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!  

How to be together

We sat together yesterday, our group of seven, on a Monday afternoon. And the curtains in the room were open to the afternoon sun, closed as the sun blinded us, and then open again to watch the beautiful dark frames of leafless trees against the pink and yellow and blue sky as the sun began to set. And, with the early evening news as a background, we noticed, for ourselves and with each other, our music was made of...

...sound and silence,

terror and safety,

change and consistency,

feeling frozen and being in motion,

comfort and discomfort,

certainty and uncertainty,

sleeping and awake,

light and dark,

presence and absence,

judgment and acceptance,

loud and quiet,

intensity and gentleness,

curiosity and detachment,

containment and freedom...

And then, this morning, I read and listened to this gorgeous conversation between Krista Tippett and Ann Hamilton. When Krista asked her what questions we should be asking, without hesitation, Ann responded:

"...how to be together. I mean, isn’t that — that seems like the biggest question. How to be together." (Ann Hamilton) 

Yes! And yes again!

There are so many who believe music therapy sessions with people who don't use speech as their first language are about "playing for your clients." In fact, it is about

listening, 

noticing, 

playing,

 experiencing,

 being

 and wondering 

together.

"...when you’re making something, you don’t know what it is for a really long time. So, you have to kind of cultivate the space around you, where you can trust the thing that you can’t name. And if you feel a little bit insecure, or somebody questions you, or you need to know what it is, then what happens is you give that thing that you’re trying to listen to away. And so, how do you kind of cultivate a space that allows you to dwell in that not knowing, really? That is actually really smart, and can become really articulate? But, you know, like the thread has to come out, and it comes out at its own pace." (Ann Hamilton)

Asking for help (the hard way)

Some days I come home from work feeling as if my clients all hate me.

Now don't all jump in with the "oh, come on, they don't hate you! Why do you insist on seeing yourself that way? They appreciate you, why would you say such a thing?!" comments. 

Because that would be missing the point.

The things is: it was hard being a music therapist today. And, yes, I did (and always do) say to myself, "oh, come on, they probably don't hate you. Well, maybe they do, but probably it's not really about you." 

Here's what I'm thinking (hoping) (thinking and sooort of hoping, because, really, it's not a great thing to hope): I'm thinking my clients absorb so. Much. Hate. Every. Single. Day. And here I come in, Ms. Gosh-I'm-so-glad-to-be-here-guys-let's-listen-to-each-other-and-see-what-we-can-hear-in-each-other's-music. And there's crying and yelling and toileting accidents and more yelling and more crying and running around and trying to run out the door and handing me my guitar case and climbing on things and hitting each other and pulling and pushing and more toileting accidents.

And we sing, and we play about it, and we stop to get people cleaned up. Okay, well, usually I'm the one playing about it and singing about it, because my clients don't really use speech, and they are often too busy being overwhelmed. And I put it out there, "I know things have been really difficult for you, and it's a lot to cope with all the time." 

And I feel inadequate. I feel like one of those teeny little bandaids that keep falling off. My words and my music hardly cover any one of my clients' deep wounds. And I try to remind myself, "this is what chronic trauma and chronic grief look like. What can I offer in the music, in my words, in my presence? Will it mean anything?" 

Thanks to juliaf for the image!

Then I start in with the whole internal drama of "What if I'm just making assumptions? What if they just think I'm being a pain in the ass? And wrong? What if they wish I wouldn't come because I just remind them of what sucks in their lives and then I'm standing there singing and talking about it and happy to see them, for God's sake?"

So there I was driving myself home (and crazy) today, feeling kind of crappy. And I reminded myself of how much hatred my clients have internalized. How there's nowhere for it to...go! I mean, it just...sits there and festers in them. And my acknowledging it and hearing it is probably new and unexpected. And uncomfortable. 

Listening to the hatred many autistic people (especially those who live in congregate care) have been asked to hold over and over again is plain intense. And I leave sessions feeling as if my clients hate me.

Actually, though, after the initial "oh, woe is me" phase, I do manage to realize, "um, this is countertransference." And I start to wonder if what's really happening is that my clients are asking me to help them - to help them cope with the hatred they're having a hard time metabolizing. In their own way, I think they're asking me to hold on to the hate, to figure out what to do with it, say it out loud for them, and help them find a way to make sense of it. 

