Tuesday, November 27, 2012

Wow! It was an honor just to be nominated!

Top Resource for CounselorsA few weeks ago, a kind woman by the name of Rebecca from the Masters in Counseling website, sent me a note to tell me my blog had been nominated as one of 100 Best Resources for Counselors. Who knew?

And then, a short while later, she sent me a congratulatory note. How neat! And I'm in such fine company to boot. Thanks, Rebecca, and thanks to the kind folks who nominated me, and, mostly, thanks to you, you lovely readers you! I very much appreciate (and am humbled by) your willingness to slog through my commentary and carryings on about my music therapy experiences.

As it happens, a few other favorite bloggers are also on this list, so check them all out at some point.

Wednesday, November 21, 2012

Bringing it all back to "Do"

I live in New Jersey, and everywhere I went during the two weeks after mega storm Sandy (work, the grocery store, the library, the gas station), people asked me, "Did you lose power?" 

And I was struck by the metaphor contained in the question: "Did you lose power?" 

People in this area experienced, quite literally, being- let alone feeling- "powerless" (on a lot of different levels). They struggled through "power failure" and had to wait for their "power to be restored." 

Many of my students at Montclair experienced "loss of power", leaving them sounding  somewhat rattled when we returned to class. A music therapist I know described her disabled clients' distress as they coped with yet another storm requiring their temporary relocation to safer and warmer living quarters (we had Hurricane Irene last year, along with a freak snow storm at the end of October, both of which caused a lot of power outage and flooding). 

In pondering our collective experience, I got to thinking, as I tend to do, about how this connects to our work as music therapists- how we react to the unbalancing effect of going through a frightening experience such as a major hurricane (for example). 

As I played around in my mind with this idea of power loss and restoration, I thought about how we in music therapy are, essentially, working in a musical way to restore power, intra- and inter-personally. 

And, sure, this may be sort of a weird way to say it, but, if I were to say this using musical terms, I guess I'd be saying that in music therapy we're working toward "bring(ing) us back to 'Do'." 

[A special thank you to MJ Landaker for her recent post about the important connection between music theory and music therapy. It certainly helps to understand why music is so "powerful" (if you will).]  

Tuesday, September 25, 2012

Celebrating National Psychotherapy Day

It's National Psychotherapy Day today- the first one ever- and I'll be celebrating by heading, just as I do every other week, to my therapist's office. Why? Because I firmly believe getting my own therapy is an important part of my job as a music  therapist. 

Knowing who I am and what kind of emotional baggage I'm carrying around with me helps me be present and attentive to the clients I serve when I show up to provide music therapy.

When my clients do their best to avoid hearing me invite them to look at a belief they're strongly committed to (sometimes even going so far as to literally stick their fingers in their ears), when they fall asleep mid-session because something we're addressing feels way too overwhelming, when they fight mightily against change...I have a pretty good idea of what it's like. I've felt and done the same (okay, maybe I don't actually stick my fingers in my ears or fall asleep in therapy, but I can be pretty darned noisy if I don't want to know something). 

I'll be honest with you: I am uncomfortable recommending any music therapist I know who hasn't spent at least some time looking at his/her own issues in therapy. I mean, what are we communicating to our clients if we think we're above getting our own therapy? If we, essentially, perpetuate the attitude of stigmatization associated with taking care of one's emotional and mental health? 

One of the (many) reasons I loved the HBO show In Treatment was that the writers made sure the therapist, Paul Weston, went (even though he was kicking and screaming the whole way and was more of a pain in his own sessions than any of his clients ever were in theirs)  for his own therapy! 

Psychotherapy for therapists goes beyond the usual nice, self-care sorts of things we tend to talk about in music therapy circles (you know...the whole getting a massage, taking regular vacations, taking a bubble bath and the like). It's an ongoing commitment to self-discovery, a recognition that, yes, we can and do get in our own (as well as our clients') ways, and figuring out how to (much as we may bravely resist) make changes in our perceptions and ideas about our selves, our lives, and our relationships. 

So, good people, with a grateful nod to Ryan Howes (a blogging buddy who shares his insights over at the Psychology Today blogs as well as being a contributing editor at the Psychotherapy Networker), I invite you to consider how you might join in the acknowledgement and celebration of National Psychotherapy Day

After all, mental health and self-awareness are most certainly worthy of celebration!

