It's January, and that means it's Social Media Advocacy Month

As you've probably surmised, from the festive badge and such, it's that time of the year again where we music therapists use the power of social media to advance the cause of music therapy in our respective states. 

The good news: it seems to be working! 

As the lovely Kat Fulton of Music Therapy Ed points out, we've been recognized in major publications (online and off), and we've even been named Persons of the Week for gosh sakes! Amazingly, nowadays we can even see characters who are music therapists in books, on television series and in movies. 

As a person who's been at this a while (ahem!), it's refreshing to meet people, tell them I'm a music therapist and have them respond with "Cool!" rather than "you're a what?" 

Dena Register (see below for her 2016 article) sees our advocacy styles as falling into three different categories. She identifies us as Connectors, Reflectors and Directors (I mean, don't we all really want to direct?). This is certainly true, and many of us do have these characteristics. But I want to propose another feature music therapists of the world possess, which is that of being Innovators. 

We've only just celebrated our 65th anniversary as an official profession. In that time, we have grown in remarkable ways. We've become an actual profession, complete with professional competencies, standards of practice, a code of ethics, board certification, journals, along with new and innovative research methods that use the arts as their basis!

We are curious, we're determined, and we work hard to find news ways to grow and extend what we already know as a field. When we're faced with our clients day after day, we are truly with them. We take our failures, and we try again, learning from our mistakes as we boldly explore new ideas and approaches. 

Yes. We are Innovators. And because of that, there is a profession called 'music therapy.' 

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

And I will now step off of my soapbox and invite you to read Dena's perspective on the matter: 

Social Media Advocacy Month 2016

Dena Register, PhD, MT-BC

Certification Board for Music Therapists

Regulatory Affairs Advisor

Each New Year brings the opportunity to reflect on all that we have accomplished and to determine what is needed in the coming year to move forward. As the Regulatory Affairs (CBMT) and Government Relations (AMTA) teams reflect on the first 10 years of the State Recognition Operational Plan, we are grateful for the number of individuals that have actively engaged in the advocacy process. We have had the incredible fortune to watch groups of diverse individuals pull together, capitalize on their strengths, and create access to services for clients and families that benefit greatly from music therapy.

One of the observations we reflect on regularly is what makes an advocacy team successful. The teams that stand out are those that have 3 different kinds of participants: Connectors, Reflectors and Directors. While this is certainly not an exhaustive list, this seems to be a “triple threat” of action-oriented personalities that are able to work in tandem and move a group forward.

Building Bridges 

“Connectors” are people who are gifted at building bridges by bringing others together and recognizing complimentary skill sets in those that they know.  Connectors enjoy creating opportunities for people from diverse background and experiences to meet and interact. The role of the Connector in advocacy is to maximize the human resources available to them and to increase the network for their cause by helping interested parties get to know one another and discuss common interests. It is often the Connectors who are able to establish relationships with legislators or other decision makers that develops them into incredible advocates.

Holding Up the Mirror 

“Reflectors” are gifted at taking in information, experiences, and perceptions and—as the name implies—reflecting back the most salient points to those around them. Reflectors often have a knack for diffusing situations by indicating an understanding and empathy for someone else’s position. Reflectors also make great advocates because of their fierce loyalty to their cause. Their ability to see issues from multiple perspectives and then to communicate that to multiple audiences brings all sides of an issue to the foreground for discussion. Reflectors unite various individuals and guide the group to a vision that recognizes the complexity of all issues.

Consulting the Compass

“Directors” are the ones who are able to see the big picture of possibilities that exist beyond the current situation. They are able to assimilate the work of the “Reflectors” and the “Connectors” and navigate a course of next steps based on that information. Directors also gather additional relevant information as they move forward and constantly attend to what course corrections are necessary to get to their end goal. Those who are most successful in this role demonstrate flexibility in their thinking and actions, which allows them to accommodate to various situations that are presented and that often change without prior notice. Directors take a broad view of an issue, projecting out beyond it’s current status or challenge and using an ideal vision or end goal to guide the day-to-day steps necessary to get there.