And the only way they can ask for that help is to get me to a point where I feel as if they hate me. And I have to be able to experience that awfulness. That terrible "nothing I do has any effect on you, I feel as if I have no power over my life" feeling.

Because until I've fully gone through the pain and rejection with them, they don't know that I've heard them. And until I go through it I don't know how they're feeling.

Next week, I will go back to them. I will sing about it, and I will say it out loud and give it a voice in the music. And hopefully the relationship will grow just a little deeper. Because I allowed myself to feel as if they hate me.


This is one of the songs that came up in the session. 

"I Wish I Knew How It Would Feel To Be Free"

It started some months ago when I, quite by accident, discovered that one of the men I work with (he's autistic, he doesn't use speech to communicate) can indicate "yes" or "no" by pointing to (well, usually by grasping and releasing) one of two index cards. He doesn't need my help (other than to hold the cards in front of him). 

He doesn't always do it. In fact, sometimes he very pointedly chooses not to do it. Sometimes he crumples up the cards and tosses them aside. Which is why they're laminated.

I think, understandably, his feelings about communicating and being heard are deeply conflicted. Even if he were to begin pointing at more words and letters to communicate, the likelihood he'd be listened to is...well...slim. The people in his life are largely committed to seeing him as severely disabled. Period.  

We've been sitting in that unsettled, anxious, frustrated, what-the-hell-do-we-do-now state for a while. I can see he wants to say more. He picks up the letter boards I keep nearby, but he gets upset and then tosses them on the ground.

Aside from trying to come to terms with the whole idea of actually communicating with me and having me understand him- overwhelming in and of itself for him, I think- there's the fact that it probably won't change his life in any appreciable way. 

When it was time to stop we walked back to the unit and I dropped him off in his group (letting him know when I planned to return for his next session). I went into the office and signed him back in, and then I walked around so I wouldn't upset him by walking back through his group. He doesn't tend to like when we have to end.

But he knew I was there. So he left his group (much to the dismay of his staff) and wanted to follow me. He doesn't usually do this, so I sat with him for a little while in the back hallway. 

I wasn't sure what to say, but the words that ran through my mind were the title of a Billy Taylor song, I Wish I Knew How It Would Feel To Be Free. 

I didn't remember much of the song, and I wasn't sure it was something I could conjure up sitting there in the hallway. All I could think to offer him was the reminder that "nobody can take away who we are inside." 

We sat quietly as the shift changed and after a few minutes he got up and headed back in to his day area. 

Sometimes this work is really hard. Really, really hard. 

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

Music Therapy Advocacy Month- Our Most Powerful Advocates

Advocacy --> Recognition --> Access

Since 2005, the American Music Therapy Association and the Certification Board for Music Therapists have collaborated on a State Recognition Operational Plan. The primary purpose of this Plan is to get music therapy and our MT-BC credential recognized by individual states so that citizens can more easily access our services. The AMTA Government Relations staff and CBMT Regulatory Affairs staff provide guidance and technical support to state task forces throughout the country as they work towards state recognition. To date, their work has resulted in thirty-five active state task forces, two licensure bills passed in 2011, and an estimated ten bills being filed in 2012 that seek to create either a music therapy registry or license for music therapy. This month, our focus is on YOU and on getting you excited about advocacy.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

A story Paul Nolan (my teacher when I was in graduate school at Drexel University) loves to share is about how he used to constantly drill us in class to answer the question he insisted our clients would inevitably ask us: What am I going to get out of this? How is music therapy going to help me?

I, who had already been a music therapist for thirteen years with people who didn’t use speech to communicate, was convinced this was never going to happen.

Ahem.

Well, I was doing my internship at Hahnemann Hospital when I was referred by one of the psychiatrists to work with a man who was struggling with depression related to the spread of his cancer. Would you believe, the first words out of his mouth after my brief introduction and explanation of who I was and what I was there to do, were: What am I going to get out of this? How is music therapy going to help me?

Seriously!

I think I probably scared him a bit when I laughed out loud, and I asked him if my teacher had put him up to this.  And then, after explaining Paul’s perpetual insistence on our being able to answer this question, I answered him.

He agreed to let me sit with him and play music. But he was absolutely clear in his refusal to take part in any way other than to suggest a few songs and to listen. So that’s what we did.

We had a couple of sessions, and he’d gone home and that was the last I’d heard.

A few weeks later, I happened to be walking to the nurse’s station in the different unit of the hospital, and, as I walked by one of the rooms, I heard someone call out: Hey! Music Lady! Would you mind coming in? I have something to show you.

