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!  

Fifty shades of "no"

I've been sitting and stewing over the fact that one of my clients decided not to come to his session yesterday. Obviously, it's not the end of the world, and it's mostly likely he'll be back. But I know he's upset with me and he's struggling with a lot of feelings because of the difficult work we're doing right now.

Occasionally, clients with whom I've developed a fairly stable relationship (and I can tell you, that has usually come after quite a long time of working together- usually years), who I can almost always count on to be there for their sessions, refuse to come to music therapy. 

And  when I say "refuse to come to music therapy" I mean I've walked over to their building, signed them out, collected their outer gear, walked in to the group where they spend their days (along with the rest of the people who live with them and along with their staff people), and asked, "would you like to come to music therapy today?" 

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I'd like to pause here to say what a vulnerable moment this is- for me anyway- as a music therapist. I mean, I'm standing there, exposed, and, honestly, it's like inviting someone out on a date in front of their entire family. Only it's therapy (which is just as intimate as a date, if not more so at times) and the other people in their group may have feelings about this particular person being invited to go to music therapy (when they themselves are not being invited) and their support staff who usually have their own feelings about the person who's scheduled for music therapy as well as a series of opinions about me and what I represent (sometimes good and sometimes not so much). Additionally, support staff have a series of beliefs and understandings (usually passed down from their supervisors) about their role in clients heading out to programs (such as music therapy). Commonly, those beliefs and understandings involve making sure the person is clean and tidy and goes and does what s/he is supposed to be doing. 

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Now, most of the time, the folks I've worked with for a long time jump up and come over on their own and then pull me to the door. Others go and sit in their wheelchairs, waiting for me to take them out. Some people who have a harder time initiating actions or simply have a lot of physical involvement making it more difficult for them to stand and greet me, wait for me to approach them and let me know they want music therapy that day by making an effort to get up and go with me.

Over the years I've discovered a large (and important) part of my work is figuring out how my clients (most of whom don't use speech) communicate "no".  Some people (the ones who usually hop up to meet me) simply don't get up when I appear and remain seated. Some (who need more physical assistance) let me know by not allowing me- or just not helping me- to put on their coats. Others avoid going toward the door, and I've had a couple folks  pretend (vigorously) to be asleep. A few of my clients will come part of the way with me and then stop repeatedly or keep going in the "wrong" direction, and still others come to the session, wet themselves and have to return to their buildings to get their clothing changed. 

The gentleman I went to pick up yesterday is someone who usually gets up the minute he sees me and comes quickly over to take me by the wrist and pulls me toward the door. His "no" came after a particularly hard series of sessions in which I've been challenging his way of thinking about me and about the role of music therapy. 

His "no" started when he stayed seated, looking at me with a rather unhappy face, leaning his head on his hand. I wondered (out loud to him) if he had a headache (it was pretty loud) or if he was tired (sometimes he doesn't sleep too well). I waited a short time and then I told him I'd go out for a few minutes, come back and check again with him. "If you still don't want to come, that's fine, and I'll check in with you again next week."

So I went and stood in the hallway for three or four minutes and then tromped back in with my armload of sweatshirt, coat, gloves and a hat for him. He still didn't move. 

Mercifully, his support staff didn't tell him to "get up" (which is what usually happens, and, when they do that, he usually stands up and comes with me, but I'm well aware the entire time that he would not have been there had they not told him to be, which, I think we'd agree, is an awful feeling- for both of us). 

I offered to sit with him for a bit, because sometimes he actually needs some more transition time (or to just think about whether he really wants to skip music therapy that day- and it's very rare that he does), but he still didn't get up. 

Just as I was about to turn and leave, he got up and walked past me to the table (where there was more space for me to sit with him and also plastic blocks he likes to hold). He couldn't find any blocks (they were all zipped into a bag, and I guess he didn't want to mess with it just then), and he went to sit down in another chair. This time there was space next to him, so I sat down and pulled off my hat. 

