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!  

Taboo Topics in Music Therapy- Part III- The List (so far)

Here's a list of taboo topics I generated. I found I had to keep adding to it as I went along. I also included many of the offerings of the conference participants. Feel free to comment and add your own. I dare say there are quite a few taboos to be found in music therapy as yet. 

Taboos (I have known and loved)

1. Sexual feelings and/or arousal

a. for clients

b. dreams about clients

c. our clients feelings about us

2. Fantasies

a. that we will be the one person who makes a difference in our clients’ lives (or that we are the be-all and end-all in their lives)

b. sexual fantasies

c. fantasies of taking clients home and taking care of them, also known as “rescue fantasies”

d. dreaming about clients

3. Mistakes on the part of the music therapist

4. Fee disasters/money/financial transactions

5. Hatred for/anger toward a patient

a. hating a patient’s music

b. clients who are hurting/frustrating us

6. Getting sick and not being able to do your job for a while

a. can include mental illness as well as physical (i.e., needing to take a break from work)

b. music therapists who have mental illness

c. fear of getting sick when working with clients who have communicable diseases

7. Feelings of incompetence

a. not knowing what to do in a session

b. feeling lost

c. feeling uncertain musically

8. Feeling that we need to be all-knowing, all loving (a.k.a. “Music Therapist Syndrome”- the belief that we must always be nice and cheerful, and that it is our job to make our clients feel better, and that we should never be “mean” and confront them or push them in any way or to talk about “sad” subjects.

9. Feeling bored or tired/sleepy during sessions

10. Clients who gross us out or offend us

11. Therapist’s fears/terrors

12. Therapist’s personal issues around shame/guilt

a. May include therapist’s own abuse history

13. Being fired

14. Issues with staff/co-workers/clients’ families

a. having to report staff/clients’ families for abuse/neglect/etc.

b. fears of retaliation should we report abuse

c. dealings with staff regarding clients (having differences of opinion)

d. staff undermining our efforts as therapists

15. Being uncomfortable with the system within which we work

a. disagreeing with the way client services are provided

b. having to represent a facility we don’t always feel comfortable with

16. Boundary violations

a. treating clients or their families as friends

b. hugging/touching clients as a matter of course

c. violating client confidentiality

17. Guilt over terminating/guilt over not terminating

a. “I should have tried harder.”

b. not working on closure

c. difficult endings

d. ending because we don’t know what else to do

18. Fear of violent clients or those who act out in other ways

a. constant anxiety when having to go and work with a particular client

19. Clients who fall asleep in sessions

a. leading to fear that we are inept or ineffective therapists

b. that we’re doing something wrong or boring

20. Having favorites

a. when we admit it we’re less likely to act on it than if we deny it.

b. also the belief that we have to love all of our clients

21. Fear that a client may commit suicide

a. along with the fear that we will miss the warning signs and it will be our fault

b. and the corresponding fantasy that we will be the one to save this client

22. Being in the role of “helper”

a. discomfort with being in the role of ‘helper’

b. not being aware of the power difference between client/therapist

23. Seeing clients as more disabled than they are

a. sometimes leads to an attitude that “they don’t understand what we’re doing, so it won’t hurt them” (this is the kind of belief that can lead to situations like the one with Corey Brown, the music therapist who molested his clients)

24. Working with someone your own age

a. Or working with someone you’ve known in a different context (including survivor guilt)

25. Running into clients outside of the therapy context

a. Clients who want to connect through various online social networks

b. Clients asking for sex/marriage/personal phone numbers

c. Clients who grope themselves/who try to grope the music therapist

26. Clients who are better musicians than we are

27. The myth of music as a “non-threatening” medium

28. Guilt over privilege

29. Assuming our clients are heterosexual, or identify as a particular gender

30. Hating a particular style of music and/or refusing to learn or play a particular style in music therapy sessions

31. Clients dying or getting seriously ill (sometimes in the middle of a session)

32. Racism, sexism, able-ism, heterosexism (in all of their infinite varieties and forms)

33. Music therapists who do not dress in a professional manner (i.e., whose dress is seductive or overly casual)

Why we don’t talk about these things (some of these reasons are taboos in and of themselves, I would say):

• We don’t always know the answer
• We don’t want to look unprofessional/bad
• Ashamed/embarrassed/fear of being blamed
• Music therapy students who are over-protected/over-directed
• Not always recognizing countertransference
• Helplessness
• Not wanting to deal with repercussions
• Competition between colleagues
• Not having a supervisor/mentor/safe resource
• The need to constantly “prove” that music therapy is a valid therapy
• Wanting to be a good example
• Diminishing the impact of an issue (i.e., making light of a difficult topic)
• Fear of being seen as a fake/incompetent

  

Is failure an option?

