Back at it!

Okay. Seriously, this break from the blog has gone on way too long. Here's the thing though: 

I retired from my job in 2021. 

Yeah, I know. I never would have thought I'd be capable of it either, but here I am. Alive. Retired! And, astonishingly, kind of digging it. So...what the heck am I doing with myself?

I just finished a draft of an article for a special edition of Voices (with huge thanks to my friend, Dr. Henny Kupferstein, who kindly helped me re-organize and finish the thing already, before it ended up becoming a 387 page book). The title is Getting to 'no' you: When nonspeaking autistic people refuse music therapy. Here's the Abstract, in case you're curious:

Nonspeaking autistic people frequently begin music therapy at the request of others. Typically, family or care systems are tasked with making decisions on their behalf and have decided this service will be of benefit. Consequently, music therapy is a given rather than a choice. For this paper I have used my own evolving understanding to explore the complexities and power dynamics related to nonspeaking people being able to say ‘no’ to music therapy. Elements in this discussion include: (a) the ability, and safety, to say 'no' in the context of a culture of compliance (b) the complicated relationship between music therapists and the systems within which they work, and how this affects the therapy relationship, and (c) the role of music therapy practice standards. I advocate the following:  (1) presume competence; (2) enter the therapy space with curiosity and openness, (3) be willing to ‘get to know’, (4) coping skills or communication attempts are not ‘behavior’ in need of correction, and (5) learn how each nonspeaking person communicates ‘no.’ Actively encouraging and respecting treatment refusal goes a long way toward building a respectful music therapy practice/relationship.

 It was, as most things I seem to do are, a complicated topic. Not so much complicated because nonspeaking people should be listened to (that's a given), but more because I wanted to address (in as respectful and calm a way as possible) how many elements stand in the way of nonspeaking autistic people being heard at all, let alone experiencing self-determination. It, um, required a lot of editing before I could submit it. 

I finally finished reading Music heard so deeply: A music therapy memoir, by my colleague, Betsey King, which I quite enjoyed (especially the stories of her work). In fact, as I've discovered, one of the nicest things about being retired is having time to read! 

I've been exploring collage, because...why not? This one was inspired by one of the folx I worked with for a long time. He is a brilliant, curious man, who, besides being a news junkie, wanted to learn about space. 

As you might imagine, I miss the people who I spent so many years with as a music therapist. I suspect you'll be hearing about what it was like to spend my last year or so working, and retiring,  during a pandemic. 

So....you know...welcome back!  

A book chapter, a presentation, and an interview

Whew! What a fascinating and busy few months it's been! 

Aside from my usual and intense immersion in work, there have been some nifty things happening. Here's what's been up:

First, I am extremely honored to be a part of a new book, edited by Sue Hadley, who is one of the people I greatly appreciate and admire, because she's willing to talk about the stuff nobody else talks about. This time she's talking about race and culture in terms of how it's experienced by music therapists. Here's the description of the book from Barcelona Publishers:

Experiencing Race as a Music Therapist: Personal Narratives is a compilation of critically engaging narratives that grew out of conversations with 17 music therapists living in different parts of the world, from various “racial” groups, about their experiences of their racialized identities in the therapy setting. The music therapists describe the raced and cultural contexts in which they were born and describe the racial demographics of the places they have lived at various times in their lives. The countries in which the individual music therapists spent their formative years include Australia, Canada, Iran, Japan, Korea, New Zealand, Puerto Rico, South Africa, the United Kingdom and the United States, with many of them also having traveled to other countries. The music therapists discussed their specific experiences of their racialized identities when they were studying music therapy and how they experienced their racialized identities in their professional lives. Many of them also described the differences they were aware of in terms of how they experienced themselves as raced or how they experienced the therapeutic relationship when they were working with people of their own “race” compared with working with people who were from a different “race.” From these narratives, we can see that our life experiences shape how we understand ourselves and others, our assumptions and biases, and the effort with which we form relationships with different groups of people. The music therapists in this book have shared their experiences in the hope that we can learn how to sit in our discomfort, without judgment, lowering our defenses, in order to learn more about ourselves and others, so that we can deepen our understandings and our relationships across racialized lines.

I've been slowly reading through the narratives, and they are engaging and thought-provoking. I encourage you to check out this book. It is a wonderful invitation to deeper reflection and conversation about a topic that does not generally come up in our field.

Second, I spent a lot of time trying to organize a presentation I did for the most recent Mid-Atlantic Regional music therapy conference, "Countertransference Songs: Another Way to Listen" (you know- countertransference- one of my favorite topics!). Here is how I described the session:

Far from simply being a means by which to convey skills and the general expression of feelings, music can be used on another level to better understand our clients- especially those who don’t use speech as their main communication modality. Paying attention to the music that emerges in sessions- for example, the sounds we typically use in response to particular clients, or songs that suddenly pop into our minds as we work intensely with someone - can offer us another avenue by which to understand what is going on within the therapy relationship.