As it turned out, he was back in the hospital- sicker this time. And, although his participation during sessions had been rather minimal, he had remembered his experience in music therapy when he went home. He said he’d told his family all about it. And when he had to be re-admitted he had decided to bring along some of his own music (that he wanted to tell me about), and he also brought a record album (yes, a vinyl record album) of a band made up of a bunch of guys he knew back in the late 1970s. During one of his previous music therapy sessions he mentioned that he had taken a photograph of them, and they liked it so much they made it their album cover. And he had been hoping I’d come by, so he could show this to me.

Now, many years later, as I’m sitting here contemplating this idea of advocacy, I’m realizing that one of the ways we start to know how important music therapy is to our clients is when they begin to become their own advocates- when they want more music therapy, and they do what it takes to get services.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

A question that often comes up when I tell people I’m a music therapist and I work with folks who have a variety of intellectual and developmental disabilities (just after the usual “How interesting! What is music therapy?” question) is: How do you know it’s making a difference? If your clients are severely disabled and can’t tell you, how can you know whether or not your clients are benefiting from music therapy?

And I tell them sometimes it takes the form of my realizing that, after years of my client sitting and waiting for me to invite him or her to music therapy, he is now standing up when I come in the room to greet me and pull me to the door so we can go to his session. 

Or it's deciding that snack time (which can be considered one of the holiest times of day for some of my clients) is less important than going to music therapy and rushing through snacks so we can get to a session. 

At other times, it’s someone picking up an instrument for the first time to play it and not throwing it across the room.

I always think it’s cool when my clients (again, this is after many years of waiting for me to approach them and ask if they want to come to music therapy), see me go into the room where we have our group session, get up on their own and start to come in while I’m preparing the space.


An even more important way that I know what we're doing matters and is "working" is when my clients tell me (usually through their actions) "no" they'd rather not have music therapy on a given day. Because, ultimately, isn't being one's own advocate what we're working to support?

So, in this month of music therapy advocacy, I want to propose the following:

There is no more powerful music therapy advocate than a person who has been receiving our services and has gotten to a point where s/he wants to make sure those services continue.

And what a wonderful testament to the importance of the work we do when our clients can become their own advocates!

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

For lots more blog posts about music therapy advocacy, 

please visit:

http://www.musictherapymaven.com/social-media-advocacy-month/

Behavior? Or unanswered question?

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For at least the twelfth time in the last few years, I sat in a session today with one of my (many) clients who doesn't use speech, asking him if he might put his thoughts and reactions to the fact that we hadn't seen each other in two weeks (because I was away at the music therapy conference) into the music, and I was struck by the thought, "Geez, what if he has questions that he wants me to answer?"


I don't know whether anyone else ever wonders about this, so I'm throwing it out into the blogosphere, because it bugs me. 


All of us have questions, and when we're little kids we have about a million of them! And we ask our parents (and aunts and uncles, and any adult person, frankly) at least nine hundred thousand of the many gazilions of questions that happen to come into our excited little curious minds.


But...my clients who don't use speech can't do that! And who's to say they don't have a million questions of their own? Yet, how do you ask all your questions when talking isn't your thing?


So, as I've given this some thought, my theory is that the folks I work for are sort of forced to come up with other ways to get their questions answered. And those ways may involve doing some unusual things- maybe we could call them experiments- although more likely we call them "behaviors"- which often seems to imply "doing something that someone finds aversive, offensive or annoying and must attempt to stop".


Hm.  


Well, what if those "behaviors" and unexpected and odd things that this person is doing are really about asking questions that s/he needs to have answered? And what if instead of listening and collaborating to try to help figure out the question/answer, we're focusing on the fact that the "behavior" must go? 

The eyes have it

I was very conscious of my clients' eyes this past week. 

I'm not sure why I was struck more than usual this week (as opposed to most other weeks), but I noticed there was a lot of eye-contact (which you would kind of think wouldn't really be the case when working with folks who aren't usually all that comfortable with looking directly at people). Anyway.


Here's a summary of my, um, eye-catching (sorry) moments:

1. D stared at me for quite a while during his session. Really. I'd classify it as staring. Something was going on for him, which became even more apparent when he got up and pulled me to the Music Room door (which he has only done once or twice in the 13 years I've worked with him) and headed us back to the cottage. I found myself feeling uncertain as to what was going on with him. Was he excited? Angry? Attracted? Frustrated with me? When he decided to leave the session unexpectedly, I felt disappointed and a bit confused.