Oh. My. God.  Today was long.  It was annoying.  It was frustrating.  It made me wish I did anything but music therapy.  

As guilty as I'm going to feel, I have to say it.  Sometimes I hate my job.  Okay, so now you know. I felt like a complete failure by the end of the day anyway, so I may as well publicly (yes, publicly) admit that sometimes it sucks raw eggs to be a music therapist, and I entertain evil thoughts about some of the guys I see for music therapy.  

Initially, I was just having a boring day, because a lot of my clients seemed to be out and unavailable.  Then, when they were available, they were exhausted (yes, I am rolling my eyes heavenward, why do you ask?).  

Well, okay, the real problem was one particular client who has been challenging me for...let's see how long have I worked with him? Almost five years maybe? Let's just say there has never been a time in our work together that didn't make me wonder "why the hell am I still doing this? Why is he still getting music therapy?" (or, to quote a wonderful bumper sticker I bought many years ago, "where am I going, and why am I in this hand basket?"). 

Yes, there's something wonderful and likable about him, but, for pity's sake!  I am tired of asking him to stop licking the walls, the table, the dirty clothes bins, etc.  I am ready to claw out my own eyeballs from asking him to stop writing all over his face with the ball point pen.  And, for crying out loud, enough with the kicking, punching and pinching at me!  

I think I'm most upset, because I have sincerely tried and tried, and the reality is I can do no more for this man.  I just don't have the energy to keep arguing with him.  If he doesn't want to change, then he doesn't want to change, and I'm wasting both our time trying.  

The distress part for me (until now anyway) has been that, to my way of thinking, I have to keep trying.  See, now this is why I needed to take a break from working for a little while- so I could finally recognize that my thought process was ridiculous.  It is now glaringly obvious to me that "trying" in this case is more about my need to not fail than about his need for music therapy.

I wonder if other music (and non-music) therapists go through this madness.  Or am I just insanely Don Quixotic about it all ("to fight for the right- without question or pause- to be willing to march into hell for a heavenly cause...etc.").  Clinical supervision anyone?

*Heavy sigh.*

 

Is this the end?

I had a strange experience today.  I actually had to say to one of my clients that we’ve gone about as far as we can go.  I didn’t want to have to say that to him, but it’s true.  We’ve worked together for about 19 years, and there really isn’t much else I can offer him other than my presence.  

It’s not as if he doesn’t have issues (I mean, who doesn’t have issues?).  It’s mostly that he seems to be letting me know that we aren’t going to be doing any more music therapy.  I can’t say I blame the man.  How much therapy can a person stand in his lifetime (well, some of us can stand a lot, I guess)?

I’m not sure whether he’s ready to actually stop coming to sessions.   I’m fairly certain he values our relationship a great deal.  I don’t think I’ve ever seen him rush up to other people and take their elbows and pull them to the door.  And I know I’m not the only person who takes him out of the cottage.  

I’m not sure how I feel about this.    

As it happens I just said “goodbye” to another long-term client (admittedly, since it’s an institution, the majority of my work with people is long-term...VERY long-term) who has been gradually moving toward ending in the past three or four years.  I still run into him regularly, because I work with other people in his cottage (which has to be weird for him- I know it’s weird for me).  In the last month or so, as we’ve gone from sessions to checking in to just saying “hi,” he’s needed to avoid me.  It hurts to be rejected, but I understand that he needs to do that.  

We had an amazing last session.  We didn’t exactly plan for it to be The Last Music Therapy Session, but I think we both knew it was.  It was joyful, it was celebratory, and it was moving.  Considering this particular person has not been feeling physically well for a rather long time, it seemed clear to me that he and I were absolutely in sync on this closing.  He was more animated during this ending session than I’ve seen him be in almost a year.   It felt to me as if he had the kind of goodbye he might have liked to have had when his family sent him off to live at our facility (back when he was a youngster- he’s in his 40s now).  

I so value both of these men.  They have allowed me into their lives, they’ve used the music, they’ve grown, and they are loving, sensitive guys who care about other people.  Both men also enjoy laughter and playfulness.  What wonderful gifts they bring with them (and they have shared with me) as they move on from our time together!  And what a collection of feelings- joy, sadness, pride, excitement, and a bit of nervousness- I feel as I begin to let them go.  

Sitting here in limbo

For some time now I’ve struggled during my sessions with a particular gentleman, trying to figure out whether he is ready to terminate or if he’s depressed and having a hard time doing anything or if he simply needs for me to fail him in some way.  

At some point last year he appeared to be bored in sessions- moving around the room in a somewhat listless manner, not seeming to be angry with me but also not particularly enthused about being in music therapy.  Please don’t misunderstand me- it’s not as if I think that people should come to music therapy and be all peppy and cheery and full of vim and vigor or anything.  It mostly seemed as if there was a gradual change in the relationship, but I couldn’t be more specific than that.  It was just that, for him, he seemed...well, it seemed to me that he may have been letting me know he’d gone about as far as he was meant to go with me.  My reasoning was that we’d been working together since 1995, and he had come quite a long way in that period of time, so I figured that was the logical conclusion.    

