Monday, August 23, 2010

Eating a slice of humble pie

Eat PieImage by shandopics via FlickrI knew if I waited a while, calmed myself down and thought about it in a peaceful state, I'd have a better idea of how to proceed with C. 

You may (or may not) recall that I wrote about the dreadful session I had with her a couple of weeks ago. I was feeling terrifically annoyed with myself (among other sources of annoyance) because I had allowed my anxiety about staff being upset with my "letting" C strip in music therapy (I mean, really?) cloud my therapeutic judgment. 


So, as I was driving back from Michigan (which is quite a long drive when you're headed to New Jersey) to visit my friend (a music therapist turned music librarian, as it happens), I was thinking about the coming week. Naturally, my thoughts turned to Monday morning, C's scheduled time for music therapy. 

I had (yet) another twinge of guilt as I remembered our last session before I went on vacation (just for the record, it's not unusual to have a horrible session right before a vacation- in fact, it's one of the, er, perks of being a therapist). 

And let me just say, it was not one of my shining moments as a music therapist. 

As I was trundling along the Ohio Turnpike (where they have very nice rest areas, I must say), I wondered what I was supposed to do about the stripping. I didn't want to stop working with her, because, in spite of the exposure episodes, there were moments of actual connection in the music. 

I tried to perceive the situation from C's point of view (something I've tried to do before), considering the idea (again) that she may, in fact, feel exposed. 

Then it suddenly hit me! 

A forty-five minute session is way too intense for her! Sure she may appreciate parts of the experience, and she may even find herself engaged meaningfully with the music (maybe even with me), but she's not even close to being ready to deal with that kind of constant attentive interaction for that long of a period of time!

Of course!

I need to start out with very short sessions (five to ten minutes at most) and gradually learn when C is letting me know she's ready for more time. 

Honestly, sometimes I think I've been at this a bit too long that I could manage to forget something as basic as that. As basic as: can this client tolerate a 45-minute session, or should we start small and work our way up? 

So, today I showed up in the cottage feeling a little more confident (with regard to the staff), and I explained my plan. I'm not sure they were as enthusiastic about my plan as I was, but they were agreeable enough (which I appreciated).

The supervisor (for some reason) decided to get C, and we sat outside of the room where her group was meeting.

The first thing I felt I needed to do was to apologize to C for misdirecting my frustration in the previous session and aiming it at her. Then I acknowledged that I had not remembered that when someone is paying very close, unwavering attention to you for a sustained period of time it can be uncomfortable as hell. 

I told C my plan. "We'll start with a ten minute session. I'll practically be singing 'hello' and then 'goodbye' and then we'll stop, and I'll plan to be here next Monday again."

C, tucked under her blanket, tapped her hand against her leg. I sang "hello", she listened quietly, then I heard her giggle and vocalize with me a little bit. Then I asked if she needed anything else from the music before we ended for today. She vocalized a bit more. I sang "goodbye," put away my guitar, and I escorted her back to her group. 

She was smiling.

Friday, August 13, 2010

"Expectant waiting"

Third Haven Friends Meeting HouseImage by thumeco via Flickr
I was reading an article this morning in an old issue of Unity Magazine (September/October 2005) describing  a Quaker meeting attended by the author, Mason Hayek.

Here's what he shared of his experience:
The Friends who have gathered have brought in their feelings from life as it is for each of them today...Each person has brought a bundle of feelings and sits clutching it. (p. 44)
The interior of an old meeting house in the Un...Image via WikipediaAs time passes, the silence deepens, so that any sound  will seem like a rock breaking the window of one's mind. And yet, part of what we come for is the ministry, the message that we or others may speak. The ministry of presence is helpful and the strength that comes from meditation, contemplation, creative thought, or worship will reward our coming. But the words that arise from the honest and open searching for truth by others can open new paths for us. The words can catalyze our searching. (pp. 44-45)
From one's own worship and meditation, perhaps aided by the ministry of others, may come thoughts that are too strong to restrain. When the words beat against our brains irresistibly, we must speak.  (p. 45)
A Friends Meeting for Worship is a gathering in quiet, waiting and listening for the "still small voice within." (p. 45)
The essential elements of worship can all be practiced and experienced when one is alone, but Meeting for Worship has special qualities. It is a shared experience in searching for the truth, a religious experience enhanced by interaction with other persons. That interaction allows us to test reality. We can see our lives, wishes, and fears in better perspective when we interact with others under conditions where we respect our neighbors as well as ourselves. We feel joined to one another. (p. 45) 

In her online article, Silent Worship and Quaker Values, Marsha Holliday notes:
...Friends in the unprogrammed Quaker tradition base our worship entirely on expectant waiting. 

"Expectant waiting." I think that's such a lovely way to put it!

Two summers ago I attended a class at Pendle Hill, which is a Quaker retreat Center, where we were invited to participate in a Meeting each morning. 

I went once or twice, and I reflected then, as I did again this morning, on how similar it felt (to me) to the process of music therapy, especially when working with people who don't use speech to communicate. (I've written quite a few blogs- here and here, for example- about silence as an important aspect of music therapy.) 

In particular I was struck by the idea of presence within the silence and being present to the experience of silence.  

Unexpectedly (or maybe not), as I was thinking about this, I happened to read a blog, also this morning, about the experience of silence from the perspective of a person on the autism spectrum. 

