Tuesday, March 15, 2011

In case you were wondering...

...why it's taken me so long to post new blogs, it's because I've been working away at preparing for two workshops, including another five-hour continuing education presentation, at the Mid-Atlantic Regional conference of the American Music Therapy Association

Actually, it all started when I was asked to talk about taboo topics again (who'd have thought?), so I decided to split it up and do one version for students and one for professional music therapists. 

Here's where I was hoping to head with the student version ("Taboo Topics in Music Therapy: What They Didn't Mention in School"):

Music therapy training often focuses on helping students to develop techniques and skills in order to support clients’ goals and objectives. It is only when we begin to work, first in field experiences, then in internships and eventually professionally, that we realize there are some topics that weren’t really addressed in our training. How on earth do we deal with clients who masturbate openly in the middle of music therapy sessions? What is the appropriate professional way to work with a client who has a crush on us? What if we are sexually attracted to one of our clients? How do we manage and come to terms with being a music therapist when we are coping with our own mental illness?  What is the best course of action when we are dealing with a client who pushes all of our buttons?

These are the kinds of questions student music therapists ask themselves every day, and the answers aren’t always readily available in journals, conferences, in listserv discussions, or even in life.

As therapists we are taught: what we repress we project. Without a safe space within which to bring up such topics, and without support and guidance from mentors, clinical supervisors or peers, music therapists run the risk of acting out their shame and discomfort. This can lead to burnout or, worse, unethical behavior.

The focus of this participatory workshop will be on providing a forum for student music therapists to give voice to their experiences and to have their concerns validated. This year we will dig a little deeper into why these issues aren’t being talked about and try to come up with some constructive ways we can use to figure out how to get the support we need to address the difficult topics.

The five-hour workshop will be a bit more intense (as it ought to be), and it's geared (of course) to professional music therapists. I don't know about you folks, but remember when I asked what your thoughts were about doing a follow-up workshop? Well, as I looked over "The List (So Far)" I realized that out of 33 items, something like thirty of them (seriously! Thirty!) were related to the therapy relationship in some way, shape, or form!


I decided to go for it and do a CMTE (yes, a whole five hours) where we get to look at the therapy relationship (this one is called "Taboo Topics in Music Therapy: The Intimate Connection Between Therapists and Clients"). Here's the plan of action for the workshop:

The relationship between therapists and their clients is an intimate one. When we add music, the level of intimacy increases. As with any relationship, as the level of intimacy increases, the levels of resistance, uncertainty, and investment also increase- on both the therapist’s part as well as that of the client. On the one hand we may put up unconscious barriers, preventing a deeper connection with our clients. On the other, we may become so merged as to be in danger of violating important therapeutic boundaries. As such, the  music therapy relationship can become difficult to negotiate.

In this interactive workshop we will begin by defining countertransference. Using case examples, we will work toward an understanding of: What is it? Where does it come from? How does it affect therapy? How do we begin to identify and use countertransference in our work with clients?

Participants will then be invited to share some of the difficult aspects from their own work with particular clients that challenge them in some way. Through dialogue, journaling and music-making we will process and explore some of the following questions: What are some of the ways we use to avoid looking more deeply at some of the clinical challenges we face as professional music therapists? What are some of the beliefs and ideas we, consciously or unconsciously, hold about ourselves, about music therapy, about our clients? And how do these ideas and beliefs affect our work and our clients? Why are certain topics so difficult to bring up in sessions- even if we know our clients need us to do so? What is it about the topics? What is it about our beliefs, ideas that makes it scary? What kinds of messages are being communicated by us to our clients when we don’t address difficult issues?

Through these workshop experiences, participants will work toward developing the skill of self-reflection, using a variety of techniques to process thoughts and reactions that emerge in relationship to their clients. 

But I'm wondering if maybe this topic is too taboo. So far I've only got three people signed up (and it's happening in a little over two weeks). When I consulted with a psychiatrist friend to ask her if she thought I ought to cancel if our group was so small she (wisely, I think) pointed out that doing so would convey to people that the subject should and would remain a taboo- never to be looked at by music therapists. 

So, I'm kind of thinking I'd like to go for it. A small but mighty little group can do amazing things, I imagine. 

I'd be curious to hear if you folks out in blog-reading land have any thoughts about this. Do you think I ought to cancel the whole schmear? Might this topic actually be a little too close to home for people? 


Becoming Dr Doc said...

I think it's an awesome topic. I wish I could be there.
I really think there is such merit in discussing things that are taboo.

I remember once I was encouraged to have "courageous conversations". I took this advice on and made it part of who I am in the world. I have had many a courageous conversation that has landed me in hot water, but I feel great knowing that I am being true to myself.

Taboo subjects in music therapy are not often talked about, and this is one of the reasons I love reading your blog. You have courage to talk about things that others don't.

Go ahead with your workshop, I will be there in spirit!!

Lori Parker said...

I think this is a wonderful topic! I actually am dealing with a situation with a client/resident now who has a major crush on me and it's beginning to cause problems. And I get support from my boss but not from other staff who just think it's funny...but it's not. He has gone so far to tell others he loves me and wants to date me and marry me. No matter how many times my supervisor has talked to him, it doesn't help, and I'm getting very frustrated. I try to avoid him as much as possible right now. I wish I could come to this session! What about doing it for Nationals? So I can attend! :) This seriously needs to be discussed.

Roia said...