Saturday, August 18, 2012

My life and times as a disappointing music therapist

The session that wasn't:

Walking to the session. Pausing to pull me toward somebody's car and tapping on the trunk:
"Um, no. We can not go in somebody's car. Please don't tap at it, or you'll set off an alarm and that would probably not be a good thing." 

Slowing down and sitting on a bench:
"Yes, I see that you don't want to go to do your session today, and you'd rather we sit outside on a bench."

Still on the bench:
"Yes, I realize I'm frustrating you, but music therapy is what I can offer. I can not take you for a ride, or for an escape, in someone else's car or in my car. I can, however, be your music therapist, and you can come to your session, and we can talk about it in the music."

In front of the Music Room door, but not going in:
"So, okay. You're not going to go into the Music Room."

Pushing past me and heading for the exit:
"I guess you're telling me we're not going to be doing music therapy today, and you'd rather go back to the cottage. Okay then. I'll try again on Wednesday." 

Heavy sigh. 
An unhappy face!

Wednesday, July 4, 2012

"He's not cranky- he's mischievous."

Her exact words were "he hasn't been cranky- he's been mischievous!" 

I was thinking about what she'd said the previous day about S as we started our session.  As his support staff, she probably was finding him to be rather frustrating. But, in my mind, there has to be a reason for it. 

What does it mean when someone's being mischievous? What if he's learning to assert himself? What if this means he now has enough of a sense of 'self' to assert? And he's not there yet, but he's trying to figure out what having a 'self' means?

That's kind of cool!

Now, back to S in his music therapy session. He was very quiet. His music was also quiet- contemplative, more interactive (in contrast to his usual energetic crashing and playing with great energy and a few brief pauses). He didn't play when I played. He was clear that this was a conversation, not a jam session where we play together. 

Self and other. Separate beings.

Wow. A major developmental step!

A modern chorus line
A modern chorus line (Photo credit: Wikipedia
A part at the very end of the first song from A Chorus Line ("I Hope I Get It") came to my mind as we stood together (a part which, frustratingly, they didn't include in the video I'm linking):

Who am I anyway? 
Am I my resume? 
That is a picture of a person I don't know. 
What does he want from me? 
What should I try to be? 
So many faces all around, and here we go. 
I need this job. 
Oh, God, I need this show.

I sang it for him, and I talked a little bit about the context for the song. It's sung by a man auditioning for a part as a dancer in a chorus line- which, to me anyway, seems to be a sort of anonymous group of dancers in a Broadway play- the goal of which is to be as uniform and in unison as possible. The character who sang this section of the song was thinking about his identity. I interpreted the lyrics as saying here's a man who is trying to come to terms with the face, the persona he has to present in order to get a job as a dancer.

I connected it to how I thought perhaps S might feel as a man with a disability who lives in an instituionalized setting. Having to put on a face (a persona), perceived by people, based on his behaviors and what is written about him in the institutional paperwork

Perhaps he too is wondering: who am I anyway? Who or what defines me? How do I define myself? And what does it mean in terms of safety, my identity as a man, as a disabled person?

Again, his musical responses (taps on the drum or tambourine) were very thought out and short.

We had about 5 minutes to go. I invited S to help me know if I'd been on the right track (by glancing my way) or if not (by making a sound). After a while, he looked my way, and he went slowly to the door and walked out.

Thinking he was done with me (and that either I was way off and misunderstood him- or he needed a bathroom, or maybe he felt a bit overwhelmed), I packed up my stuff. 

I was just about to follow him out, when he reappeared at the door!

He came back over, and I took out my guitar again. I sang a goodbye, in it telling him how excited I was for him. This is a truly important, although difficult, period in his life- one with the potential to offer him growth and a deeper self-awareness. He stayed until we finished, tapped the tambourine goodbye, and we walked slowly back to the day area.

Once we got there, he hovered near me (he doesn't usually). Then he reached into my instrument bag and borrowed the tambourine again, tapped it a few more times, put it back in the bag, and he headed off slowly in a different direction. 

See you later, S. 

Friday, May 4, 2012

Sharing an excellent TED Talk with you

True, this doesn't really count as a blog post. But you need to hear this. Trust me.

