Friday, April 30, 2010

Well *that's* good to know

http://blogs.psychcentral.com/unplugged/2009/04/ten-things-a-good-therapist-should-be-aware-of/


As a music therapist working with people who mostly don't use speech as their main communication mode, I thought this was a particularly helpful blog post (written by Sonia Neale).


I particularly appreciated her last comment: "Even after thirteen years, therapy can be an inherently exhausting process." 

Thursday, April 15, 2010

"Rescue me!"

SuperwomanImage by cotton_man via Flickr
Okay, this may seem like a weird thing to blog about, but I'm doing it anyway. 


I was contemplating the fact that I have periodic rescue fantasies that involve my clients. 


I don't know what else to call them. And there seems to be an element of "Rescue me!" in them, so there you have it. 


I'm sure it has nothing to do with my clients who avoid leaving at the end of their sessions. Or find the longest and/or slowest way back to their cottages possible. Or the fact that as soon as I drop some people off after their sessions, they are pulling me back to the door to leave with me. 


No, I'm sure that's not it.


Cup of guilt anyone?


Anyway, I was thinking about the fact that the rescue fantasies that seem most prominent in my mind always seem to involve thinking about driving with my clients (not going anywhere in particular- just driving) and cooking for my clients (I spend a lot of time in the kitchen).


Escape from the life they have and being nurtured and fed.


I just thought that was interesting. 




Tuesday, April 13, 2010

Taboo Topics in Music Therapy- Part III- The List (so far)

Taped - Owen's 1Image by fensterbme via Flickr
Here's a list of taboo topics I generated. I found I had to keep adding to it as I went along. I also included many of the offerings of the conference participants. Feel free to comment and add your own. I dare say there are quite a few taboos to be found in music therapy as yet. 



Taboos (I have known and loved)

1. Sexual feelings and/or arousal
a. for clients
b. dreams about clients
c. our clients feelings about us

2. Fantasies
a. that we will be the one person who makes a difference in our clients’ lives (or that we are the be-all and end-all in their lives)
b. sexual fantasies
c. fantasies of taking clients home and taking care of them, also known as “rescue fantasies”
d. dreaming about clients

3. Mistakes on the part of the music therapist

4. Fee disasters/money/financial transactions

5. Hatred for/anger toward a patient
a. hating a patient’s music
b. clients who are hurting/frustrating us

6. Getting sick and not being able to do your job for a while
a. can include mental illness as well as physical (i.e., needing to take a break from work)
b. music therapists who have mental illness
c. fear of getting sick when working with clients who have communicable diseases

7. Feelings of incompetence
a. not knowing what to do in a session
b. feeling lost
c. feeling uncertain musically

8. Feeling that we need to be all-knowing, all loving (a.k.a. “Music Therapist Syndrome”- the belief that we must always be nice and cheerful, and that it is our job to make our clients feel better, and that we should never be “mean” and confront them or push them in any way or to talk about “sad” subjects.

9. Feeling bored or tired/sleepy during sessions

10. Clients who gross us out or offend us

11. Therapist’s fears/terrors

12. Therapist’s personal issues around shame/guilt
a. May include therapist’s own abuse history

13. Being fired

14. Issues with staff/co-workers/clients’ families
a. having to report staff/clients’ families for abuse/neglect/etc.
b. fears of retaliation should we report abuse
c. dealings with staff regarding clients (having differences of opinion)
d. staff undermining our efforts as therapists

15. Being uncomfortable with the system within which we work
a. disagreeing with the way client services are provided
b. having to represent a facility we don’t always feel comfortable with

16. Boundary violations
a. treating clients or their families as friends
b. hugging/touching clients as a matter of course
c. violating client confidentiality

17. Guilt over terminating/guilt over not terminating
a. “I should have tried harder.”
b. not working on closure
c. difficult endings
d. ending because we don’t know what else to do

18. Fear of violent clients or those who act out in other ways
a. constant anxiety when having to go and work with a particular client

19. Clients who fall asleep in sessions
a. leading to fear that we are inept or ineffective therapists
b. that we’re doing something wrong or boring

20. Having favorites
a. when we admit it we’re less likely to act on it than if we deny it.
b. also the belief that we have to love all of our clients

21. Fear that a client may commit suicide
a. along with the fear that we will miss the warning signs and it will be our fault
b. and the corresponding fantasy that we will be the one to save this client

22. Being in the role of “helper”
a. discomfort with being in the role of ‘helper’
b. not being aware of the power difference between client/therapist

23. Seeing clients as more disabled than they are
a. sometimes leads to an attitude that “they don’t understand what we’re doing, so it won’t hurt them” (this is the kind of belief that can lead to situations like the one with Corey Brown, the music therapist who molested his clients)