So how about you? Are you a Connector, Reflector, or Director? Or maybe there is another description you would use? We would like to hear from you about other characteristics or personalities that you find “key” in advocacy.

It's that time again (and not a moment too soon!) - A guest post from Judy Simpson

January marks the beginning of our annual Social Media Advocacy campaign, spear headed by the incomparable Kimberly Sena Moore. This year I'm feeling a particularly strong affinity for our theme, which is exploring and honoring our unique identity as music therapists, as I'm finding myself in the distressing position of having to fight to keep a long-term music therapy position in our facility, a battle which we may be losing. 

I will be working hard over the next few days to clearly and succinctly articulate to the state decision-makers exactly what, how and why the Music Therapy Unit offers the men and women in our developmental center something they are unable to get from any other service. While I'm doing that, I'm truly grateful to Judy Simpson (who has written a guest post honoring this month) for helping me get started by so beautiful saying...

“We are…MUSIC THERAPISTS!”

Judy Simpson, MT-BC

Director of Government Relations, American Music Therapy Association

When I started my career as a music therapist in 1983, it was not uncommon for me to describe my profession by comparing it to other professions which were more well-known.  If people gave me a puzzled look after I proudly stated, “I use music to change behaviors,” I would add, “Music therapy is like physical therapy and occupational therapy, but we use music as the tool to help our patients.” Over the years as I gained more knowledge and experience, I obviously made changes and improvements to my response when asked, “What is music therapy?” My enhanced explanations took into consideration not only the audience but also growth of the profession and progress made in a variety of research and clinical practice areas. 

The best revisions to my description of music therapy, however, have grown out of government relations and advocacy work.  The need to clearly define the profession for state legislators and state agency officials as part of the AMTA and CBMT State Recognition Operational Plan (http://www.musictherapy.org/policy/stateadvocacy/) has forced a serious review of the language we use to describe music therapy.  The process of seeking legislative and regulatory recognition of the profession and national credential provides an exceptional opportunity to finally be specific about who we are and what we do as music therapists. 

For far too long we have tried to fit music therapy into a pre-existing description of professions that address similar treatment needs.  What we need to do is provide a clear, distinct, and very specific narrative of music therapy so that all stakeholders and decision-makers “get it.” Included below are a few initial examples that support our efforts in defining music therapy separate from our peers that work in other healthcare and education professions.

·        Music therapist’s qualifications are unique due to the requirements to be a professionally trained musician in addition to training and clinical experience in practical applications of biology, anatomy, psychology, and the social and behavioral sciences.

·        Music therapists actively create, apply, and manipulate various music elements through live, improvised, adapted, individualized, or recorded music to address physical, emotional, cognitive, and social needs of individuals of all ages.

·        Music therapists structure the use of both instrumental and vocal music strategies to facilitate change and to assist clients achieve functional outcomes related to health and education needs.

·        In contrast, when OTs, Audiologists, and SLPs report using music as a part of treatment, it involves specific, isolated techniques within a pre-determined protocol, using one pre-arranged aspect of music to address specific and limited issues. This differs from music therapists’ qualifications to provide interventions that utilize all music elements in real-time to address issues across multiple developmental domains concurrently.

As we “celebrate” 2014’s Social Media Advocacy Month http://musictherapystaterecognition.blogspot.com), I invite you to join us in the acknowledgement of music therapy as a unique profession.  Focused on the ultimate goal of improved state recognition with increased awareness of benefits and increased access to services, we have an exciting adventure ahead of us. Please join us on this advocacy journey as we proudly declare, “We are Music Therapists!”

About the Author: Judy Simpson is the Director of Government Relations for the American Music Therapy Association (http://www.musictherapy.org). She can be reached at simpson@musictherapy.org

 

The big comfy couch incident

Image by SimplySchmoopie via FlickrWell! Work, this morning, was a bit crazy (to put it mildly). 


Both the 9 AM and 10:30 AM groups were either getting ready to take part in or getting ready to watch the big Halloween parade at our facility (which is actually pretty cool- a local high school marching band comes, there are costumes, people bring their dogs, their babies, etc.). 