I invited him to let me know if he wanted me to leave by looking toward me and if he wanted me to sit with him to indicate this by tapping my arm. He glanced my way, fleetingly, twice and made no move to grab my hand (which is what he generally does). 

"Okay then. I'll check in with you next week. I'm glad you let me know you didn't want to come today, and I'm glad you let me know you'd rather I don't sit with you right now."  

I wished the guys a decent weekend and headed out into the hall, kind of hoping he'd change his mind and come after me. He did not. 

I headed back to the Music Room, pondering the whole thing, reminding myself that he was likely wanting me to feel as rejected as he'd probably felt in our session. 

But then the inevitable worry began: Did I say something in the wrong way in his last session? Did I accidentally offend him? Did I hurt him by saying something he wasn't ready to hear yet? Is it irreparable? Will he give up and stop coming to music therapy? 

As I was pondering these questions, yet again, this morning, I realized, not only is this the usual litany I go through when a client chooses to not come to music therapy on a given day, but my confusion- my wondering what happened, did I do something wrong, will this person leave- probably very much mirrors the feelings my clients have had with regard to their families placing them in an institution.

Perhaps (along with "no") I was "hearing" his (and many of my clients') experience of ambiguous loss,  which is a loss that doesn't have clear closure and around which there are questions and a great deal of uncertainty. It's often thought of in terms of families' feelings regarding a child who is disabled or mentally ill or a parent or spouse who has Alzheimer's (for example), but there is little, if anything, written about the experience of the person whose family sees them as "gone" or "lost" to them because of their disability. 

When I arrived back in the Music Room, I found myself singing the following song, and once again, I felt amazed at the way our minds speak to each other through music.

My life and times as a disappointing music therapist

The session that wasn't:

Walking to the session. Pausing to pull me toward somebody's car and tapping on the trunk:

"Um, no. We can not go in somebody's car. Please don't tap at it, or you'll set off an alarm and that would probably not be a good thing." 

Slowing down and sitting on a bench:

"Yes, I see that you don't want to go to do your session today, and you'd rather we sit outside on a bench."

Still on the bench:

"Yes, I realize I'm frustrating you, but music therapy is what I can offer. I can not take you for a ride, or for an escape, in someone else's car or in my car. I can, however, be your music therapist, and you can come to your session, and we can talk about it in the music."

In front of the Music Room door, but not going in:

"So, okay. You're not going to go into the Music Room."

Pushing past me and heading for the exit:

"I guess you're telling me we're not going to be doing music therapy today, and you'd rather go back to the cottage. Okay then. I'll try again on Wednesday." 

Heavy sigh. 

When sessions go to hell (yes, Virginia, in a hand basket!)

Image by jamelah via Flickr

Damn! I was all set to wax lyrical about what a wonderful first session I had had with two new clients, C and J, two Saturdays ago. 


I'd even started the blog already. I had a nice little picture all picked out and everything. There was a little singing bird. It was downright idyllic, if I do say so myself.


Well. 


That little gloat-fest sure didn't last too long. 


When I showed up this past Saturday, it all went to hell. (Please observe said hand basket above and to the right.)


First, the room we'd used the previous week was completely unavailable. Apparently, it had just been painted and they didn't want anyone in there until the paint was dry.  It was a nice, relatively quiet room with space, with a big water-bed looking thing (that looked like a cross between this, this, and this), where last week C, who seems to experience a lot of sensory discomfort, tucked herself in under her blanket and her giant beanbag and sang along with her series of sweet little "bee bah" sounds. 


Okay. "So the room isn't available," I thought. I can work around that. I think.


Then, while I was checking out other room possibilities, I noticed that the other person in our small music therapy group, J (who became "the other person in our small music therapy group" simply because she kept walking in to the room last week, and I finally said, "why don't you just join us on a regular basis?"), was unavailable, because she was having some behavioral issue that required a lot of people to stand around her and look concerned. And not too happy. 


Hunh.