24. Working with someone your own age
a. Or working with someone you’ve known in a different context (including survivor guilt)

25. Running into clients outside of the therapy context
a. Clients who want to connect through various online social networks
b. Clients asking for sex/marriage/personal phone numbers
c. Clients who grope themselves/who try to grope the music therapist

26. Clients who are better musicians than we are

27. The myth of music as a “non-threatening” medium

28. Guilt over privilege

29. Assuming our clients are heterosexual, or identify as a particular gender

30. Hating a particular style of music and/or refusing to learn or play a particular style in music therapy sessions

31. Clients dying or getting seriously ill (sometimes in the middle of a session)

32. Racism, sexism, able-ism, heterosexism (in all of their infinite varieties and forms)

33. Music therapists who do not dress in a professional manner (i.e., whose dress is seductive or overly casual)

Why we don’t talk about these things (some of these reasons are taboos in and of themselves, I would say):

  • We don’t always know the answer
  • We don’t want to look unprofessional/bad
  • Ashamed/embarrassed/fear of being blamed
  • Music therapy students who are over-protected/over-directed
  • Not always recognizing countertransference
  • Helplessness
  • Not wanting to deal with repercussions
  • Competition between colleagues
  • Not having a supervisor/mentor/safe resource
  • The need to constantly “prove” that music therapy is a valid therapy
  • Wanting to be a good example
  • Diminishing the impact of an issue (i.e., making light of a difficult topic)
  • Fear of being seen as a fake/incompetent
  


Thursday, April 8, 2010

Taboo Topics in Music Therapy- Part II- The handout


Here, as promised, is the handout from the presentation. If you'd like to use it in some way, please do. Just kindly give me credit, eh? 


Taboo Topics in Music Therapy
March 26th, 2010
Mid-Atlantic Region Music Therapy Conference, Pittsburgh, PA

It’s the stuff we don’t look at and we don’t talk about that gets us into trouble.

Identifying Personal “Taboos”
Part 1
Clues that something may be going on in sessions that needs exploring (some parts of the following list have been taken directly from Pope, Sonne, and Greene’s book What Therapists Don’t Talk About: Understanding Taboos That Hurt Us and Our Clients):

  • Avoiding certain topics
  • Changes in how you are using the music in your sessions (i.e., using more music than usual, less music than usual, noticing a particular musical pattern, etc.)
  • Doing the same thing with every client/group
  • Finding yourself bored or unusually tired/drowsy during sessions
  • Having a particularly strong reaction to a specific client
  • Obsession
  • Seeking repeated reassurance from colleagues
  • Creating a secret
  • Fantasizing or daydreaming about a client
  • Increase in physically handling or touching a client
  • “Forgetting” the therapy goals
  • Feeling extremely uncomfortable with a client
  • Feeling embarrassed by your reactions to a particular client

Part 2
In the process of exploring, ask yourself a lot of who/what/why/how/when/where questions, such as the following:

  • What’s going on for me in this situation? What is my reaction to this client/group/staff person/situation? What’s going on in my life?
  • Why am I reacting in this particular way? To this particular client/group/situation? What’s going on in the session?
  • Whose need am I meeting?
  • What information do I have/need to try to figure this out?
  • Do I have this reaction to all of my clients or is it just with this person?
  • How has my use of music with this client changed?
  • Has there been an overall change in how I interact with this client?
  • Has there been a role reversal (where I feel as if my client is acting more like a therapist than I am)? Why might that be?
  • What is different about the way I’m interacting with this client versus how I interact with my other      clients?
  • When did my behavior with this client shift? Was there a specific incident that I recall?
  • Has a client (or have I) ever done something that put me in a very awkward or uncomfortable position? Have I worried that other people would find out?
  • Have I ever tried to justify my behavior with a particular client?
  • Have I been avoiding discussing this situation/my feelings with a trusted colleague or clinical supervisor? Or have I only talked about it peripherally or in an “edited” way?
  • With whom can I discuss this situation and get some guidance/support?


Part 3
Situations/encounters/issues I’ve had in my experience as a music therapist that I have avoided talking about, feel ashamed about, I’m not sure how to handle, or that have made me very uncomfortable:
1.

2.

3.

Referring back to each of the situations you described above:

When (Situation #1) _______________________________________________happens/happened I feel/felt:  ________________________________________________. This affects/has affected me/my work in the following ways (i.e., made it difficult for me to work with a particular client/group, created an uncomfortable work situation, kept me from doing something I should have done, led me to do something I wouldn’t otherwise have done, or I don’t know if it has affected my work):


Some of the actions I take/have taken to address the situation/encounter/issues are:
a.

b.

c.