There was all kinds of flurry and insanity, what with trying to get the guys/gals outfitted with their various costumes and such. There was annoyance, there was attitude, there was drama...well, you know how it goes.


Now, mind you, the guys in the second group weren't actually going to be in the parade. We were just working on getting chairs outside and guys assembled in heavy sweatshirts and caps (it was cold out there today!) so we could all watch before the parade, er, passed us by (as the saying goes). 


Mercifully, we got ourselves all out there in time, caught the all-too-brief parade, cheered loudly for the guys who had gone to boldly march in their costumes (the cottage had gone as race-cars, and they were all sporting their "cars" with frames draped over their shoulders- it was pretty nifty), and managed to get everyone safely back inside with only one incident report having to be filled out (um, that was me, because one of the guys who used to love watching parades and being in the middle of the action...well. He wasn't in that good of a mood to be moved around. My deepest apologies to R for my misunderstanding.)


To put it mildly, we were all shot!


I went to join E on a big, mushy couch, because he seemed to have been out of sorts all week, and I just wanted to check on him. We've known each other for 22 years. To not check on him would have been totally rude. 


So E and I were just sitting there, hanging out and decompressing from the morning's events, and T came over and decided to join us. 


Now, the reason this is news (and very cool) is that T's usual approach to sitting on couches is to shove whoever is on the couch off. This is usually accomplished by pressing his fingers firmly into the back of the person's head, but bopping people over the head has also been employed at various times. 


But he didn't do that. T came over, sat on the other side of me (I was in the middle), and he took my hand, carefully, and he held it for about five minutes. Then he smiled, got up, and continued walking around the room


Now, that's what I'm talking about!

Getting to "no" you

Image by donnamarijne via FlickrWhile I was avoiding writing my proposal for the regional music therapy conference this afternoon, I started thinking about one of the women with whom I work- this would be the woman who spent a lot of time being undressed in our sessions initially. 


I thought you might be interested in a brief update.


C has managed to keep her clothes on (although her shoes and socks go flying at times- but who can blame her for that?) since we decided it would work a lot better if we had a much (much) shorter session time of about 7 to 10 minutes. 


Most importantly, she has been able to peacefully let me know when she is not interested in having a session, and that seems like a step in the right direction to me. 


I've said this before, and I'm saying it again: Any time one of my clients feels safe saying "no thanks, not today" to me, I know I'm on the right track. 


Now I just have to hope/trust that, at some point, she'll feel safe enough to say "yes" more often. 

Hovering

Image via Wikipedia

On Wednesday this past week, O, was hovering nearby, poking and pushing at me as I tried to find E's jacket in the never-endingly-impossible-to-ever-find-anything-in-it closet. He actually followed me from room to room as I hunted through wardrobes and fished through various drawers for E's hat.

I told him I was glad he wanted to say "hello", but "right now it's E's time," and I promised I'd check in with him when we returned. If he still wanted me to sit with him then, I'd make some time for him.  

Well, E and I left and came back. And forty-five minutes later O was still reaching out and poking at me.

Guess he must mean business.


These days O's music therapy is on an "as needed" basis. When he wants some time with me he lets me know (as evidenced by the above mentioned interaction). He seems to like to just sit quietly, performing his usual series of rituals, while listening to me play the guitar and sing. 


It's probably helpful for you to know that O has terrible problems with his sensory system, and he often asks (and by "asks" I mean pokes and prods until we get the hint) people he knows and feels safe with to help him when he needs a back massage to alleviate his discomfort. 

On this particular day I figured he probably wanted me to provide some deep pressure to his back. 

He pushed me onward, out into the hallway, and we sat on a couch.


As I sat next to him, pressing my hand hard into his back, I grinned as I thought about our first music therapy session together, some seventeen or eighteen years ago. 


At the time we conducted our sessions in the dorms. Each of the dorms had four beds in it. In honor of the session (and in order to create a space that at least sort of implied "we do music therapy here") I pulled in two chairs and brought along my cart full of instruments, setting some of them out on a dresser.  


I picked up O from his day area (the cottages were all locked back then) and brought him to this makeshift music therapy space.