I first heard Brene Brown on Voices in the Family with Dr. Dan Gottlieb (one of my favorite ways to spend Sunday morning is to listen to my local NPR station, WHYY in Philadelphia). And I loved what she had to say! She is a researcher (cool!) who studies shame and vulnerability (wow!). 

In this TED talk, she tells us about how being vulnerable is an act of courage. More importantly, she reminds us that shame is diminished with empathy. 

I have a lot to say (shocking, I know) about both vulnerability and shame, but enough of my blather!  I want you to listen to this talk, because it's important. 

Friday, April 27, 2012

Music Therapy Show with Janice Lindstrom

I feel as if I've finally arrived in the land of music therapy. I've had an interview with the lovely and thoughtful Janice Lindstrom, the woman and music therapist behind the Music Therapy Show!

We talked about relationally-based music therapy, using a process (versus product-oriented) approach, countertransference, using music to listen to and reflect on what our clients present to us in sessions, and all kinds of nifty stuff.

If you'd like to give it a listen (and share your thoughts on these subjects) (that are near and dear to my heart), here it is!

Listen to internet radio with Janice Lindstrom on Blog Talk Radio

Wednesday, April 18, 2012

Last chance lost...

I noticed this song- "Last Chance Lost"-  running through my mind over and over again as we struggled to come to some kind of....okay-ness, an okay space today in our session. My client has some very strong feelings toward me, and although he knows "we don't have that kind of relationship" it's hard for him to hear it. Over and over.  

Yes, and it's hard for me to keep having to say it, because I feel cruel. I mean, I realize I'm not being cruel. I'm being truthful (and a therapist), and I know it would be more cruel to lie to him and pretend I don't see how much he wishes this weren't "just music therapy" and it was a better version of his life. 

And I'd be lying to you if I didn't say the rescue fantasies on my end can be intense. If I weren't so used to this happening it would be freaking me out. But this is something I go through, and it's more so with some people than with others. 

But here he was, this man who doesn't use speech, working so hard to be heard- using his voice even (which is rare)- and there I was...rejecting him again. 

When I step away from the session for a while and think about it, I have an idea of how to proceed and what we need to look at: Where are the feelings for me coming from? What might they be helping him to avoid feeling? What relationship(s) might he be trying to create or re-create in our sessions? And so forth. 

But...right there in the session...I feel like such a jerk. 

It's not that I'm afraid he'll be angry with me- although it would mean the beginning of the long period of anger. 

There always seem to be stages in the music therapy process- at least with the folks I work with individually. Initially there's a long period of "I don't trust you." That's usually followed by "okay, maybe you're not so creepy," which eventually works its way into "must we leave now?" Then we get into the "I like you/I can't let you know how much I like you" period which gradually becomes "I love you and you should never leave me!"  

I think my client and I are in that latter period right now. And I'm in the complicated "be firm but kind and figure out a way to reject without being rejecting/remember you're trying to help him realize how he's relating to people that's not really working for him/come on, Roia, you can do this" part of the work. 

And I know. The big anger is coming. Okay, so maybe I'm a little afraid. It's hard to give up being loved. Not that the anger indicates an absence of love. It's just easier, I'm sure you'll agree, when your client is in the "you totally rock" phase versus the "you rejected me and you are horrible and cruel" phase. 

Anyway. We struggled. He was sad. I was sad on his behalf. 

It was hard for him to return his instrument at the end of the session, and he insisted on carrying it back with him to his cottage- where he finally gave it back to me after a brief, gentle tug to make sure I understood he wasn't happy about relinquishing me or the instrument. 

The only part of the song I remembered as we worked through this session was "last chance lost". When I read the lyrics I was fascinated (for the hundredth time) by how our minds create musical connections with people, with moments and experiences. 

Last Chance Lost

by Joni Mitchell

Last chance lost
In the tyranny of a long good-bye
Last chance lost
We talk of us with deadly earnest eyes
Last chance lost
We talk of love in terms of sacrifice and compromise
Last chance
Last chance lost

Last chance lost
The hero cannot make the change
Last chance lost
The shrew will not be tamed
Last chance lost
They bicker on the rifle range
Blame takes aim
Last chance
Last chance lost

© 1994; Crazy Crow Music 

Saturday, February 18, 2012

Online Conference for Music Therapy 2012 Resources- Part 3

Recognizing and Responding to the Emotional Pain of People Who Don't Use Speech

This is the third installment of the handouts for the 2012 Online Conference for Music Therapy. This is a selection of quotes I have found useful to my thinking as a music therapist. The references for the quotes are also included. 