When (Situation #2) _______________________________________________happens/happened I feel/felt:  ________________________________________________. This affects/has affected me/my work in the following ways:


Some of the actions I take/have taken to address the situation/encounter/issues are:
a.

b.

c.

When (Situation #3) _______________________________________________happens/happened I feel/felt:  ________________________________________________. This affects/has affected me/my work in the following ways:


Some of the actions I take/have taken to address the situation/encounter/issues are:
a.

b.

c.


Looking at our resistance
Some of the reasons I have had for not talking about the above situations/encounters/issues are (try to be as specific as you can in describing your feelings and beliefs):
a.

b.

c.

Identifying Resources
Here are some people with whom I feel safe enough to discuss these situations/encounters/issues (i.e., a clinical supervisor, a music therapist whose work I admire, a current or former professor, a trusted colleague, a personal therapist, a group of peers, an online community- in all cases, bearing in mind the matter of client confidentiality, other resources, etc.):
a.

b.

c.






References, Books, and Articles I’ve Found That Are Helpful or Thought-Provoking

Bridges, N. A. (1998). Teaching psychiatric trainees to respond to sexual and loving feelings: The supervisory challenge. Journal of Psychotherapy Practice and Research. 7, 217-226.

Bright, R. (1996). Grief and powerlessness: Helping people regain control of their lives. London: Jessica Kingsley Publishers.

Corbett, A. (2009). “Words as a second language: The psychotherapeutic challenge of severe intellectual disability” (45-62) in (Cottis, T., Ed.) Intellectual disability, trauma and psychotherapy. New York: Routledge.

*Corey, G, Corey, M. S., & Calllanan, P. (1998). Issues and ethics in the helping professions (5th Ed.). Pacific Grove, CA: Brooks/Cole Publishing.

Davies, A. & Sloboda, A. (2009). “Turbulence at the boundary” in  Odell-Miller, H. & Richards, E. (Eds.) Supervision of music therapy: A theoretical and practical handbook, in Schaverien, J. (Series Ed.) Supervision in the arts therapies, New York: Routledge. 

*Dileo, C. (2000). Ethical thinking in music therapy. Cherry Hill, NJ: Jeffrey Books.

Dileo, C. (2001). “Ethical issues in supervision” in Forinash, M. (Ed.) Music therapy supervision. Gilsum, NH: Barcelona Publishers.

Foster, N. (2007). ’Why can’t we be friends?’ An exploration of the concept of ‘friendship’ within client-music therapist relationships. British Journal of Music Therapy. 21(1), 12-22.

Gabbard, G. O. & Lester, E. P. (1995). Boundaries and boundary violations in psychoanalysis. New York: Basic Books.

Gabbard, G. O. (1996). Love and hate in the analytic setting. Northvale, NJ: Jason Aronson.

Hunter, M. & Struve, J. (1998). The ethical use of touch in psychotherapy. Thousand Oaks, CA: Sage Publications.

Kim, J. (2009). First love- An idealized object in music therapy. Voices: A World Forum for Music Therapy. Retrieved from http://www.voices.no/mainissues/mi40009000333.php

Koo, M. B. (2001). Erotized transference in the male patient-female therapist dyad. Journal of Psychotherapy Practice and Research. 10, 28-36.

Kottler, J. A. (2003). On being a therapist (3rd Edition). San Francisco, CA: Jossey-Bass.

Kottler, J. A. & Carlson, J. (2003). Bad therapy: Master therapists share their worst failures. New York, NY: Brunner-Routledge.

Misch, D. (2000). Great expectations: Mistaken beliefs of beginning psychodynamic psychotherapists. American Journal of Psychotherapy. 54(2), 172-203.

Oosthuizen, H. (2009). “Some thoughts on being a white music therapist” Voices: A World Forum for Music Therapy. Retrieved from http://www.voices.no/columnist/coloosthuizen021109.php

*Pope, K. S., Sonne, J. L. , & Holroyd, J. (1993). Sexual feelings in psychotherapy: Explorations for therapists and therapists-in-training. Washington, DC: American Psychological Association.

*Pope, K. S., Sonne, J. L., & Greene, B. (2006). What therapists don’t talk about and why: Understanding taboos that hurt us and our clients. Washington, DC: American Psychological Association.

Richards, E. (2009). “Whose handicap? Issues arising in the supervision of trainee music therapists in their first experience of working with adults with learning disabilities” in  Odell-Miller, H. & Richards, E. (Eds.) Supervision of music therapy: A theoretical and practical handbook, in Schaverien, J. (Series Ed.) Supervision in the arts therapies, New York: Routledge.