@Dr Doc I love the idea of "courageous conversations"! That's a brilliant way to put it. Thank you. And thank you for seeing me as someone who is courageous. How wonderfully flattering. :- ) I will be appreciating your good spirit while I'm workshopping away.

@Lori I've had lots of clients (most of whom don't use speech) with crushes, and it is always always awkward. What I'm wondering is why your supervisor is talking to this gent. Have you told your client directly that you don't have this type of a relationship? And is your supervisor a music therapist? So many questions. Sorry to bombard you. I've been reading (or trying to) a great book I just bought by Karen Maroda, "Psychodynamic Techniques: Working with Emotion in the Theraeutic Relationship". She has a whole chapter on erotic feelings in therapy.

I am, by the way, thinking it might be cool to do this at the national conference. But I think I'll give it a code name- something simple like "Using the therapy relationship" or to that effect. But you're right, it needs to be discussed, and it often isn't!

Lori Parker said...

Well, I'm one of 2 MT's at my facility. And I'm in the Community Life department. I work as the Manager of Expressive Arts. We are a residential community for adults with borderline, mild and moderate intellectual disability. My supervisor is not an MT, but she talked to the guy because I asked her to. I actually used to have a good, healthy, therapeutic relationship with him. He has been in plays and classes and took guitar lessons. However, in his mind he has turned it into more than therapist and client. He is "high functioning" enough to understand and knows the things he is doing are wrong. And other residents make comments about it (what he says and his feelings) to me in public. Not great. So I feel very uncomfortable talking to him about it. I have made comments in the past and told him to stop. But it's gotten to the point I needed help. Everything I say or do - even negative - he sees as a chance.

I think a good "code name" would be awesome! You'll have to let me know what it is so I can be sure to come to that session!

Meghan Hinman said...

Hey Roia, I think you should definitely still do the CMTE even if you only have a few people! Educating only 3 more people about this important topic is still 3 more people who maybe didn't think so much about this stuff before. Plus, you could do really intimate stuff with only 3 people... it'd almost be like its own little therapy workshop. That would probably be a really cool experience for you. I wish I was able to register for CMTE's (I barely pay my bills right now)... but I know it will be awesome.

Laura Cousins said...

To the best of my knowledge, this hasn't happened to me. Yet. But even so I think it is a crucial topic. Taboos should never be ignored - they require special treatment because that is how they have BECOME a taboo in the first place - but they should never be ignored.

I too wish that I could attend. Is there any possibility of devising a web-based version of the workshop? Something to think about, anyway.

Goodness me, you have been busy. But it's good to see you posting again!

Erin said...

I love the topic. I think it is important to address. I have had a number of uncomfortable circumstances already, and I am brand new to the profession. I would attend, were I able to get to the conference.
Good luck,

EB said...

I like the idea. If you were in my region, I would seriously consider yours. It has that promise of being both interesting and practical.

Roia said...

Wow, thanks, everyone, for your support! Clearly, I wasn't incorrect in thinking this is something that needs talking about (as in, it's not just me who struggles with these issues). I truly appreciate your taking the time to comment and add your thoughts.

@Lori That is a difficult situation. Is there any possibility of trying to work with this person to understand why he may need to stay so focused on you (as in, is there something going on in his life that is so upsetting that he would rather put all his focus on you instead of dealing with the issue that's bothering him? Is this about power- or lack thereof? It certainly sounds as if you're feeling powerless, and sometimes when it's hard to articulate that one feels powerless, they unconsciously get other people feel that way- through the "miracle" of projective identification). Good luck with the situation!

@Meghan Yes, I think it would definitely be cool (and intimate) to have a very small workshop. I'll be happy to see you at the conference, and I will know with you that your practice will be booming and bills will be paid. :- )

@Laura Hm. I'll have to think of how to do this in a web-based way. One of the important aspects of the workshop, I think, is the interactive/music-making element. Let me see how it goes live, and then I'll have to ponder it.

@Erin It's amazing how much stuff we don't realize we know until we're out there in the world doing our thing.

@EB "Interesting and practical"- nice description! Thank you. May I quote you on that someday?

Rachelle said...

I would attend this workshop if it were available at this conference. It's a hugely important consideration for all of us - even people who work in more behavioral/activity-oriented ways. Maybe when you submit it to the national conference (please??) you could work it to meet the new ethics requirement? That would get more interest for sure.

Roia said...

@Rachelle Thank you for the support! I agree that this affects music therapists no matter what their theoretical leanings. I'm not sure I'm the right one to talk ethics (not because I'm unethical, mind you- it's just that I don't think that's where my skill is). Actually, my hope was to talk more specifically (if I can organize myself to submit a proposal before the deadline, that is) about the music therapy relationship and how to use it to have a deeper understanding of our clients. Meanwhile, Carol Shultis is doing a CMTE on ethics at our regional conference. I wonder if she plans to do one at the national one as well.

Ryan Howes said...

Just dropping by and glad I did, Roia! This is a great topic, probably one of the most personally and professionally enriching topics you could cover. I'm not even a music therapist and now I want to know the answers to some of the questions you raise. And for what it's worth, I'd be more likely to attend a workshop titled "Taboo Topics..." than the milder versions. I hope it goes great!

Roia said...

@Ryan How cool! I was *just* thinking about you (I think I saw your name over at the Psychotherapy Networker online area- yay). I think the class went fairly well. Only thing I would have changed would have been to have more processing using the music, but I guess the topics were tough, and we only had five hours to get comfortable with each other. Hope I'll get to do a second version at the national conference.

So glad to see you again!