No problem, I'll just work with C in the vestibule where she's sitting (tucked under her blanket with her giant beanbag) (is anyone else noticing a theme here?). I'm flexible. I can do this. 


Two seconds into singing "hello" to her (after her staff kindly unplugged the radio that had been playing), C got up and left. 


And that was that.


After that we moved into a whole following around (me following C), pulling (C pulling me, because I guess my following her wasn't going the way she'd expected), stripping (C's, not mine, thank God), bathroom going (again, not me for a change), insisting I put the radio back on (you guessed it, C wanted the radio), irritated "BEE-BAH" sounding...thing. 


There were two (maybe two) blissful (okay, maybe it wasn't blissful, but we're talking comparatively here) minutes in which C sat and smiled as I played and sang with her. 


Then we were back off and running.


Heavy sigh.


A few years back (in 2006, I believe) my friend, Judy and I did a presentation at the Mid-Atlantic music therapy conference which we called "The Myth of the Perfect Music Therapist, or How I Learned to Stop Worrying and Love My Mistakes". 


I think this would definitely qualify as one of those bummer sessions that are more "part of the process" or "grist for the mill" (as the sayings go) than shining examples of moments in therapeutic gloriosity.


I suppose, if there's anything for me to have learned from this, it's that if we music therapists can't own and acknowledge our lousy sessions/days and accept them as part of life, then our clients won't be able to do that either. 


Not that it's any kind of easy.


Well. There's always next week.

Is change a good thing?

The first good thing about last Wednesday was that J decided to go with me to his session. 

That may not seem like a big deal but for him it is. We've had a year and a half (maybe a bit longer) of his hemming and hawing about being in music therapy. Since he doesn't use words to communicate, "hemming and hawing" looks like his walking with me (for all intents and purposes looking as if he's planning to come to his session) only to get completely stuck and not move- unable to move toward the session area and unable to walk back to his day area. (Insert long pause here.)

Sometimes his "hemming and hawing" looks like pulling me (yes, literally) in various directions and not really going anywhere. Sometimes it involves my suddenly noticing that he didn't let me know he needed to use the toilet. (Insert more pausing.)

We had been using the Music Room for sessions.  I've worked with J for quite a few years now, and it had taken us a long time to get to the point where we could safely leave the cottage, walk to the other building, and get to the Music Room, not run out the door in the middle of the session without letting me know he needed to stop for the day (that also took some practice), and get back to the cottage without anything too dramatic occurring. 

A little over a year ago J got to the point where, when he walked with me to the Music Room, he flatly refused to go in, opting instead to pull me around the building, pull me around outside, and pull me to the canteen (never to the cottage). I finally had to say "enough. We need to go back to working in the cottage!" J is a good two heads taller than I am, and, frankly, I need the use of my hands and arms, Furthermore, if I wasn't feeling safe, neither was he (or maybe it was the other way around). 

So there we've been: in the cottage. 

J is clear that he doesn't want to stop music therapy. Even when he doesn't want to actually go to his session, he holds on to my hand tightly and pulls me to sit with him in his day area.

"See Roia? This is where I live."

It has felt frustrating, confusing, heartbreaking and maddening at various points.

Last Wednesday (which is where I started this blog) I found myself, again, wondering out loud to J about his intense ambivalence (a.k.a. "hemming and hawing") with regard to his use of the music therapy process. (Mind you, J has been ambivalent from the beginning, but we had at least worked to a point where he was decidedly certain of his wish to get himself to his sessions.)

I noted that one of the hardest things about going to therapy (any kind of psychotherapy), and I say this from my own experience as well, is that as we get healthier the people and situations in our lives sometimes look, well, a lot sicker. It's a lot harder to tolerate boundary violations, drama, and generally obnoxious behavior when you've made an effort to be more mindful in your interactions and to get your own dramas under control.

The average person can decide for themselves, "I no longer wish to be in this relationship" or "I need to make some life choices so I don't find myself frustrated by being in jobs that are not challenging to me" or some act that requires a sense of agency.