As soon as he got into the room he yanked all the covers and sheets off of the beds, hurled all the instruments onto the floor, kicked over both chairs and knocked over my music cart. 


AAAAUGH!!


The only thing I managed to save (barely) was my guitar, which I'd snatched up when I saw the rhythm instruments go flying.


Whew! 


I mean...really.


Whew!


I sent him back to his day area (wondering why exactly I'd gone into this damned field anyway), went back, cleaned up the mess, and wondered what the heck I was supposed to do now.


I showed up at the next session with nothing but my voice (I learn fast, eh?).  I knew he liked "backrubs," although at the time I didn't realize it had to do with sensory problems. Just as I did this past Wednesday, after I let him know what I was planning to do, I pressed the palms of my hand to his back. And then, unaccompanied by any instrument, I sang to him. 


I sang about what I was doing, what (safe) ways he could use to let me know if he needed me to stop, and I sang about keeping the room a safe (is anyone else noticing a theme here?) place. 


Happily, although it took some time, O got used to me, and I began to understand what worked for him and what didn't. 


The fact that he now can let me know when he needs my assistance (or not) and that I can sit with him playing the guitar with no instruments being hurled about makes my day. 


And it reminds me that music therapy matters. It may not always look as I expect, but it matters. 

12/16/09 Quote- effortlessness, waiting, self-awareness

Image by jhave2 via Flickr

From an article by Wayne Muller, "Effortlessness", in Unity Magazine, May/June 2003, pp. 4-6:

Deep within all things there is a natural rhythm, a music of opening and closing, expansion and contraction. Our heart, our lungs, the seasons, the oceans- all life expands and contracts, opens and closes, softens and hardens and then goes soft again. This potent opening and closing cannot be forced to happen, nor can it be stopped. It is simply the way of all things.

We need only remain clear and awake to listen for how things really are, to feel how the smallest changes of energy and attention move in us, in our relationships, in our work. We can learn to follow the spaces between things. Not to fight and push and cajole, but rather simply to wait until the true way reveals itself easily and clearly in this moment. 

My thoughts as I read this:
This seems to me a wonderful (and poetic) reminder of why it's so necessary for us, as music therapists (as any kind of therapists), to examine and to be aware of our own issues and motivations in our work. If we're not aware then we run the risk of "pushing, struggling and cajoling" our clients into getting better (behaving better, functioning better) instead of simply being with them and trusting that they will move forward at their pace. 


When I notice myself reacting in a session with a sense of urgency and "I must do something right now"  this passage reminds me: sometimes I just have to wait and be with my client(s) until s/he/the group is ready to move forward.


When I'm not willing to do that I know my focus has shifted to myself and to my own fear that I'm somehow not fulfilling this idealized (and delusional) notion that I have to be "the perfect therapist who can fix it all for her clients."

You don't know what people know when they can't tell you...

From the Daily Mail in the UK, here is yet another reason we can't decide we "know" what people who don't use speech know or don't. Thanks to Anne Barbano for tweeting it to my attention.

Patient trapped in a 23-year 'coma' was conscious all along

By Allan Hall
Last updated at 1:59 AM on 23rd November 2009
A man thought by doctors to be in a vegetative state for 23 years was actually conscious the whole time, it was revealed last night.
Student Rom Houben was misdiagnosed after a car crash left him totally paralysed.
He had no way of letting experts, family or friends know he could hear every word they said.

Rom Houben was trapped in a coma for 23 years and had no way of letting anyone know he could hear what they were saying (pictured posed by model)

'I screamed, but there was nothing to hear,' said Mr Houben, now 46.
Doctors used a range of coma tests, recognised worldwide, before reluctantly concluding that his consciousness was 'extinct'.
But three years ago, new hi-tech scans showed his brain was still functioning almost completely normally.

