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? 


GirlWithTheCane said...

Excellent that I've struggled with myself as I've worked with people with developmental disabilities, for a long time in a very small town where the people with whom I worked knew more about me because of the nature of small towns than they'd know if we were in a larger community.

Having seen people make great progress with me as a worker (not as a counselor, but as a life skills worker sometimes involved in a great deal of what went on in their lives) I don't think that we have to be absolutely blank slates. Because I have disabilities and the people that I work with have disabilities, I sometimes use that as a way to talk about thoughts and feelings related to being a person with disabilities in society (as an example). But I'm very comfortable being a person with disabilities, so I feel "safe" doing that - there's no baggage attached to it for me. The people that I support don't get to hear about stuff that I haven't fully emotionally processed. It's not fair to them. So most of our interactions regarding me stay very "surface", because I wouldn't want to risk putting someone in the middle of my countertransference situation.

Does that make sense?

Excellent blog...good questions...

Roia said...

Thanks so much for your thoughts! Yes, I *think* what you're saying makes sense.If I'm understanding you- I'm not sure it's entirely necessary to have completely worked through one's issues in order to be supportive of someone else as they deal with their own stuff. On the other hand, it depends on the type of relationship (as in, a therapy relationship is different from a caregiver relationship which is different from a family relationship which is different from a friendship). And it depends how, in what way, and for what reason one chooses to share her or his experience.

Honestly, I don't think it's ever possible to actually be a "blank slate"- for anyone. I mean, we're always being who we are in some way. So our clients will see us (on some level), but they will most likely see us from their own perspective and what they "need to see" in us. At least, that's how I think about this. I appreciate your tangling through this with me!

Tamara G. Suttle, M.Ed., LPC said...

Roia, another thoughtful and thought-provoking post. Thank you.

I'm not sure if it's because I started in mental health 20+ years ago - when we were all taught to be "blank slates" or if it's because I was raised in a very "black and white" thinking home or if I was just grappling with my own identity at the time . . . . Whatever the causes, I know that in the beginning of my career, I kept very rigid boundaries with each of my clients.

Over time, that rigidity has melted away in my practice. Today I can say that I no longer see the wisdom of the "blank slate," most often find comfort in the grays, and am perfectly at peace with who I am. Coincidentally (or not), there is very little that rigid about my self-disclosure other than to say that "it depends . . . ." One client may hear that I had a partner who died . . . , another may know I that I own a Pekingnese . . . , and a third may know that I had back surgery as a teen. If there is a clinical reason to disclose (and I am fairly certain that it's not for my own benefit), there is very little that I am reluctant to share.

I think, overall, this is a good direction for mental health professionals to move in. We certainly shouldn't burden our clients with our own issues and dilemmas; however, neither should we present as being . . . unflappable, unerring, or untouchable by life's ups and downs.

It's a balancing act at all times, isn't it?

Roia said...

Tamara, thanks for weighing in on this! I am in absolute agreement with you that sharing of ourselves needs to be done for a clinically valid reason. That said, I think my clients may know more about me than they probably ought- simply because we've worked together for SO many, many years. Also, within the context of institutions, it's hard not to have everyone know everyone else's business. As such, it's tough to figure out how to maintain the therapy boundaries within such an insistently "curious" (I'll use that term gently) system.

So, yes...balance = not so easy.