Rolvsjord, R. (2006). Whose power of music? A discussion of music and power-relations in music therapy. British Journal of Music Therapy. 20(1), 5-12.

Searles, H. F. (1979). Countertransference and related subjects: Selected papers. Madison, CT: International Universities Press, Inc.

Van der Klift, E. & Kunc, N. (1994). Hell-bent on helping: Benevolence, friendship, and the politics of help. Retrieved 9/23/05 from http://www.normemma.com/arhellbe.htm

Ulman, K. H. (2001).  Unwitting exposure of the therapist: Transferential and countertransferential dilemmas. Journal of Psychotherapy Practice and Research. 10(1), 14-22.

Yalom, I. (1989). Love’s executioner and other tales of psychotherapy. New York, NY: Perennial Classics.

* Books that are particularly useful.
Copyright 2010 Roia Rafieyan

Tuesday, April 6, 2010

Taboo Topics in Music Therapy- Part One

December 10, 2009: Mum's the WordImage by Mr.Thomas via Flickr
It was time. I hadn't been to or presented at a conference since March of 2008 in Cherry Hill (that would be in New Jersey) (at the Mid-Atlantic Regional conference of the American Music Therapy Association) (or MAR-AMTA for short) (MAR for even shorter) (I mean, geez!).

So I started to think to myself, "what can I talk about that hasn't been talked about before? Or that I haven't talked about before? How can I make this useful for people?" 


I've done presentations about working with adults with intellectual and developmental disabilities and autism, countertransference, looking at power and control, using music therapy to support people with disabilities who have been abused (which is an awful lot of people), survival skills for new music therapists, the myth of the perfect music therapist, paying attention, feeling powerless as a therapist...


What could possibly be left?


Oh, yeah. The stuff nobody talks about in the music therapy field (or so it seems). Things like, "what do I do when my client starts to masturbate in the middle of the session?" or "my client seems to hate me!" Or "oh, my God, I think I have a crush on my client!" 


Those are actually only the very shiny surface of the whole collection of stuff we don't talk about as music therapists. The list, as I discovered when I did this presentation a couple of weeks ago, is endless! 


No. Seriously. 


I had a room full of music therapy professionals and students (thanks for the presentation love, guys!) coming up with item after situation after topic for me to add to the big list we were generating on the giant flip chart!


There are so many things that simply aren't addressed in school, in the literature, at conferences! 


And here's a taboo topic for you:  we music therapists can often make it seem as if our work is all sorts of "sunshine, lollipops, and rainbows!"


Well, okay. That can be true. Sometimes it does look all happy and easy, and sometimes it is fun, but music therapy is hard work! 


It's therapy! 


Being a music therapist can be hard work too. It's our job to say out loud to our clients the stuff  that isn't being said. 


And what I wanted to do with this presentation (and I think we accomplished that) was to say out loud the taboo topics in our field. The stuff nobody talks about or writes about, but that we have to deal with every day in our sessions.


My official "mantra" for the month:


It's the stuff we don't look at and we don't talk about that gets us into trouble.


Likely this is the same stuff people don't like to talk about in general, but, as music therapists, it seems (to me anyway) as if it would be a good idea if we're willing to look at the stuff that makes us uncomfortable. 


After all, we're asking our clients to look at the things that make them uncomfortable. Aren't we?


[Coming up next time: The handout from the conference]


Friday, April 2, 2010

Finally back on track

Potato Head - Couch Potato : )Image by oddsock via Flickr
You may well be wondering where the heck I've been for the past month and a half!  Frustratingly enough, my clients were probably wondering the same thing.


As it happened, I had to undergo some unanticipated surgery to correct a rather painful medical situation. 


All I can say about it at this point is: boy, am I glad that's over! And, yes, I'm feeling much MUCH better, thank you for asking (because I know you're nice, and I know you will ask). 


Oddly enough, there are actually several good things to say about all this:


Thing #1: My two kindly music therapy colleagues went to almost all of my clients (at my request) and let them know that I would be having some needed surgery and I would be out for a little while. And they emphasized the fact that I planned to return. 


Thing #2: I have a full-time job. I have good health insurance. I have lots and lots of sick time, because I very rarely get sick (yes, I did just knock on wood). I do not take this fact for granted!


Thing #3: I have two neighbors (both women in their 70s) who were absolutely amazing after my surgery. They checked in on me, they ran errands for me, and they just made sure I was alive and everything was okay. What phenomenal gifts they are! 


Thing #4: I discovered that "recovery from surgery" means "lie on the couch and can't do much of anything". Yes. Well. I did a lot of that.


So. Now that I'm back to work, I can also be back to blogging. Thank goodness!