Mr Houben describes the moment as 'my second birth'.
Therapy has since allowed him to tap out messages on a computer screen.
Mr Houben said: 'All that time I just literally dreamed of a better life. Frustration is too small a word to describe what I felt.'
His case has only just been revealed in a scientific paper released by the man who 'saved' him, top neurological expert Dr Steven Laureys.
'Medical advances caught up with him,' said Dr Laureys, who believes there may be many similar cases of false comas around the world.
The disclosure will also renew the right-to-die debate over whether people in comas are truly unconscious.
Mr Houben, a former martial arts enthusiast, was paralysed in 1983.
Doctors in Zolder, Belgium, used the internationally accepted Glasgow Coma Scale to assess his eye, verbal and motor responses.
But each time he was graded incorrectly.
Only a re-evaluation of his case at the University of Liege discovered that he had lost control of his body but was still fully aware of what was happening.
He is never likely to leave hospital, but as well as his computer he now has a special device above his bed which lets him read books while lying down.
Mr Houben said: 'I shall never forget the day when they discovered what was truly wrong with me - it was my second birth.
'I want to read, talk with my friends via the computer and enjoy my life now that people know I am not dead.'
Dr Laureys's new study claims that patients classed as in a vegetative state are often misdiagnosed.
'Anyone who bears the stamp of "unconscious" just one time hardly ever gets rid of it again,' he said.
The doctor, who leads the Coma Science Group and Department of Neurology at Liege University Hospital, found Mr Houben's brain was still working by using state-of-the-art imaging.
He plans to use the case to highlight what he considers may be similar examples around the world.
Dr Laureys said: 'In Germany alone each year some 100,000 people suffer from severe traumatic brain injury.
'About 20,000 are followed by a coma of three weeks or longer. Some of them die, others regain health.
'But an estimated 3,000 to 5,000 people a year remain trapped in an intermediate stage - they go on living without ever coming back again.'
Supporters of euthanasia and assisted suicide argue that people who have lain in persistent vegetative states for years should be given the opportunity to have crucial medical support withdrawn because of the 'indignity' of their condition.
But there have been several cases in which people judged to be in vegetative states or deep comas have recovered.
Twenty years ago, Carrie Coons, an 86-year-old from New York, regained consciousness after a year, took small amounts of food by mouth and engaged in conversation.
Only days before her recovery, a judge had granted her family's request for the removal of the feeding tube which had been keeping her alive.
In the UK in 1993, doctors switched off the life support system keeping alive Tony Bland, a 22-year- old who had been in a coma for three years following the Hillsborough disaster.
Dr Laureys was not available for comment yesterday and it is not clear why he thought Mr Houben should have the hi-tech screening when so many years had passed.

Battling inertia one session at a time

From the Random House College Dictionary Revised Edition (1984), the definition of "resistance" and "resist":

Resistance: n. 1. the act or power of resisting, opposing, or withstanding. 2. the opposition offered by one thing, force, to another....4. Psychiatry. opposition to an attempt to bring repressed thoughts or feelings into consciousness. 5. (usually cap.) (esp. during World War II) an underground organization working to overthrow the occupying power, usually by acts of sabotage, guerilla warfare, etc.

Resist: v.t. 1. to withstand, strive against, or oppose. 2. to withstand the action or effect of. 3. to refrain or abstain from, esp. with difficulty or reluctance.--v.i. 4. to make a stand or make efforts in opposition; act in opposition; offer resistance. --n. 5. a substance that prevents or inhibits some action, as a coating that inhibits corrosion.

I didn't think D was going to be attending music therapy today. When I arrived in his cottage to pick him up he was sprawled all over his chair napping. But, I'll be darned, he got up and put on the rain poncho with some help from me, and we walked over to the Music Room, even more slowly than usual. He seemed so sluggish it was watching someone moving through a vast and entangling substance.

When I saw him the previous week, he was so exhausted, I'd given up early and walked him back.

After removing his rain gear and handing it to me, he went to lie down on the couch, appearing quite beat.

I asked him what he needed from the music, inviting him to look toward me when one of my suggestions sounded right to him. Did he need the music to express something he was having trouble saying? Did he need music to soothe him? To energize him? He chose "energize him" (looking at me directly rather than looking away as he had done when I offered him the other options).

