole drama unto itself.

V couldn't seem to organize herself, so her staff got her wheelchair for her. S wanted to run around (and when she runs around it usually involves many curtains being torn down and a general swath of destruction in her wake). M started to vocalize in an angry-sounding way and looked as if she was about to take a bite out of whoever was standing or sitting too close to her. L appeared in the hallway, naked (evidently naked is popular on Mondays...who knew?). 

Music therapy anyone?

The staff took the person who was naked and the person who was all set to run down the hallway with her to get them reassembled, and I took the rest of the ladies in with me. V was still quite distraught, and yanking at my clothing with a death grip. M was still vocalizing loudly and approaching me (and V, who was now clinging to a handful of my shirt and pulling me down toward her), sounding a bit desperate. N was vocalizing, somewhat less loudly, as she attempted to settle herself in a chair (sometimes it takes her a while; she has a bit of the OCD).

M ended up walking out the door and went with her staff person (who told me she needed to shower the person who'd been naked). 

Okay. O....K....We're breathing.

I went back to V, held on to her hands and joined her distressed vocals with my voice, attempting to find a soothing, but reflective, simple vocal pattern (not an easy task, given the circumstances). She let me move behind her wheelchair so I could give her some deep pressure input to her shoulders and arms. V began to rock and very slowly settled down.

Gradually, the rest of the group came in, and we were able to finish the session with some minor semblance of order. 

But, yeah. Pain. Not fun. 

Saturday, February 6, 2010

Asperger Square 8: She will never

Asperger Square 8: She will never

Interesting that I should have seen this post by Bev at Asperger Square 8 shortly after writing this a few hours ago.

I still maintain: you're a lot less likely to mess up if you respect the fact that people are paying attention to and understanding what you're saying.

Thank you, Bev. And I'm sorry she had to listen to other people's opinions about who she is and isn't. 

Who knows?

Lost wordsImage by kool_skatkat via Flickr
One of the things people always ask me when they learn that I work with people who don't use speech to communicate is this: "Yes, but, how much do they really understand?"

And I always respond in the same way: "Just because someone can tell me verbally that they understand what I'm saying doesn't mean that they do."

My policy (if in fact one can call it a "policy") has always been to treat people as if they're understanding me. I figure it's the most respectful approach. And I'd way rather err on the side of presuming competence than insult someone by assuming incompetence. 

Usually, for me anyway, the more salient issue is whether or not I understand what the people I call "my clients" are trying to say to me.

Last week, for instance, I could clearly see that B was trying to communicate something to me. He wasn't doing it in a particularly effective way, but he was clearly trying very hard and being quite patient. He'd stand up, repeating his action in almost exactly the same way each time, and then he'd pause, waiting for me to miraculously get it.  

I didn't. 

Well, really, I couldn't. He wasn't giving me enough information. 

It was obvious that B perceived my attempts to hear him, because when I said to him, "I'm not understanding you" he'd sigh, and he'd try again. 

I encouraged him: "Use the music to tell me." 

And he picked up and tossed the instruments on to the floor, retrieving them and throwing them again. Over and over.

After, I swear, ten or twelve times of making this effort with no hope of my figuring out what he was trying to say, we just sat there together. 


Neither one of us could fix this. 

So we sat. In silence. And we felt fully how frustrating it is to not understand. To not be understood. To not know. And to not be known. 

I wondered, as I sat with him, if what he really needed me to understand is that this is his experience of silence. 

Tuesday, February 2, 2010

When sessions go to hell (yes, Virginia, in a hand basket!)

hell in a handbasketImage by jamelah via Flickr
Damn! I was all set to wax lyrical about what a wonderful first session I had had with two new clients, C and J, two Saturdays ago. 

I'd even started the blog already. I had a nice little picture all picked out and everything. There was a little singing bird. It was downright idyllic, if I do say so myself.


That little gloat-fest sure didn't last too long. 

When I showed up this past Saturday, it all went to hell. (Please observe said hand basket above and to the right.)

First, the room we'd used the previous week was completely unavailable. Apparently, it had just been painted and they didn't want anyone in there until the paint was dry.  It was a nice, relatively quiet room with space, with a big water-bed looking thing (that looked like a cross between this, this, and this), where last week C, who seems to experience a lot of sensory discomfort, tucked herself in under her blanket and her giant beanbag and sang along with her series of sweet little "bee bah" sounds. 

Okay. "So the room isn't available," I thought. I can work around that. I think.

Then, while I was checking out other room possibilities, I noticed that the other person in our small music therapy group, J (who became "the other person in our small music therapy group" simply because she kept walking in to the room last week, and I finally said, "why don't you just join us on a regular basis?"), was unavailable, because she was having some behavioral issue that required a lot of people to stand around her and look concerned. And not too happy. 


No problem, I'll just work with C in the vestibule where she's sitting (tucked under her blanket with her giant beanbag) (is anyone else noticing a theme here?). I'm flexible. I can do this. 

Two seconds into singing "hello" to her (after her staff kindly unplugged the radio that had been playing), C got up and left. 

And that was that.

After that we moved into a whole following around (me following C), pulling (C pulling me, because I guess my following her wasn't going the way she'd expected), stripping (C's, not mine, thank God), bathroom going (again, not me for a change), insisting I put the radio back on (you guessed it, C wanted the radio), irritated "BEE-BAH" sounding...thing. 

There were two (maybe two) blissful (okay, maybe it wasn't blissful, but we're talking comparatively here) minutes in which C sat and smiled as I played and sang with her. 

Then we were back off and running.

Heavy sigh.

A few years back (in 2006, I believe) my friend, Judy and I did a presentation at the Mid-Atlantic music therapy conference which we called "The Myth of the Perfect Music Therapist, or How I Learned to Stop Worrying and Love My Mistakes". 

I think this would definitely qualify as one of those bummer sessions that are more "part of the process" or "grist for the mill" (as the sayings go) than shining examples of moments in therapeutic gloriosity.

I suppose, if there's anything for me to have learned from this, it's that if we music therapists can't own and acknowledge our lousy sessions/days and accept them as part of life, then our clients won't be able to do that either. 

Not that it's any kind of easy.

Well. There's always next week.