Roia Rafieyan, MA, MT-BC

Quotes I Have Known and Loved

“...the way others make us feel is the best clue as to the way they themselves are feeling.”  (Lovett, 1985;  p. 80)

“Real behavior change comes from a relationship;  the more serious the need for change, the more serious this relationship needs to be.  This need leads us from the realm of technology with its powers of predictability and orderliness into the uncertain and shifting territory of philosophers and poets.  What does it mean to be honest?  What does it mean to be present for another person and for ourselves?  What are the balances, at any moment in a relationship, between acceptance and challenge, between listening and being heard?  How do we invite others to accept our caring and concern and how do we all grow to feel we are part of one another in this world?  These uncertainties and failures have often led to difficult behavior in the first place.  How do we grow beyond it?”  (Lovett, 1996;  p. 224)

“Countertransference is part of every therapeutic relationship (regardless of the therapist’s theoretical orientation).  By definition, unrecognized and unanalyzed countertransference impedes our ability to be fully and actively present in the room with the client.” (Pearlman and Saakvitne, 1995;  p. 23)

“...empathy allows the therapist to gather information about the world the patient lives in and to use the information to build connectedness with the patient.”  (Cohen and Sherwood, 1991;  p. 220)

“We sometimes forget that our work often involves significant personal change and, equally dangerous, we forget how such change happens in our own lives.  Many of us have changed because ‘life happened’- events and the people in our lives significantly altered the way we saw the world.  Sometimes this is an abrupt turning point, sometimes a process occurring over years.  Sometimes- but this is only a small part of how most people actually change their behavior- we elect a formal relationship with a therapist to help us change, but no therapist (I hope) would presume to launch a program for change without taking time to get to know the person’s background and personal style.  This kind of groundwork is essential in forming a therapeutic alliance.”  (Lovett, 1996;  pp. 85-86)

 “Music psychotherapy involves three dynamic elements:  the client, the therapist, and the music.  Within this triad, the therapist and the music work together to help the client, serving similar or complementary role functions, very much like two parents working together to help their child and with the same possibilities for alliances, rivalries, conflicts, and valences.  Thus, both therapist and music can serve as a source, activator, and object for transference and countertransference, and both can provide the transitional space needed to work out the various role relationships being reenacted within the triad.”  (Bruscia, 1998;  p. 76)

“...systematic self-analysis must be a part of an effective containment effort.  Specifically, therapists must examine their own contributions to the intense feelings generated in the dyad.” (Gabbard and Wilkinson, 1994;  p. 82)

“Our attunement to our countertransference requires the same evenly hovering attention with which we listen to our client’s material.”  (Pearlman and Saakvitne,  1995;  p. 23)

“The important thing is not our flowery language, but rather that we are fully present and attentive to our companion.”  (Muller, 1996;  p. 117)

 “Many therapists are much more willing to assume the mantle of the good object than the cloak of the bad or threatening object.  Perhaps this is why so many of us are shocked when we realize the degree of anger and abuse we have to absorb from patients in the course of a career.”  (Lewin and Schulz, 1992;  pp. 228-229)

“...psychotherapy does not promise perfect attunement or mirroring, but entails repeated cycles of connections and disconnections and then repair and reconnection.”  (Pearlman and Saakvitne, 1995;  p. 17)

“...there is a common myth that the experienced analyst or therapist understands the patient swiftly and unerringly.  Although some patients try to oppose this, risking the retort that they are ‘resisting,’ other patients do expect it.  Perhaps it satisfies a wish to find certainty.  Some therapists also appear to expect it of themselves;  perhaps to gratify an unacknowledged wish to be knowledgeable and powerful.  It is not surprising, therefore, how often student therapists imagine that immediate understanding is required of them by patients and supervisors.  This creates a pressure to know in order to appear competent.”  (Casement, 1991;  p. 3)eve of “not 

 “Fresh insight emerges more convincingly when a therapist is prepared to struggle to express himself within a patient’s language, rather than falling back upon old thinking.”  (Casement, 1991;  pp. 27-28)