I played "We Are the Champions" for a couple of reasons: first, it starts out quietly and builds (following the mood-iso principle of matching the person's general state musically and moving the music in the emotional direction one is trying to achieve). Second, the lyrics (to me anyway) offer a powerful commentary about struggling to overcome difficulty and standing firm in one's truth.

The song didn't seem to do much for him (although he seemed to be listening behind his closed eyes).

"D, I'm not sure what to offer you. You're letting me know you're very tired. I don't know whether it's because you don't feel well physically, or if you're feeling downhearted. If you truly don't feel physically well, then please let me know by standing up and going to the door, and we'll go back to the cottage so you can rest. If you're feeling downhearted or depressed, it may help if you take the first step by sitting up."

I played an energetic riff on the guitar, and I improvised a song in which I presented him, again, with this choice: stop for the day or make an effort by sitting up. I pointed out that I can't make him stay awake, and if he wants my help he needs to meet me halfway (by not lying down and at least trying to engage in the session).

To my surprise, he did sit up as I sang, and he remained sitting for the final ten minutes of the session!

I invited D to use the instruments or his voice to give me an idea of what it's like for him to move right now (to go from lying down to sitting up). He chose his preferred instrument, the tube shaker, and picked it up and put it down a number of times. He began to use his voice, and there was a quiet, low, somewhat whimpering quality.

We (okay I) talked about resistance, and I congratulated him for pushing through his inertia to be able to sit up and take a (figurative) step forward.

Yet another way in which my clients amaze and impress me.

"I'll Fly Away"

The last thing I remember about K is how worried I was about his health. He had been coming to music therapy and literally crying, "ow, ow, ow". I'd gone straight to the nurses and told them (again), "there's something very wrong with K. I've known him for 20 years, and this is not a sound I have ever heard him make." They assured me they were looking into it.

It was heart-breaking to listen to him. It was difficult to focus when I knew something was wrong. I felt powerless to help him and angry because I had been expressing concern about his health for at least a year.

When I got back to work last Wednesday after a week-long vacation, I heard he was in the Intensive Care Unit at the local hospital. I made plans to go and visit him on Thursday.  

It was too late.  K died Wednesday night.

Alone.

P, one of his regular support staff, also devastated, asked if I would sing the song "I'll Fly Away" for his memorial service. I didn't know the song, but I found the music and started to learn it.

***************************

D was a bit draggy when I went to pick him up for his session this past Saturday. But he got right up to come with me. 

As soon as we got to the Music Room he moved all the instruments off the couch and parked himself there, in a reclining position, facing me. 

He looked sort of glum as I sang a greeting to him, and we spent some time just breathing quietly together. D stared out the window, as he often does, and as I watched him, my mind started to sing, "I'll Fly Away".

I played it for him- painstakingly, since I had only barely begun to learn the song. It seemed to offer a powerful message for him.  He turned to look my way, and he listened intently as I sang.

Some glad morning when this life is o'er,
I'll fly away;
To a home on God's celestial shore,
I'll fly away.

[Chorus]
I'll fly away, Oh Glory
I'll fly away; 
When I die, Hallelujah, by and by,
I'll fly away.

When the shadows of this life have gone,
I'll fly away;
Like a bird from prison bars has flown,
I'll fly away

[Chorus]
I'll fly away, Oh Glory
I'll fly away; 
When I die, Hallelujah, by and by,
I'll fly away.

Just a few more weary days and then,
I'll fly away;
To a land where joy shall never end,
I'll fly away

[Chorus]
I'll fly away, Oh Glory
I'll fly away; 
When I die, Hallelujah, by and by,
I'll fly away.

(written in 1929 by Albert E. Brumley)

The best way I can think of to describe it is that it seemed as if D's eyes, gazing out the window, were singing this song.

A thought crossed my mind as I shared "I'll Fly Away" with D- a song I will be singing for K's memorial service in a couple of weeks. K taught me, as well as many of my practicum students, about being a music therapist (he was a part of the "Sick and Tired" crew I described in my last post). As a result of his death, I've now had occasion to learn this powerful song, and what's more, to share it with another of the people I support.

So, in a way, K remains present, and he continues to share his gift. 