2. R looking at me rather intently and frequently today. This is very unusual for him, because he usually looks at my hands and at what I'm doing on the guitar. I have very little conscious memory of him ever even looking at my face! I was joking with one of the other music therapists at work that I must be doing one heck of a job. After working together for almost 23 years (seriously), R finally approaches me and greets me when I arrive in his home. Maybe this is an extension of that?


3. W has been expressing some intense feelings toward me. I have, of course, been responding with "that's not our relationship." During a recent session, I said to him, "you know, it seems as if I'm really frustrating you a great deal lately."  He responded by looking at me. Very. Pointedly. [Insert slight squirm here.] And then he left his session early also. But this time, aside from feeling a bit confused, I also felt (yes) frustrated. ("Take that, you blasted music therapist!")


4. V greeted me today by scooting over to me, looking me in the eye, and taking both of my hands in hers when I arrived in her group. This, I must say, was a way friendlier "hello"  than she had been using when I showed up over the past three weeks! (Observe, to your right, the fascinating and unusual unhappy face she somehow managed- without even intending it- to create on my arm with her nails...isn't that wild?) (And, no, don't worry. I'm fine.)


It certainly looks as if the eyes have it this week! (Sorry, again, for the dreadful string of puns.) (Really, I can't help it.)

Holding on to our clients' stuff

I seem to be slowly amassing a little pile of stuff from RD (the young man who makes sure I take a little bit of his space along with me when I leave his cottage). 


FIrst it was the purple battery cover for something along with the red disc-ish thing. 


Then, a couple of weeks ago, I had to ask one of the other music therapists (who also works in that cottage) to take back the two air hockey strikers that he'd put in my instrument box . I figured they'd need them if anyone wanted to play air hockey. (Uh-oh, I think I just realized what that red disc-ish thing is- it's probably the puck! Oops! Guess I'd better get that back to the cottage as well. The strikers aren't going to be of much use if there's nothing to strike. Ulk.)


Then last Saturday he put in two dominoes, and today it was a big yellow wooden bead.


Today he used the cabasa and the kalimba, and he put them back in the instrument box (not under the couch or on top of a very high cupboard) (thank God). 


I'm excited to say his sessions are lasting the full forty-five minutes these days (as opposed to ending abruptly after a few minutes, which was the case for quite a while). I think acknowledging his need to know what to expect and saying out loud that I don't tend to tell people what to do in music therapy (unless some specific limit needs to be set) really helped him. Ironically, I think it let him know, well, what to expect. Now he doesn't seem to feel as anxious when he comes to his sessions. 


I mentioned, again, to RD I thought it was interesting to keep finding little objects from his space tucked away in mine. And I asked if maybe it was because a part of him was concerned as to whether or not I'd remember him when we ended the session. 


True, there wasn't any earth-shatteringly clear response or anything, but I figure if I keep commenting about it and pondering the situation with him, letting him know I'm curious and want to understand him better...he'll find a way to tell me what he needs me to know. 

Who's in charge here?

I realize this is going to sound like I'm ranting. And not only that, I'm fairly certain I'm going to sound judgmental. And you know what? Maybe I am. This issue is so profoundly important that I think it deserves a bit of a rant, so I'm going to ask you to bear with me today, because this is serious.


It's not exactly news to anyone that I work with people who have intellectual and developmental disabilities (many of whom also happen to have autism and many of whom do not use speech). When I'm talking about clients (below), I mean it to apply not only to doing music therapy with folks who have a whole bunch of labels, but I'm talking about working as a music therapist in general.


So, why am I carrying on? Let us commence with the rant now, shall we?


I have an important question I want us to consider: Is it our clients' jobs to listen to us? Or is it our job to listen to our clients?


I ask this, because I've been noticing what seems to be a tendency in music therapists to go in to a new session and expect their clients who have severe disabilities to just do what they ask them to do. As in, "here are the planned activities/events, and here's what I think you ought to do. Your job, client of mine, is to perform these tasks/activities. And my job is to get you to do that. Period."


Well. Okay...but...


Let's pause a second and think: whose need are we here to meet?


If we want to teach our clients to be better listeners, are we modeling that by listening to them? If we want to help our clients to be be better at paying attention, how willing are we to pay attention to them? If we want people with significant disabilities to engage with us, what steps are we going to take in order to engage on their terms? 