“I am suggesting that countertransference - as an aspect of projective identification - is not only the basis for analytic work but central to the basic process in all human communication and knowing.  We only know what is happening because we are moved from within by what we have taken in and responded to from our own deep feelings.  The space between people is filled - when it is and to the extent it is - by what we evoke in one another.”  (Young, 2005, March 27)

“Exploring one’s countertransference involves asking oneself whether this response feels unfamiliar, significant, unusual.  What does the response tell you about feelings that may be out of your awareness?  Does a particular dream stay with you?  Are you behaving differently with this client than previously?  Than with other clients?  Are the feelings more familiar to you in a different (e.g.. non-clinical or historical) context?  Do they seem alien or distressing or syntonic and comfortable?  These questions invite the therapist’s awareness and self-exploration which both deepen and expand her use of countertransference.”  (Pearlman and Saakvitne, 1995;  p. 27)

“My ego ideal, as regards my functioning as therapist, required that I endeavor always to be helpful to the patient, that I be unflaggingly interested in him, and that I experience no negative emotions whatsoever toward him- let alone express such feelings to him openly.  I regarded my personal identity as changeless, and my therapist-role as similarly fixed and absolute. 
I have described elsewhere that, in the course of subsequent years of personal analysis and clinical experience

...my sense of identity has become...my most reliable source of data as to what is transpiring between the patient and myself, and within the patient.  I have described...the ‘use’ of such fluctuations, in one’s sense of identity as being a prime source of discovering, in work with a patient, not only countertransference processes but also transference processes...[Searles, 1966-1967].
The main point of the present remarks is analogous to the one just quoted:  as with the analyst’s overall sense of personal identity, so the customary style of participant observation which he has developed over the years, his observation of the ways wherein he finds himself departing from this normative style, in his work with any one patient, provides him with particularly valuable clues to the nature and intensity of this patient’s transference responses and attitudes toward him.  Beyond the analyst’s privately observing such variations in his customary mode of participant observation, he can find it constructive, with increasing frequency as the analysis progresses, to share these data with the patient.”  (Searles, 1979;  pp. 577-578)

“When we discard technological responses to personal problems, we leave a world of some predictability (the primary reassurance that technologies provide) for a world of uncertainty...”  (Lovett, 1996;  p. 96)

“Therapists sometimes have to tolerate extended periods during which they may feel ignorant and helpless.”  (Casement, 1991;  p. 8)

“It is all too easy to equate not-knowing with ignorance.  This can lead therapists to seek refuge in an illusion that they understand.  But if they can bear the strain of not-knowing, they can learn that their competence as therapists includes a capacity to tolerate feeling ignorant or incompetent, and a willingness to wait (and to carry on waiting) until something genuinely relevant and meaningful begins to emerge.  Only in this way is it possible to avoid the risk of imposing upon the patient the self-deception of premature understanding, which achieves nothing except to defend the therapist from the discomfort of knowing that he does not know.”  (Casement, 1991;  p. 9)

“My best experiences in supervision have resulted from the supervisor asking me what I was feeling at a particular moment - usually a moment when I felt I did not understand the material.  I would go so far as to say that this has never failed to provide at least some enlightenment.  Interrogating the countertransference must not be seen as seeking a fact which is available on the surface of the mind.  Countertransference is as unconscious as transference is.  Understanding it is an interpretive task.”  (Young, 2005, March 27)

References for Quotes
Bruscia, K. E. (1998).  “The Signs of Countertransference” (pp. 71-91) in The Dynamics of Music Psychotherapy (Bruscia, K. E., Ed.).  Gilsum, NH:  Barcelona Publishers.

Casement, P. (1991).  Learning from the Patient.  New York:  Guilford Press.

Cohen, C. P. and Sherwood, V. R. (1991).  Becoming a Constant Object in Psychotherapy with the Borderline Patient.  New Jersey:  Jason Aranson Inc.

Gabbard, G. O. and Wilkinson, S. M. (1994).  Management of Countertransference with Borderline Patients.  Washington, D.C.:  American Psychiatric Press.

Lewin, R. A. and Schulz, C. (1992).  Losing and Fusing:  Borderline Transitional Object and Self Relations.  Northvale, NJ:  Jason Aranson.

Lovett, H. (1985).  Cognitive Counseling and Persons with Special Needs:  Adapting Behavioral Approaches to the Social Context.  Westport, CT:  Praeger.