I hope it's true for you, K, wherever you are...that "like a bird from prison bars [you have] flown" and that you're in a state of being in which "joy shall never end".

The state of "I don't know"

There are a few recurring themes (if I may go all musical on you) which I've noticed in my work with Bc.  One is that sometimes he shows up, and sometimes he doesn't.  Another is that sometimes he seems very interested in what we're doing- all involved, playing music, engaged, and sometimes he doesn't. Yet another is sometimes he's very groggy in his sessions (and sometimes so am I), and sometimes he's not.  

Okay, so maybe there's actually only one theme here:  sometimes yes, and sometimes not so much.  

I haven't worked with Bc all that long (comparatively speaking).  I'd say it's only been, maybe, three or four years. I've often found, having worked in an institution for almost (gasp!) twenty-one years, that it takes more like six to eight years to start to get a sense that maybe we have a relationship happening here.

On two separate occasions, in the past month or so of working with Bc, I've had this very strong sense of feeling bothered.  Not exactly bothered, really- it was more a wondering, "Does this man really want music therapy? Am I just getting on his nerves?  I have to work so hard to get his attention, and even when I may actually have his attention, I'm not sure that he's interested in this.  Do I even exist as something or someone who matters to him?  I just feel like he's avoiding dealing with me, and I'm constantly trying to get a sense of 'does this matter?  Do I matter?'"

So there I was, pondering these things, and it suddenly hit me. "Is this how Bc feels in his life? Like he has to work so hard to get people's attention, and then maybe they'll be interested in paying attention to him, and maybe they won't. Maybe Roia will stick around, maybe she won't. Is it worth the effort to trust someone who's probably going to disappear anyway?"  

It has occurred to me that it's possible that my clients spend a large amount of time experiencing uncertainty. And I, by extension, as their music therapist, spend an equally large amount of time feeling uncertain. I've written (well, I've made mention of) ambiguous loss in two previous posts (here and here). Families disappear.  Staff comes. Staff goes.  The thing is, I think it's connected to this constant state of "I don't know" that my clients and I seem to co-experience in our sessions.

If you've ever been in an institution (for whatever reason), then you start to notice that, in spite of all the schedules and the "you're supposed to be here at this appointed time" and the regimented this, that, and the other thing, the menus, the activity schedules and so on...there is still a strong sense of uncertainty in the experience of being there.  

By uncertainty, in this instance, what I mean is, "Which staff is on today/tonight? What kind of mood is s/he in? What is that going to mean for the kind of night I'm going to have or not have? Is this person still my staff, or has s/he moved on to work in another building? When will my family be visiting me? Do they know I'm here?  Do they care?" You get the idea. 

As a music therapist, I'm called on to hear this somehow and translate it to music.  To give it a voice.  To acknowledge it. This constant state of "I don't know."

"That was so much fun!"

"That was so much fun!"  Well!  I don't usually hear that from the direct support staff who take part in music therapy groups with me.  Actually I don't usually have any staff with me when I'm doing music therapy.  Long ago I decided to work alone when I do sessions, because the direct support staff and I tend to...work in very different ways.  Ahem.  

As such, you may be wondering why I actually decided to include the staff when I started a new music therapy group with the women in Group 2.  Well, for one thing, this can be a pretty rough crowd- I've seen one of these women tear apart an entire bathroom, ripping down shower curtains, tossing clothing and bathing items asunder, and then shred her clothing in a matter of seconds (let me tell you- that's a talent).  Another woman tends to yank hair, scratch, and bang her head on the floor.  As you might imagine, having their support staff around could be a very good thing.  

Another reason I wanted the staff in this group to come with me is that they are consistently with that specific group on Monday evenings.  Most importantly (to me anyway), these three group leaders (as they are referred to in our facility) really seem to like the ladies they support (I'm not being nasty here- sadly, I don't always see this attitude in this line of work).  They were very enthusiastic when I asked them if they were interested in our doing a music therapy group.  

