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 sense of identity has 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

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