Lovett, Herb (1996).  Learning to Listen:  Positive Approaches and People with Difficult Behaviour.  London:  Jessica Kinsley.

Muller, W. (1996).  How Then, Shall We Live?  Four Simple Questions That Reveal the Beauty and Meaning of Our Lives.  New York:  Bantam Books.

Pearlman, L. A. and Saakvitne, K. W. (1995).  Trauma and the Therapist:  Countertransference and Vicarious Traumatization in Psychotherapy with Incest Survivors.  New York:  W. W. Norton.

Searles, H. F. (1979).  Countertransference and Related Subjects:  Selected Papers.  Madison, CT:  International Universities Press.

Young, R.M. (2005, March 27).  Analytic Space:  Countertransference in Mental Space (Chap. 4).  Retrieved from http://human-nature.com/rmyoung/papers/paper2h.html

Online Conference for Music Therapy 2012 Resources- Part 2

Recognizing and Responding Musically to the Emotional Pain of 
People Who Don't Use Speech

As many of you already know, working at becoming a better listener, a more mindful clinician, and a curious practitioner is one of my passions. And this struggle to make sense of my experiences as a music therapist is something I try to share in my writing. 

To that end, I offer you links to a number of blog posts I've written over the past five years that are (mostly) directly related to the ideas I shared in my presentation for the 2012 Online Conference for Music Therapy. 

Some folks asked about working with groups, and I made note of posts addressing that subject. I also included a post about writing a process paper, which I still think is one of the best ways to start thinking about your sessions ( or should I say re-thinking your sessions?). 

I hope you find them to be useful.

Roia Rafieyan, MA, MT-BC

9/9/09 blog post

11/26/08 blog post (Writing a process paper)

5/1/09 blog post (Group music therapy countertransference example)

4/7/09 blog post

2/6/10 blog post (on not being understood)

1/26/10 blog post (quote from Mercedes Pavlicevic’s book “Music Therapy: Intimate Notes”)

10/25/09 blog post

9/29/07 blog post (addresses respecting “no")

2/10/10 blog post

6/7/11 blog post (countertransference songs)

12/27/10 blog post (working with groups)

11/21/10 blog post (countertransference songs)

12/6/11 blog post (using music to process countertransference)

11/29/11 blog post (using music to try and understand clients who don’t use speech)

6/24/11 blog post (communication)

7/14/11 blog post (countertransference and communication)

Online Conference for Music Therapy 2012 Resources- Part 1

Recognizing and Responding to the Emotional Pain of People Who Don't Use Speech

Thanks so much to those of you who were able to join me at the 2012 Online Music Therapy Conference! And to those of you watching the recordings, a hearty welcome as well. For anyone else who may find this to be of use, feel free to make use of the information but please give me credit for having made the effort to put this together. Thanks! 

Roia Rafieyan, MA-MT-BC

Elements to Pay Attention to as You Work to Listen to People Who Don't Use Speech

Pay attention to what’s going on for your clients
The physical
·       Sensory/movement issues?
·       Medical issues?
·       Environmental issues?

The historical
·       What has gone on in this person’s life- including trauma history (biography)?
·       Patterns of behavior and contexts within which they occur?
·       Relationships with family, peers, staff (and any changes in these)?

The musical
·       How does the person use music?
·       Which instruments/sounds does s/he gravitate toward (vocal or instrumental)?
·       Meaningful music?

The right now experience
·       What’s going on in the relationship and how is my client responding to the experience?
·       How is the person using music/sound/behavior to connect/disconnect?
·       What questions are coming up for you as therapist?

Pay attention to what’s going on for you
The physical
·       What are my somatic reactions during the session?
·       Do I have a pattern of responding in a particular way?
·       How am I feeling physically on a given day?

The historical
·       Have I done my own therapy work (aware of my own issues)?
·       How much support do I need to do this work?
·       What beliefs and ideas do I carry with me?

The musical
·       Have I taken care of myself musically?
·       What are my musical blocks (fears) and needs?
·       What role does music play in my life?

The right now experience
·       What’s going on in the relationship and how am I responding to the experience?
·       What patterns are emerging (for my client and for me)?
·       What thoughts, fantasies, songs etcetera, are running through my head while we’re working together?

Pay attention to what’s going on in the music
The physical
·       What instruments are we using (vocal/instrumental? quality of sounds produced?)?
·       Are you/your client mainly using your voice or playing instruments?
·       Use of silence?