But a person who lives in an institution, whose life is basically organized for him by other people in so many ways, who doesn't have or see any real prospect for getting out of the institution may not be able to do that. 

Even if he makes a monumental effort to convey what is important to him (and many of my clients do!), most institutions don't have the capacity to listen.

To know this, to live this, is nothing short of tortuously frustrating. 

In effect, I could see that J may (quite legitimately) feel as if I have offered him a taste of something that he could only have when he was in his music therapy session. And he may feel angry, resentful and hurt by that. And, yes, he may feel quite ambivalent about wanting to continue this kind of work.

In effect, I feel as if I have supported him to grow within a system that isn't willing to grow. 

As I acknowledged all this to J, he listened, quietly walking around the room where we worked, the noise of television sets, blaring music, and people's voices forming a constant background to our makeshift therapy space.

J walked over to me with a sort of wailing sound (a sound he often makes) and pulled the guitar carefully over my head (it's attached with a strap), waited for me to put it down, and pulled me gently out the door and back over to his day area. 

He sat down in a chair and just watched me as his staff, mostly ignoring him except to verbally acknowledge his return, began to chatter with me. 

"See, Roia?" his eyes seemed to ask me.

Yes, J, I see.

I'm sorry.

This past Wednesday, he got up and came right with me to his session.

Having an effect

I have been thinking about a session I had last week with one of the men I work with who is on the autism spectrum.  He and I have worked together, first in a small group and now individually, for the past ten years.  I have noted that I often feel quite lost in his sessions.   While it seems to be very important to him to have an opportunity to get out of his living area and walk to the Music Room (which is in another building), he generally just sits quietly when he gets there.  Occasionally, he’ll reach out and take one of the instruments I place near his chair (he is clear that he does not want to get up and come to the piano or explore any of the other instruments around the room), putting it back shortly thereafter.  He doesn’t use speech to communicate, although occasionally he may vocalize quietly.  So quietly, in fact, that I can barely hear him. 

I have been slowly making my way through Music Therapy with Adults with Learning Disabilities (Watson, ed., 2007), and I admit I felt relieved when I read the following: 

“The music made with adults with learning disabilities will be varied, as with other clients, but there may be particular characteristics.  The therapist may find that she is working with very little material (for example, when working with clients with profound and multiple learning disabilities).  This demands that the therapist is able to wait and listen, avoiding playing to fill the silence rather than in response to the client.  Other clients, whilst bringing music, may find it hard to initiate or lead music, leading to fragility in the contact between the therapist and client, where the therapist may feel as though they have complete responsibility for sustaining the music.”  (Watson,  p. 28)

I frequently feel as if I’m doing most of the musical work in my sessions at the institution.  Obviously there are a lot of reasons for this.  For one thing, the people I work with have movement challenges, making it very difficult (as Watson comments) to initiate and/or sustain interactions, musical and otherwise.  Another likelihood is that living in an institution for many years can bring about an intense case of learned helplessness.   I think, also, there tends to be an idea that I’m the one who knows how to make music, so it’s sort of left to me to do the main music-making.  Put another way, this is a setting that lends itself strongly to maintaining specific roles.

At any rate, during this particular session, I had a strong image of the notes from the music I was playing just bouncing off of my client and falling quietly to the floor.   I mentioned it to him, and then I let my mind wander around with that thought for a while.  If you read this blog regularly, you know that I am a firm believer that the feelings (and songs) that come up for me (and all therapists) while in the middle of a session are important pieces of information.  Naturally, it occurred to me to wonder (out loud) whether he too might be feeling a sense of ineffectiveness- in other words, of not having an effect on his life, on the people around him- a powerlessness in the face of the unfixability of...his life?  His surroundings?  His body (he has been going through some health issues lately and really has difficulty with medical type people)?