Now, termination of music therapy services is something that doesn’t happen all that often in an institution.  Well, okay, maybe it just doesn’t happen much in ourinstitution.  The feeling in our facility has generally been, “if the client is getting something out of being there, and there aren’t any problems, then carry on.”  I’m not necessarily against that way of doing things.  I think our clients need emotional support, and, since it takes quite a long time to develop a solid and consistent relationship, it seems sensible to continue indefinitely.  I suppose another way of saying it is that those of who work in developmental centers really become our clients’ support systems.  Taking that away when there isn’t necessarily an option to develop a non-paid support system doesn’t seem very fair or particularly therapeutically helpful.  

I’ve had to terminate with people when they moved out of the center to live in the community, and I’ve had clients who have chosen to simply stop participating in music therapy.  I also had to work towards closure with a large number of clients when I went to graduate school.  But I haven’t had a lot of experience with working toward termination with someone because they’ve achieved the goals and objectives that were set at the beginning of therapy.   

Well, I thought to myself, here’s an opportunity to have a complete therapy process.  We’ve gone from building a relationship to really using the music, to change (internally and externally), and now we can work toward closure.  So that was my big plan.  We could work toward closure.

I talked about endings with my client, and I started to prepare him, figuring we could start by decreasing our two sessions a week to once a week.  Since he doesn’t use speech to communicate, I had to rely on his actions, his reactions, and my own countertransference reactions to get a sense of how things were going.  For a long time, things just didn’t feel right.  I worried that part of the problem was me, because, if I were to be truthful, it was hard for me to think about terminating with this man.  He is someone I like a lot, and it has been so exciting to watch him grow as a person and in his relationships with the people in his life.  I fretted over the fact that he may have picked up on my reluctance to let him go, fearful that he was trying, in some way, to please me by not wanting to end.  

I suppose the best way to describe this period of time was to say it was one of ambivalence.  I got the impression he really didn’t want to end (and maybe he was afraid of ending), but I also felt as if he didn’t have much hope or commitment to music therapy as he used to have.  Much of the time I felt quite confused as to how to proceed.  

At some point I felt as if I’d made a terrible mistake and misunderstood his wish to end.  And, so, after a lot of conversation with my clinical supervisor and with my client (with, of course, the talking being on my end of it), I decided to go back to two days a week with him, feeling that he had actually needed more support from me when he appeared ambivalent and not less.

Now, after about six months of not working toward termination, I still don’t have a sense of what’s going on with him, and there continues to be a quality of “I’m not interested in this” happening at the same time as “this is important to me”.  While I haven’t mentioned it, it has certainly crossed my mind that endings of any sort are a major source of stress for him, and his ambivalence with regard to terminating may very well have been related to his distress around abandonment.  Session endings used to cause all sorts of angst for him (he used to fight me bitterly when it was time to say “goodbye”), but these days he seems rather listless, without a lot of fight left in him. 

I was thinking on Saturday about how I often feel as if I’m failing as his music therapist.  While I frequently realize I’m not quite on the right track with a lot of my clients, I don’t usually feel as if I’m messing up the relationship and really doing some terrible damage of some sort.  As such, I started to wonder whether I was picking up on some of his own feelings of failure, or, as I mentioned earlier, if he, on some unconscious level, needs for me to fail him (like in a reenactment of the many people who have failed him in his life).  

I shared some of these thoughts with him in our most recent session, and, while he was clearly listening (he was actually keeping a closer eye on me this past session than he has been doing of late) I didn’t get the impression that I’d quite gotten to the heart of the problem.  

As I played music with him, reflecting on the situation (because I really do find that I can think more clearly when I’m using the music), I suddenly found a question in my mind...”Is it possible that the real issue for him is his failing body?”  This particular man has always been an active and very independent person.  He propels himself in his wheelchair, he moves to what is of importance to him, and he is one hell of a determined guy.  In recent years though, he has struggled with a lot of health issues- sometimes serious enough to force him to be inactive for long periods of time.  His physical strength has decreased, and he’s not as agile as he used to be, and sometimes I wonder if he is experiencing pain.  Perhaps the real failure here has been his declining physical health?

So, I asked him if he was struggling with strong feelings about the state of his changed body and physical abilities.  He looked at me.  As we sat quietly together I felt a deep sadness descend over us.  It was the kind of sadness that always makes me want to do something, and fast.  I didn’t though.  I just sat with him, because it seemed to me that he needed some time (and maybe my quiet company) to experience his grief over this loss.