Mike, the author of the blog Journal of an Autist reminds us:
Even silence speaks...Start by listening through all your senses, and you will hear us speak, even in our silence.

I'm not sure whether it's a taboo or not to talk about therapy and spirituality (I certainly don't see music therapy, or any kind of therapy, as a space to conduct one's religious agenda), but it's hard to not see the parallels. We create a sacred space within which the therapist, the client, and the music come together for the purpose of growth. There is complexity within these relationships and an effort to make sense of the complexity.  There is a joining together for a common purpose...all of these seem like deeply spiritual experiences to me.

I wonder what your thoughts are about this.

Tuesday, August 10, 2010


ShameImage by fabbriciuse via Flickr

I'd love to be able to explain why I haven't been writing any blog posts of late, but I'm not sure I could. It's not as if I haven't had things to say. I mean, I've got various notes in journals and on scraps of paper reminding me of thoughts I've had, issues I want to blog about. I've (mostly) accepted that I will write when I need or have to write. 

Today I'm feeling a need to write.

Yesterday morning I showed up for a session with a client I haven't been able to see for two weeks. There were some scheduling changes and then there were some scheduling conflicts, and that's the way it sometimes goes. 


I knew I had to be prepared for possible reactions to my absence. On the other hand, I wasn't sure how "real" I was to her as yet. C and I have only worked together since January. She seems to recognize me these days, but the relationship still feels fairly tenuous.

I found her at the other end of the cottage, and she smiled (which seemed like a pretty good start). She walked along with me and then pulled me toward the bathroom. I was hoping we wouldn't have a stripping issue, but her staff told me she might need to use the toilet. Okay then. 

Her staff accompanied her to the bathroom area, reminding C that she needed to be supervised (for a few reasons we needn't get into), and I waited in the empty day area where we'd be working. 

While I was waiting, K, one of the supervisors (who happens to be a former music therapist), came over to ask me how things were going with C. She was being nice, because I knew that it was code for "The staff are annoyed with you, because you 'let' C strip when she's in music therapy." To K's credit, she wanted to hear my take on the stripping. 

Apparently, I'm the only person who has this problem with C suddenly taking off her clothes (other than the afternoon shift).  


I don't know exactly why C strips in music therapy. Maybe it's because I'm mostly new to her. Maybe it's because I only see her once a week (and even that can vary because of her schedule and mine) not every single day, and she doesn't know me that well. Maybe she's testing me. 

All I can say for sure is: I'm trying.  

So that was how I went in to the session.

C came on out of the bathroom with her staff person, and she was in good spirits, everything was going along, she picked up her giant beanbag to set it on her lap, sat on a comfortable couch, and we were off. 

She was vocal, I was reflecting, she was engaged, I was responding...all good things. She was bothered, for some reason, by a couple of binders sitting on the table, so I took those and put them in the next room, and we resumed our musical interaction.


C decided she needed to go to the refrigerator (there's a dorm sized fridge in the day area where we were working). Now, understand that: 

1)The last time we had dealt with the refrigerator, there was a lot of iced tea to be cleaned up. A LOT of iced tea. 

2) She has a very sensitive stomach, and I wasn't sure what she was safely allowed to have. 

3) It was 11 AM and not long before lunch when I knew she'd get something to drink anyway. 

4) I wanted her to focus on the session. Yes, that was my issue, but for that moment I decided it was a legitimate wish on my part.

Well. I asked her to wait until later, and that was when it all started to deteriorate. Rapidly. Suddenly, the jacket, pants, underwear, adult diaper, shirt and bra were on the floor. 


I managed to get her into the bathroom area (and pick up the assorted clothing items) and then it just went from bad to worse. I was aggravated, C was freaking out, and it was argue, fight, fuss, refuse, be naked (not me), and consider becoming a hermit so I'd never have to deal with people again.

Finally, after about 10 minutes of achieving nothing I decided to ask for help.  

Her staff (the one who had helped her in the bathroom earlier) came in, and C set up a yell, but she got dressed.


I hung around in the bathroom for a while, trying to watch what her staff did to get her organized (wondering what I had done wrong, not thought of, why I went in to music therapy anyway). 

When they came out of the bathroom area (which is a big area, I must tell you, with a bunch of stalls, showers, a bathtub, and so forth), and C was dressed and calmer, I reminded C (and her staff) that I would see her in two weeks, and that I hoped we could find a way to have her stay dressed.

Her staff commented that "Oh, she'll be dressed when you get here. It's after that we're not sure about," which is code for "If you were a competent professional, my client would not be naked by the end of your session, would she?" 

"Thanks for your help."

I stewed about this for the entire rest of the day, feeling horrible and inadequate. 

And then I realized this morning that the thing that made me most angry about the situation yesterday was that I ended up acting from a place of anger and shame with regard to my reactions to the staff people and not from the perspective of a clinician. 

As such, I'm not only frustrated by the fact that the whole session went to hell suddenly, but I'm also bothered by the fact that I felt as if I allowed my feelings about staff's opinions about what I do/don't do/how I do it to get in the way of my being C's music therapist. 

Now, I'm sure that as soon as I settle myself down about all of this, I'll be able to use these new pieces of information I have (yes, also known as countertransference) in a more constructive way (you, for one thing, using it to get a better understanding of what my client may be going through that she feels the only way she can communicate with me is by stripping).

Until then, I'm still annoyed and agitated about the whole thing.