"You are showing them that they exist"

Excerpt From the transcript of the On Being show in which Krista Tippett interviewed Michel Martin:

MS. MARTIN: What we are simply saying is, I see you. I mean, I know for example when — you know, when I was working for “Nightline,” and I went to Turkey after there was a terrible earthquake there, and like, you know, thousands of people were killed. And I was feeling really useless. Um, thinking, boy I wish I were a doctor. I wish I were a structural engineer. I wish I could do something more useful. But then people would come up to me and say, thank you for being here. And I would feel, like, wow, why are thanking me? And then I thought — and I called my — you know what we do at a time like this. You know, I called my husband, because [laughs] I really feel like so useless. What am I doing here? And he said, you are showing them that they exist. And I appreciated that, because I’ve held onto that. It’s like sometimes the best thing we can do for people is let them know that we see them.

MS. TIPPETT: Mm-hmm.

MS. MARTIN: And so sometimes, you know, other people’s bad news is, you know, their lifeline, and letting them be understood. In fact, this was the very first story I did when I was at The Post as a little baby reporter at The Washington Post, and I was sent out on the summer — it was one of those terrible stories that you hate to do because some little boy had fallen out the window of the projects.

MS. TIPPETT: Yeah.

MS. MARTIN: And I had to knock on the woman’s door to get a comment from her. And I kid you not, I walked around the block three times before I mustered the courage to knock on her door, because I knew I had to. And I felt like, you know, and I knocked on the door. And she — and I said, I’m so sorry, I heard about your son, I came to see if there was any — a comment that you had. And she said, where have you been? Because she felt that if someone from the media didn’t come, then this was invisible and it had no meaning. And she had things she wanted to say, like why weren’t there any safety screens on the windows, which there were supposed to be. So, I bring that up to say a lot of times, what sometimes what middle class people see as intrusion, other people with no power see as validating their existence.

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This part of the conversation was so meaningful to me, particularly a day after sitting with my clients in their "I hate this place!" rage, fear, anxiety, uncertainty. Literally, from the first session to the last, I heard some variation on this experience of powerlessness. In the first cottage, one of the women was screaming about how much she "hates this place!" The person I actually went to pick up for her session was having a rough time of things, and I found myself feeling quite lost and powerless to be of much help to her. The person I worked with in the afternoon was clear in his wish that I would take him away, because he indicated a wish to leave the session space for a while and he directed me straight to one of the vans sitting in the parking lot. 

My last session was with a challenging group of men who live in an untenable situation- stuck in a room, all day long, dependent on whoever was coming in to support them, and angry, frustrated, powerless. One of the men, the youngest in the group at only 31, yelled and yelled and yelled, as he often does, but this time, even though he doesn't use words to speak, I distinctly heard, through his yelling, the words "I HATE THIS PLACE!! I HATE THIS PLACE!!" 

Our session had begun with one of the guys being pushed back into the room by his annoyed staff person. I knew he preferred not to be with us, and I had encouraged him to go and be in the other area, so instead of taking off his shoes, his shirt, his pants and grabbing at me, he kindly got up and walked toward the door. His staff person pushed him back in, because, she said, "he keeps going and leaving the day area and eloping, and we are so short-staffed, I can't watch him and all these other guys as well, so he's going to have to stay in here! Everyone gets frustrated that there aren't any staff, and then they call off!" She, too, was in an awful situation.

It was hard to know what to offer the men, musically, that could even come close to supporting them. All I could do was acknowledge it and let them know, "I hear you, and, yes, it is very hard to live here, and right now it's also very hard to work here. And I hear you saying you hate this place, and I'm sorry you're feeling so disrespected." 

And so, as I felt as if absolutely nothing I could do would be of any help to the guys, one of the most poignant moments was when the young man who was screaming came over to me, after four times, handing me my guitar case and seemingly letting me know he wanted me to leave, picked up a brush that was sitting on the table, and he handed it to me. I was holding my guitar, and I thought, "Whaaaa?" Until he pulled my hand to his head, and he kept a hold on me as he slowly had me brush his hair. 

So, Michel Martin, thank you for reminding me that what I do have to offer my clients is "show them that they exist."

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!  

Asking for help (the hard way)

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

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

Because that would be missing the point.

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

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

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

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

Thanks to juliaf for the image!

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

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

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

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

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

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

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


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

Behavior? Or unanswered question?

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


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


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


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


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


Hm.  


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

Who's in charge here?

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


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


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


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


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


Well. Okay...but...


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


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


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


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


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


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


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

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