If we can't understand the language someone is speaking (particularly if their language does not contain words), are we truly serving that person when we expect him/her to do what we ask before we even make the effort to try to learn about who they are?


Again I ask the question that my college music therapy professor asked us all the time: whose need are we here to meet? And is that need best met by our coming to our clients in a music therapy session and expecting that they will do what we'd like them to do? 


Or is that need best met by asking that person to help us learn about who they are (even if they don't use speech to say it) and then creating the musical space within which our client can find a way to communicate and then making a point of hearing it?


We are music therapists. Let us honor that fact and work hard to develop skill in the art of listening. 


Let me end by saying this: when we work with folks who confuse us (and even if we think we know what's going on), the first place to start- always, always, always!- is by paying close attention and listening as hard as we can! 

The Act(ion) of Thinking

Image via WikipediaI've been thinking about RD of late (well, particularly today, because we had a session this morning). 


RD is a very sweet young man on the autism spectrum (he does not use speech to communicate), and he is very particular about things. And by this I mean that he seems to believe that all things should have a place (I think I can thank one of his family members for his excellent manners and his tidy nature.)


It so happens, that we work in a terrifically messy room in his cottage (oddly enough, it's the, um, "sensory room") (yes) (well). 


Anyway. 


No matter how much I try to clean up all the clutter in the place before I go and pick him up for his session, he still finds things to, er, tidy. 


He also likes checking out all kinds of objects. He has a collection of action figures with giant feet (I don't want to know!), and his staff people find him books and various things that have moving parts to them. He keeps them all in a big box with his picture on the front. Great! 


So. Back to the aforementioned "sensory room"...


Because this is, apparently, a full service sensory room, there are almost always broken battery-operated sorts of things lying around in varying states of function and dysfunction. This means that the batteries are lying around (lovely), and the little parts that keep the batteries quietly tucked inside the gadgets are also roaming about freely.


RD, being the tidying kind of guy he is, and being the kind of person who likes to bond with objects, has been picking up these little plastic parts that were supposed to hold in batteries. He just turns them over and over in his fingers and holds them close to his face so he can examine them.


While he's doing that, he sings. He hums little melodies (I've come to learn that he repeats specific melodies with small variations here and there). I either sing them back to him or play them on the guitar (with my own variations and chords). And while he's scurrying about the room arranging things, we sing and play back and forth with each other. 


The other thing you need to know is that, when he borrows an instrument from me (to check out as described) he often puts it back in the closet that's in the sensory room. As such, I have to go and retrieve the instrument quickly because otherwise it'll be there for all eternity (I have reached the official limit on my brain's memory card, and, let's face it: some things are just going to have to go!). 


Now, not only does he take my stuff and put it in the cottage closet, but he puts stuff he picks up in the cottage on my music cart or in my instrument bag. I am forever pulling things out of my bags (after his session) and putting them back in the room (back in circulation, as it were).


Okay.


So, as I mentioned above, I was thinking about RD, and I was wondering: why does he keep putting cottage things in my bags? And why does he keep putting my stuff in the sensory room closet? What's that about? Is there something he might want me to know? Or that I should be noticing about this?


And I thought, hm. So I mentioned to him during his session that maybe he needs to have me hold on to a small piece of him when I go (i.e., don't forget me, please). And maybe putting my stuff in the cottage closet is a way for him to keep a piece of me as well. 


When I gave it some more consideration, it occurred to me, again, that here's a guy who likes everything to have its own place- whether it's the "right" place or the "wrong" place. And I remembered that he himself grew up in a few different places, being sent around to various family members, because his mother died when he was an infant. 


And now here he is with us, in an institution.  


And it made me think about objects. And about having a place to be. And I wondered (out loud to him) if maybe it was important to him that he have a specific place to be. And what his thoughts are about being in the "right" place or the "wrong" place. And which one he feels the institution might be.


RD's response was to increase his singing. He and I sang back and forth for ten more minutes than usual today (we usually make it for 20 minutes, but today it was 30!) before he hopped up and began pulling the guitar off of me to indicate that we were finished.


So, I'm thinking this is veeeery cool. 


Definitely warrants some more thinking...

What is advocacy and why do we do it?- Part 1

Advocating for music therapy is, at its most basic, about telling people who we are, what we do, where we do what we do, with whom and how. It can be as simple as meeting someone at a party and responding to "what do you do for a living?" with "I'm a music therapist." And it can be as complex as working with legislators to get licensure for music therapists in your state. 