The historical
·       Which music has been important to this person and to you as therapist as you’ve worked together?
·       Do any particular songs trigger any particular reactions for your clients?
·       Musical themes which you/your client keep coming back to?

The musical
·       How musical are we being (aesthetics)?
·       Is the music being neglected entirely?
·       What role is the music taking on within the context of psychodynamics?

The right now experience
·       Why am I playing right now (what am I hoping to find out?  What am I looking for?)
·       What is going on in the music right now?
·       Who is playing/singing what right now?

Pay attention by:
  • Reflecting and interpreting
  • Learning more from reading, asking a lot of questions, taking classes, other disciplines
  • Listening more (especially to people who have autism)
  • Do your own work (get therapy, get supervision, join a peer supervision group)
  • Be aware/mindful
  • Ask yourself questions and be willing to find out the answers
  • Consider “whose need am I meeting here?”
  • Learn to tolerate ambivalence, ambiguity, not knowing, uncertainty

Sunday, February 5, 2012

Music therapy at the boundaries

It happens I'm a part of a group on LinkdIn for psychologists, counselors and coaches. Not that I'm a psychologist, counselor or a coach, mind you... 

But anyway.

We've been enjoying (okay, I've certainly been enjoying) a robust discussion with regard to the question of "how much of our personal selves do we share with our clients?"

To the best of my recollection (which is a bit, er, well, let's just say it's not what it used to be), Rachelle Norman has tackled this question (a couple of times, actually) in her blog, Soundscape Music TherapyA while ago she wondered how much should she share regarding the birth of her baby (who is awfully darned cute, if you must know), and, in a more recent post, she talked about The Top 10 Rules to Break. A big hooray to you, Rachelle, for addressing this complex and apparently rather heated issue!

So, back to the conversation going on at LinkdIn...

I've been sort of surprised at how many counselors and therapists seem to believe, rather ardently, that the "rule" regarding the "therapist as blank slate" is too stringent. A large majority advocate sharing more of themselves as a way of "being authentic" with their patients. If I'm understanding them correctly, they seem to feel, "that's what our clients are really looking for- for someone to be authentic with them."


Among the questions that came up for me in reading comments along these lines was: are we really being inauthentic with our clients if we don't share on a personal level with them? And does being authentic with someone always mean being transparent? 

When I looked up the word, I learned that being "authentic" is associated with being genuine, or being truthful. Which is not the same as being self-revealing. Hm.

For me, I think the question of what and how much to share of ourselves boils down (as most things in the therapy situation seem to do) to another central question: whose need am I meeting in this situation?

As many music therapists are aware, simply because of the nature of our profession, we actually share quite a bit of ourselves through the music-making we do with our clients during sessions. Just as we learn about our clients through their musical expression, they learn an awful lot about us when we interact with each other musically.

Obviously, we do our best to keep to professional boundaries- for many legitimate reasons. One very large reason is the power inequity. It is (usually) a paid relationship. Therapy isn't meant to be a friendship, and, whether or not we choose a fairly egalitarian approach to our work as music therapists, we can't control (or ignore) our clients' perceptions that we have a certain amount of power, authority and influence in their lives. 

As an example, in my particular line of work (with people who have intellectual and developmental disabilities), I often remind myself of the fact that I have keys to my clients' homes, and they don't.

I wonder if, in the end, it's about coming to terms with the duality (maybe it's a plurality?) we are asked to hold as music therapists (or any kind of psychotherapist, I imagine). Yes, our clients often do come to us in pain and in a tremendous state of need- for, among other things,  friendship and for people to be 'real' with them. Simultaneous to that, we are bound to uphold our code of ethics, to maintain an awareness of our own unmet needs (and our rather human tendency to want to take care of those needs in all of our relationships- including those with our clients), and an awareness of the power dynamic that exists in the therapy space.

It certainly isn't easy to keep track of these various elements. Of course, as my supervisor often reminds me, "that's why they call it work."

What are your thoughts on boundaries and being authentic with clients? Does it depend on the situation? Or on the particular group of people receiving services? Are you likely to have more "flexible" boundaries with certain groups of clients and not as much with others? And what does that fact say in terms of the ideas and beliefs we hold about the particular groups of people we serve?