We agreed to move the ladies from their usual living area (a room with no outside windows, in the middle of the cottage, surrounded by a lot of noise from neighboring day areas) to a room across the hall where the recreation staff works.  It's generally a quiet room, it's contained, it has chairs (even though various members of this group like to be mobile or recline on beanbags), and we can use fewer lights (the fluorescent lights are quite horrible) because it has windows.  

I also wanted the staff to understand the point of music therapy- give them a context within which to interpret what they might experience in the sessions.  I wanted to give them an idea of what I'm doing, why I'm doing it, what I'm watching and listening for, and how I'm going to do what I do. So I gave each of them a copy of a detailed memo I wrote a long time ago for supervisors who periodically come to observe sessions.  

I also gave them the Music Therapy Observation Form I've been working on for quite a while.  It's a complex form which I usually have my practicum students fill out  on a weekly basis.  It asks a lot of questions meant to provoke thought with regard to what the music therapist is seeing, sensing, hearing, and musing about during the group.  It also encourages attention to the relational qualities and dynamics within the group and how these might be expressed (or avoided) in the music.  It also notes some of the elements which might be going on (or ongoing) for clients in addition to the experience of being in the music therapy group (illness, sensory issues, motor planning problems, traumas, family stuff, etc.).  

We've had three sessions so far.  If all of the group members (minus their staff) show up we have seven women- which may end up being a lot, but we'll see how it goes.  The best we've managed so far is to have six women and two staff people. Sometimes the ladies decide to go to bed early, sometimes they head out with the teachers, and sometimes they need a break from the group and want to do their own thing.  

All but one of the women in the group are somewhere along the autism spectrum.  And, again with the exception of the one woman (who is dealing with mental illness along with her developmental disability), none of the ladies use speech to communicate.  They are, however, women with voices.  Quite a range of voices, I might add.  From low and gruff to high and sweet.

One of the things I noticed with regard to the group leaders is that they tend to chatter almost constantly with the women in their group.  This is actually, in many ways, a very good thing.  So I didn't want to discourage their natural tendency to want to interact, but their conversation, while animated and pleasant for the most part, was making it awfully hard to actually hear the group members.

Last night three of the women were present in the group.  I gently invited their support staff to listen- reminding them, "this is your opportunity to hear the ladies you work for in a completely different way."   They were quiet, and they listened. And it was great!  

I offered V a maraca.  She had come in to the room using her wheelchair, because her staff, M, was concerned she'd grab at and scratch everyone (and, indeed, she did seem headed in that direction as she began to pull roughly at M's shirt).  V held the maraca, evidently curious enough that she was able to settle herself down. In fact, she didn't grab anyone else for the rest of the session.

K was awake (last week she slept on a cushion we had brought for her- this time she had a big long beanbag and a blanket).  K is often asleep during the day, because, from what I can gather, she doesn't sleep well at night. I sang a greeting to her (and to her housemates). I invited her to turn toward each woman in the group (she is also visually impaired), asking them to alert her as to where they were located in the room by making some form of sound (her staff included).  She listened quietly as each of us made a sound or greeted her with a "hi, K" and turned her head to acknowledge that she had heard us.  

M switched chairs a number of times, making sure to stay near me, even maintaining visual contact.  She sang through much of the 30-minute session, quietly, a high-pitched and delicate collection of short little four and five note melodies and bursts (for lack of a better word).  

At one point, L agreed to come in to join us.  She still had a cold, but she accepted the tube shaker from T (her staff), and she shook it vigorously for about 30 seconds, set it down, picked it up to give it one more good shake, and handed it back to T and left.  

V eventually decided she wanted to get out of her wheelchair and sit on the beanbag with K (apparently they like each other well enough and are used to sharing this space).  There was no scratching or grabbing.  K decided to stand and move to the music (I too got up to sing and rock across from her while I followed her rocking on the guitar).

It was hard to have to sing "goodbye" to them all, because it truly was enchanting to watch the group transform into this lovely music-making collective.  T was astonished and excited (having assured me when we began that she had read all the papers I'd handed her the previous week and found them fascinating).

As we sang "goodbye" V, who had been holding the maraca so quietly, decided to join in with her voice.  Indeed, "that was so much fun."