The reason we spend so much time advocating for music therapy is so that, when you and I are a lot older music therapists (and that's not to say that I'm not seriously getting to "older music therapist status" at a rapid rate here), when we say "I'm a music therapist," people will say "oh, my child is receiving music therapy services" or "I work with a music therapist in the hospital where I'm a nurse" instead of the blank stares that I used to get when I first started out back in 1987. 

In fact, the reason some of you younger folks (you know who you are) have even heard of music therapy is because there are a lot of us older folks (ahem) who've been talking about what we do for a long time.

Now, as more people are starting to learn about music therapy our focus as a profession has been turning toward gaining state recognition for what we do. After all, people who use our services (heck, sometimes music therapists use our services!) need to know they're receiving music therapy from someone who is trained, qualified, certified, and, in some states, licensed. 

Another thing we're working toward is third party payment. While there are some music therapists who are getting reimbursed by insurance companies, it is still extremely rare. Creative arts therapy providers will become a lot more accessible to those who need them when health insurance companies add "music therapy", "dance therapy" and "art therapy" to their lists of reimbursable services.

On another level, advocating for music therapy services is about creating jobs and opportunities for ourselves. We know why what we do is important, and we want to educate the people who could use our services. It also means helping the public to distinguish between music therapy, provided by a trained, board-certified music therapist, and the therapeutic use of music, provided by talented musicians who are sensitive to the needs of others.  Sometimes advocacy is about making sure we're appropriately compensated for the services we provide. The fact is that music therapists in many work situations are vastly underpaid in comparison to other allied health professionals. 

So, as you can see, advocacy is an important enough element that we need to, literally, build it into our work. In Part 2, I'll address some of the things I think are helpful as we engage in this process. 

And how was your day, dear?

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On the plus side, nobody got hurt (although there were some brief reminders to the effect of "nobody really likes to get their head tapped unexpectedly, K."). On the not-so-plus side, I'm guessing it'll take kind of a while for my co-worker in recreation to sort through the two big stacks of paper from her desk that, um, well, er, ended up all over the floor when I turned my back for a minute to deal with L. 


I think I can safely say that this particular session felt like it was the exact opposite of the lovely one I described  to you a few weeks ago. 


Here's how this whole party started: 


I arrived in the cottage, fully aware that the women there were almost all sick with colds and stomach viruses (lovely). I had called earlier in the afternoon to ask if I should come over or skip it, and I was told, "well, people are running around with the sniffles and stuff, but..." (which I'm fairly sure was code for "Get your a** over here, lady! We've all been suffering through this, and you'd just better do your time!")


First thing, G (one of the more chatty ladies who live in this cottage) came over to announce to me that I should "stay away" from her because she's "sick as a dog," after which she proceeded to follow me around and ask me questions repeatedly until I finally got the women who are actually in my group assembled and closed the door with a firm "I'll see you later, G. Hope you feel better." [Insert heavy sigh here.]


Honestly, I was quite happy as we got started (although a bit nervous) because M had actually joined us. Her staff person walked her over (at my request), and she had miraculously managed to convince M to walk in to the session area with us! Usually I get her as far as the door to the room where we work, and she starts to hum loudly. Then she won't go in to the room with the other two or three women from the group, and she won't go back to her day area either. 


Inevitably, V gets annoyed because she is waiting for the session to begin, so she scoots (she moves on her knees usually- she has a wheelchair, but she tends to hop out of it when she gets to the room) out of the room where we work and sits on the floor, watching me and looking impatient (I'm sure if she were able to stand more comfortably there'd be foot-tapping involved). 


It took some doing for N to get in to the room, because her OCD was making it plain difficult to get through the door. We waited for her and she got in. The problem, however, was that K was sitting in the chair that N prefers to use. Stop. The. Presses.


So. N pushed and pushed (in spite of my requests that she stop doing so) at K (who, on any other day, prefers to wander around the room and throw everything she touches on the floor or across the room), trying to get her out of "her" chair. Having very little luck (K is pretty hardy), N (no slouch herself) took hold of K's shoulder and her behind and unceremoniously shoved her out of the chair. 


Oh, dear.


Somehow, I managed to get K moved to another chair at last (to the one that V prefers, God help me). Mercifully, V decided to stay in her wheelchair for a short period of time. 