Starting from the premise that the therapy relationship is the healing element, the focus and, more significantly, the work of dynamically oriented music therapy is to look at and explore the relationships that develop between the therapist, client and music.

As active participants in the therapeutic relationship, music therapists experience a range of countertransference responses when working with clients, some of which are explored in supervision and some in personal therapy. In this presentation we will start  from the assumption that countertransference includes all of the feelings, reactions, fantasies, thoughts and ideas the therapist experiences in relation to clients, either in response to how a client/group is perceiving him/her, or based on the therapist’s own personal history. Of course, one of the ways countertransference may be expressed within a music therapy relationship is through the music.

Two case studies will be presented, the first of which will describe how musical countertransference became apparent within the context of the type of music improvised in a client’s sessions. The second will follow a lengthy series of countertransference-generated songs that emerged as a part of the therapy relationship. In both cases, exploring the therapist’s musical responses moved the therapeutic process toward deeper understanding of the clients’ internal worlds.

I actually only ended up presenting one case study (since it had all the elements I described). The biggest challenge was trying distill many years worth of therapy (and tons and tons of examples) into 90 minutes! 

As often happens, in the process of reviewing the (volumes of) notes and the songs and the music that came out of this man's sessions, I gained a lot of insight into some of the ways my countertransference reactions caused me to miss some aspects of what may have been going on with him at various points in the therapy. 

Honestly, there was just so much, and it's such a complex topic, I'm wanting to present this material again within a longer context (meaning, maybe a CMTE proposal is in order). 

Meanwhile, the third exciting thing was being a guest on the music therapy world's answer to The View- yes, I got to chat with the lovely ladies of The Music Therapy Roundtable! I mean, look! They even have their very own mug (and, see, they sent me one too). How cool! Heck, how organized! 

I got to blather on and on with Rachel Rambach (of Listen & Learn Music fame) and Michelle Erfurt (the original Boom Tote designer herself!) - their third partner, Kimberly Sena Moore was in transit so she couldn't join us - about one of my other favorite topics: professional clinical supervision! And you'll be thrilled (I'm sure) to know that I discovered I have a shocking tendency to rely on the word "um" while being interviewed. Oy.

And, if you've taken it to the next level and you're a Music Therapy Pro subscriber, you can listen to yet more of my incessant chatter on their Pro podcast. 

So that's what's been happening in my land. I'd love to hear what's going on in yours! 

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 26^th, 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 (5^th 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 (3^rd 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

12/22/09 Quote- a patient defines music therapy

Florence Tyson is one of the foremothers of music therapy. And, happily, I've been at this long enough to remember her presence at  conferences back when I was a baby music therapist (she died in 2001).


Her book, Psychiatric Music Therapy: Origins and Development, (1981) has a quote from a patient at the Creative Arts Rehabilitation Center (which has since closed). I put it up over my desk at work, because I think it captures the essence of music therapy so beautifully. Evidently, Florence Tyson felt the same way, because she included it in her book (pp. 71-72).

In music therapy, the music therapist, by the very nature of musical accompaniment, makes a profound psychological statement to the patient. He says: 'With this musical experience I will journey with you from the beginning of the piece (your struggle) to the end (transformation). I will go with you through anxiety, rhythm difficulties, fantasies, whether you finish or not. I will listen to you speak, even musically.' The good therapist becomes aware of this statement and when warranted becomes a guide, brother, sister, the good friend. There is the basic reality of patient and therapist coming together, one human to another. 

With accompaniment assured, the patient can explore strengths and weaknesses, realize his or her own potentials, and define problems. A patient even may become, in a monumental step toward maturity, responsible for his or her course. This reality also may occur in a highly structured session as long as the structure is always realized by the patient to be directed toward his growth, stability and self-discipline -- as long as the demand aims at the patient's eventual responsibility and individuation.

I think that pretty much captures it, don't you?

The joy and rapture of questions

Image by Oberazzi via Flickr

People who read my blog know I'm a big fan of questions. And that I obsess over, well, everything. 


Why?


Because the only way to find out more is to ask more. And if we're not willing to ask ourselves questions, then we run the risk of walking around in life in a state of automatic. 


As music therapists, if we don't learn how to ask ourselves bigger and better questions (it really seems to be about learning how to ask ourselves better questions, I think), then our work stagnates. 


And we stop paying attention.


So I thought it was interesting (okay, yes, and delightful) that, in one day, I happened on two rather interesting items related to questions. I thought you might enjoy them as well, so I'm sending you along to have your own questioning party.


Here's where to go:

1. One is an excerpt from the book, The Interrogative Mood: A Novel? by Padget Powell. The entire thing  seems to be written in the form of a series of questions! And they're great questions! I've ordered it, and I'm awaiting it with great anticipation.


2. As if there weren't enough glorious questions in that bit of readery, I somehow discovered Jeffrey Tang's blog, The Art of Great Things. And, darn if he didn't just make a case in his most recent post for the good people of the world to ask the difficult questions. 


In keeping with the spirit of questioning, I have to wonder: What's next?