He didn’t make any clear overt response to my suggestions that day, but, as it happened, the following week, on our way to the Music Room, it was snowing out, and he was actually singing!  He had a quiet little melody which he was humming (with enough volume so I could hear that it was an improvised tune), and, while it was difficult to make out, it was clearly melodic.  Of course the minute we got to the Music Room he stopped singing, but he did add a few vocal sounds to the session.  Maybe it means something, and maybe it doesn’t...but it was nice to hear him sing.

References

Watson, T. (2007).  Music Therapy with Adults with Learning Disabilities:  Sharing Stories.  In T. Watson (Ed.), Music Therapy with Adults with Learning Disabilities (pp. 18-32).  Great Britain:  Routledge.

Belonging

I was sitting with one of my clients yesterday afternoon, trying to remember what we had focused on the last time we saw each other.  He had refused to attend the previous session, and I had taken a few days off, so my brain was blanking a bit.  

I started to play the guitar (which, for some reason, always helps me think and hear more clearly and to remember what we’ve been doing), and I recalled that the song I had played recently was “Part of Your World” (yes, I know... it’s a Disney song from “The Little Mermaid”).  The focus was on what (I think) seems to be his longing to take part in what he perceives as the “world” outside of his cottage, his housemates, and his staff.  Only... yesterday, when I thought of the song, the word that came to my mind was “belonging”.

Belonging.  I was aware that that wasn’t the word we had used in his last session, but it seemed an interesting word to explore.  My mind immediately free-associated to the idea of belonging to someone, because that also seems to be an issue for him (okay, and maybe it’s an issue for me too).  

As my mind wandered I thought about the following:

*do we identify ourselves by the people and places we belong to? 

*And, when we don’t have any family (or don’t know whether our family remembers that we exist), do we lose a sense of belonging?  

*What does that do to our sense of identity?  

*If we have a severe disability, and we’ve listened to people’s opinions about who we are and what we are without being able to put in our own views, then what does that do to our sense of belonging (let along our sense of identity)?

*What does it mean to belong somewhere?  And, really, do we ever belong to anyone or anything? (I’m thinking here of our existential aloneness.) 

*When we feel as if we don’t fit in, and our way of being is so different that we never feel a sense of belonging, do we lose our sense of a “home base”?

*Does belonging to someone or to a place give us an experience of having a “home base”?

*From the other side of things, what does it mean to have someone “belong to” us?  Can someone actually belong to us?

I wondered yesterday whether it makes sense to say that, while we have music therapy together, we sort of belong to each other.  I couldn’t get my mind to move swiftly enough to clarify that thought, so I didn’t mention it in the session.  But I’m throwing it out here to look at it some more.  

It seems to me I’ve read about the idea of belonging a lot in the more recent person-centered literature concerned with expanding the social and emotional networks of people with developmental disabilities.  Heck, it’s enough of an issue for all of us, I imagine, but we may not necessarily be conscious of it all the time. 

I have to get along to work now, but I do want to revisit this idea of belonging to each other.  There seems to be a spiritual element to it that I like.  Yes.  I do believe that, one some level, we all belong to each other.  I suppose if we all thought about each other that way, we’d probably have a less frightening world. 

"Killing me softly with [her] song"

One of the guys I work with has been flatly refusing to allow me to play music during his sessions.  He hasn’t always been this adamant about the music needing to be stopped.  And I do mean stopped.  When I start to play he pulls the guitar off of me, or he takes my hands off of the piano.  He’s even thrown my sheet music to the floor.  He’s also tossed quite a few of my rhythm instruments across the room- to the point where I only leave the lighter weight instruments available so that they won’t break or kill me if they land on the floor too hard or hit me in the head.  We’ve worked together for ten years, and during much of that time he was willing to let me play- not all the time, but there was music going on in the sessions, and I was the one doing the playing.  

A lot of years ago (I mean...a LOT of years ago), I went to a presentation by Ken Bruscia at a music therapy conference, and I took a lot of notes (as I tend to do).  One of the things that I recall most vividly from his talk was his description of music therapy as having three components:  the client, the therapist, and the music.  And the music therapist’s job is to sort out all of the various relationships which occur between these three...elements (or maybe aspects is a better word?) in a music therapy session.  