Then I had to figure out what to do to get M settled, because she kept coming over to me with magazines that were in the room and insisting that I hold them. Finally, I got the message, tore out a page and handed it to her. That seemed to be what she wanted and she promptly found herself a chair and proceeded to rip paper peacefully.


For twelve blissful seconds, we were all sitting quietly (it was such a glorious moment) when we heard a loud crash at the door. 


"[Expletive deleted]! What now?!?" (I thought, loudly, and in a rather un-music therapist-like fashion.)


L arrived, right behind her giant walker (the thing that had crashed into the door), and she decided she needed to come in and sort through the plastic groceries in the faux grocery basket (that lives in the room we use) right now!  


And L, I need to tell you, is not exactly Miss Let's-Talk-About-This-Shall-We-America."


Dear Lord!


Of course, since we were all sitting (for those twelve brief, yet happy, seconds), this required rearranging everyone so L could get to the table (which was, of course, behind everyone). 


Well, not entirely unexpectedly, in the process of tending to L, and rearranging the furniture and the various people contained therein so nobody would get run over by L's giant walker, K got up to explore, and that's when we heard the two huge piles of paper from the recreation staff's desk hit the floor. 


Cheeeeeeck!!!!


I couldn't, for anything, get K to sit anywhere, so I gave up and tried to pick up the giant mess of paper and put it somewhere somewhat unreachable until after the session.


While I was dealing with the paper, V decided she'd had enough, so she headed out the door and sat in the hallway, chin in hand, waiting for me to chase after her. Since I'm not supposed to leave V alone (and I'm not supposed to leave M or K alone either), I put a chair in the doorway so I could keep an eye on the group and on V at the same time. 


V, in spite of my best efforts, turned tail and headed back into the day area (through the bathroom door that's across the hall from our room). And, much as I hate to admit it, by that point I just figured, "Okay, that's one less person to worry about right now. Amen."


K roamed around the room some more, tapping N on the head unexpectedly. And M continued her page tearing adventures, assembling the tiny pieces neatly on her lap. 


Now.


I'd love to tell you I was able to make a brilliant interpretation to the women in the group about their actions and how they seemed to be all about going from crisis to crisis, and there's all manner of "no, pay attention to me" and some sadistic teasing, all in conjunction with the  incredibly overwhelming way they interact with me and with other people in their lives. 


But no.


Heck, I'd love to say that there was even half enough emotional space left in the room so we could even start to look at that, but that is so not where the group is yet! 


Evidently, the group's goal for right now is to (through their actions/interactions) convey as loudly and dramatically as possible, "Roia!! This is what it feels like to be here. To be us. To live life!!! Do something!!"


And, for now (I have learned) (rather slowly, I must add) that my job is to just listen and get through it. And show up next time and get through it again. And keep setting limits and keep trying to help them use the music or use the music myself.


At some point, they'll be ready to hear me talk about what I'm seeing/experiencing in that group, but not yet. 


Definitely not yet. 

Listen Hear

Evidently, November 1st was something of a celebratory day. A day to listen to what autistic people have to say. 


It's kind of unfortunate that there's a need to designate a special day for it, because most of us, autistic or not, want to be heard every day, but I guess that's the state of the world in which we live. 

Anyway, here are links to some of the blogs I read about this most auspicious occasion:

http://adeepercountry.blogspot.com/2010/11/regular-person-listening-day.html


and


http://adeepercountry.blogspot.com/2010/11/autistics-speaking-day-post.html


and also


http://adeepercountry.blogspot.com/2010/10/autism-is-world-and-youre-not-invited.html


along with 


http://flashbackdreamsequence.blogspot.com/2010/11/anatomy-of-autistic.html


and

http://www.journeyswithautism.com/2010/11/01/speaking-my-mind-and-heart/


and one more


http://life-with-aspergers.blogspot.com/2010/11/day-of-silence.html

For my part, I will do my best to keep listening.

Exposed

Image by fabbriciuse via Flickr

I'd love to be able to explain why I haven't been writing any blog posts of late, but I'm not sure I could. It's not as if I haven't had things to say. I mean, I've got various notes in journals and on scraps of paper reminding me of thoughts I've had, issues I want to blog about. I've (mostly) accepted that I will write when I need or have to write. 


Today I'm feeling a need to write.


Yesterday morning I showed up for a session with a client I haven't been able to see for two weeks. There were some scheduling changes and then there were some scheduling conflicts, and that's the way it sometimes goes. 


Fine. 


I knew I had to be prepared for possible reactions to my absence. On the other hand, I wasn't sure how "real" I was to her as yet. C and I have only worked together since January. She seems to recognize me these days, but the relationship still feels fairly tenuous.


I found her at the other end of the cottage, and she smiled (which seemed like a pretty good start). She walked along with me and then pulled me toward the bathroom. I was hoping we wouldn't have a stripping issue, but her staff told me she might need to use the toilet. Okay then. 


Her staff accompanied her to the bathroom area, reminding C that she needed to be supervised (for a few reasons we needn't get into), and I waited in the empty day area where we'd be working. 


While I was waiting, K, one of the supervisors (who happens to be a former music therapist), came over to ask me how things were going with C. She was being nice, because I knew that it was code for "The staff are annoyed with you, because you 'let' C strip when she's in music therapy." To K's credit, she wanted to hear my take on the stripping. 


Apparently, I'm the only person who has this problem with C suddenly taking off her clothes (other than the afternoon shift).  


Great. 


I don't know exactly why C strips in music therapy. Maybe it's because I'm mostly new to her. Maybe it's because I only see her once a week (and even that can vary because of her schedule and mine) not every single day, and she doesn't know me that well. Maybe she's testing me. 


All I can say for sure is: I'm trying.  


So that was how I went in to the session.


C came on out of the bathroom with her staff person, and she was in good spirits, everything was going along, she picked up her giant beanbag to set it on her lap, sat on a comfortable couch, and we were off. 


She was vocal, I was reflecting, she was engaged, I was responding...all good things. She was bothered, for some reason, by a couple of binders sitting on the table, so I took those and put them in the next room, and we resumed our musical interaction.


Until...


C decided she needed to go to the refrigerator (there's a dorm sized fridge in the day area where we were working). Now, understand that: 


1)The last time we had dealt with the refrigerator, there was a lot of iced tea to be cleaned up. A LOT of iced tea. 

2) She has a very sensitive stomach, and I wasn't sure what she was safely allowed to have. 


3) It was 11 AM and not long before lunch when I knew she'd get something to drink anyway. 


4) I wanted her to focus on the session. Yes, that was my issue, but for that moment I decided it was a legitimate wish on my part.


Well. I asked her to wait until later, and that was when it all started to deteriorate. Rapidly. Suddenly, the jacket, pants, underwear, adult diaper, shirt and bra were on the floor. 


Crap!


I managed to get her into the bathroom area (and pick up the assorted clothing items) and then it just went from bad to worse. I was aggravated, C was freaking out, and it was argue, fight, fuss, refuse, be naked (not me), and consider becoming a hermit so I'd never have to deal with people again.


Finally, after about 10 minutes of achieving nothing I decided to ask for help.  


Her staff (the one who had helped her in the bathroom earlier) came in, and C set up a yell, but she got dressed.


Wonderful. 


I hung around in the bathroom for a while, trying to watch what her staff did to get her organized (wondering what I had done wrong, not thought of, why I went in to music therapy anyway). 


When they came out of the bathroom area (which is a big area, I must tell you, with a bunch of stalls, showers, a bathtub, and so forth), and C was dressed and calmer, I reminded C (and her staff) that I would see her in two weeks, and that I hoped we could find a way to have her stay dressed.


Her staff commented that "Oh, she'll be dressed when you get here. It's after that we're not sure about," which is code for "If you were a competent professional, my client would not be naked by the end of your session, would she?" 


"Thanks for your help."


I stewed about this for the entire rest of the day, feeling horrible and inadequate. 


And then I realized this morning that the thing that made me most angry about the situation yesterday was that I ended up acting from a place of anger and shame with regard to my reactions to the staff people and not from the perspective of a clinician. 


As such, I'm not only frustrated by the fact that the whole session went to hell suddenly, but I'm also bothered by the fact that I felt as if I allowed my feelings about staff's opinions about what I do/don't do/how I do it to get in the way of my being C's music therapist. 


Now, I'm sure that as soon as I settle myself down about all of this, I'll be able to use these new pieces of information I have (yes, also known as countertransference) in a more constructive way (you know...like, for one thing, using it to get a better understanding of what my client may be going through that she feels the only way she can communicate with me is by stripping).


Until then, I'm still annoyed and agitated about the whole thing.