See, now this is what makes music therapy so fascinating and complex to me.  If you think about it (and obviously this is not news to music therapists who use a psychodynamic approach), the music therapist and the music act as co-therapists.  You might notice the nicely parental quality that this duo implies. 

At any rate, it’s interesting (to me anyway) to speculate as to what it means when a client “abandons” the music.  It has crossed my mind that by abandoning the music my client is playing out the abandonment he himself has felt in his life.  He has some issues around parental abandonment, I believe (he hasn’t seen his family for years), and the music is part of a “parental team” (so to speak), so I wonder... is this his way of protecting himself from being abandoned again?  Or maybe “I’ll abandon you before you abandon me” is his unconscious thought process.  

He is clear that the relationship with me is important, but his relationship with the music has been ambivalent, to say the least.  Maybe there’s some sort of splitting involved (as in, I could be temporarily playing the role of the “good mother” while the music has taken on “bad mother” qualities).  

I guess another possibility is that he doesn’t particularly like the music I’m choosing, or he doesn’t like the way I sing or the way I play (which would be an interesting enough issue for us to explore).  Or the songs I’m choosing have no relevance to him.  I doubt that’s the case, but I could be wrong.

From another perspective entirely, could there be something around being heard (or not being heard, as the case may be)?  It occurs to me that an autistic person who doesn’t use speech to communicate and who has lived in an institution for the vast majority of his life is used to a lot of silence when it comes to his feelings, his thoughts, dreams, opinions, fears, loves, and so on.  To hear them suddenly expressed (spoken out loud) in the music- even if I’m not exactly right on in my guesses- can be daunting and feel rather like being exposed, I imagine.

I was thinking about that this afternoon during his session, and the song I chose to use was “Killing Me Softly With [Her] Song”.  And you know what?  He didn’t stop me from playing this song:

I heard [she] sang a good song.

I heard [she] had a style.

And so I came to see [her] to listen for a while.

And there [she] was, this young [girl]

A stranger to my eyes

Strumming my pain with [her] fingers,

Singing my life with [her] words.

Killing me softly with [her] song,

Killing me softly with [her] song,

Telling my whole life with [her] words,

Killing me softly... with [her] song.

I felt all flushed with fever,

Embarrassed by the crowd,

I felt [she] found my letters 

And read each one out loud.

I prayed that [she] would finish

But [she] just kept right on

Strumming my pain with [her] fingers,

Singing my life with [her] words.

Killing me softly with [her] song,

Killing me softly with [her] song,

Telling my whole life with [her] words,

Killing me softly... with [her] song.

[She] sang as if [she] knew me,

In all my dark despair.

And then [she] looked right through me

As if I wasn’t there.

But [she] was there, this stranger,

Singing clear and strong

Strumming my pain with [her] fingers,

Singing my life with [her] words.

Killing me softly with [her] song,

Killing me softly with [her] song,

Telling my whole life with [her] words,

Killing me softly... with [her] song.

© 1972 by Charles Fox and Norman Gimbel

As I talked about this with him, we noted the irony of the fact that his silence affords him a measure of privacy in an institution, one of the least private places in which a person can live.  

After I sang the song, he got up and moved to a different area of the room.  It seemed as if he needed to think about this for a while.  I’ll be thinking about it too.  A part of me felt as if I needed to apologize to him for being musically invasive in some way.  On the other hand, it’s my job to offer him a different way of seeing his life and his experiences.  I do that using music.  Well, it certainly does remind me of, first, how powerful music is, and, second, how much power I have as a therapist (and the need for me to be conscious of that power and to use it with care).  

Having been through my own therapy, I know how hard it is to recognize something in yourself suddenly.  In music therapy, the effect is even more sudden, because, as my clinical supervisor, Janice, notes, “Music hits you at the speed of sound.”