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? 

Holding on to our clients' stuff

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


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


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


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


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


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


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


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

10 thoughts about music therapy advocacy- Part 2

I'm thinking that it might be helpful to know where I'm coming from in terms of music therapy advocacy as I share this list of thoughts with you. After all, you may be wondering what the heck qualifies me to preach at you about becoming an advocate? Here are some of the things I've done over the past twenty-three or so years:


During my time as a music therapist I have spent a lot of years as an active member of my state organization, the New Jersey Association for  Music Therapy (NJAMT). I was originally asked to join the board because I was a member of the former American Association for Music Therapy (yes, back then there used to be two associations, and they merged in 1998). I continued to serve, becoming Secretary, Treasurer, President, Newsletter Editor and ending as Public Relations co-chair. I am no longer active as a board/committee member, but I maintain my connection to NJAMT as the listserv coordinator. 


While I was President of NJAMT I also served on the NJCATA board (that would be the New Jersey Coalition of Arts Therapies Associations) as the music therapy representative for a period of time. I've helped to organize Music Therapy Day in New Jersey (which we have been holding in Trenton in the State House), and we organized a celebration of  30 years of music therapy at the facility where I work. 


As a performing singer/songwriter, I've talked about music therapy when I've had gigs, and I regularly find myself engaged in conversations about "what is music therapy" when I meet new people. These days I share stories about my work with you, kind readers. 


So. Yes. I've spent a good portion of my music therapy life advocating. I feel strongly about the work I do, and I care a great deal about the people I work for, namely my clients. With that in mind, here are my thoughts about what is helpful as we learn to become advocates:


1. Connect with other music therapists. Join a peer supervision group, connect through various social media outlets on the internet, or simply get to know the music therapists in your geographic area. I'm lucky. New Jersey has a lot of music therapists, and we have a fairly strong community, but we work at it, because it's important to us. Doing this type of work with a group of like-minded people standing next to you is a lot easier.


2. Know who you are and what it means to you to be a music therapist. It's very hard to advocate for yourself and for your clients if you don't know who you are professionally and why what you're doing is important. Really work at developing an identity for yourself as a music therapist. And I don't mean branding (although at some point that's important as well). What I mean is figure out your beliefs: about music, therapy, about what works for you and what doesn't, your approach, and hone your skills.


3. Be really good at what you do. By this I mean, find yourself a clinical supervisor. Yes, I know I sound like a broken record, but it's that important and that helpful. If you decide to get peer supervision instead, challenge yourself to go deeper- even if it means getting your own therapy- music therapy if you can. Look at your own issues. Figure out what issues and blocks come up for you when you're providing music therapy services, and work on them. This makes you accountable. 


4. Learn everything you can about the population with whom you're working.  Try to get as deep an understanding of the group of people you work with every day, and, as much as possible, try to learn from the people who experience the condition/illness/life experience. Learn what the issues are from their perspective, and then make a point of figuring out why music therapy is important for this particular group of people. When you have an idea of what someone's actual lived experience is like, you will be a more respectful and effective music therapist. And, by extension, you'll be a more effective advocate for your services (to people who may want to use your services, to facilities that may hire you, and, eventually, to legislators). 


5. Chat with people about music therapy. If you're a performing musician, you have a perfect forum for talking about music therapy (and sometimes a captive audience). Talk about what you do to high school students who are musicians. Tell people what you do when you're getting your hair cut. I mean, really. The possibilities are endless.


6. Answer questions about music therapy. Because I have a website or two, I get a lot of emails from high school and college students who are writing papers about music therapy. Do your best to be helpful. Sometimes people I've met (or relatives of people I've met) are considering the possibility of becoming music therapists. If they live nearby, invite them to come and observe you in your work (get permission from your clients/facility first, of course). 


7. If your state has a music therapy organization, join/volunteer. If not, start one. True, it's been a while since I was a very active member of NJAMT, but it was, and continues to be, one of the best decisions I made as a music therapist. It helped me to develop my skills as a leader, as a public speaker, as an organizer. It connected me with a lot of really great people, and it gave me a sense of being a part of something (which can be important, especially if you happen to be the only music therapist at your facility). It gave me the opportunity to do a lot of things I didn't think I could ever do. Your state organization keeps you up-to-date on what's happening with regard to legislation and can provide you with training so you know how to go and talk to your elected officials about music therapy.  They can be a resource for jobs in your state (or in a state in which you might want to relocate). 


8. Don't burn yourself out on advocacy. This may sound like kind of a strange thing to say after a big long pep talk, but it can happen. You can be all gung-ho for a long time, and it's great when you can do that! But you can just as easily burn yourself out without noticing it. And that's no good for anyone. So make sure that you have a life outside of music therapy as well. One of the best pieces of advice I got was when I observed my first music therapist ever. She said to make sure you always have somewhere to play your own music. Cultivate the many other things you love to do- cooking, hiking, reading, kayaking, sky diving...whatever excites you and lets you have your own personal identity as well. 


9. Sometimes in spite of your best advocacy efforts, things don't go as you hoped. It's the truth. Being a music therapist can sometimes be very frustrating. One of the most devastating experiences for me was spending twenty years at my job talking about music therapy, doing presentations for administrators, making sure people had information about what a qualified music therapist is, what skills we have, what training we have, and on and on. And one day, one of the other departments decided to hire a person who is not trained as a music therapist to work in a music therapy title and to "do music" with our clients. And there wasn't a blessed thing I could do about it. (Mercifully, the guy is really cool and never calls what he does music therapy, but that doesn't mean that the rest of the staff understands that he's not a music therapist.) It's important for you to know: it happens. It happens a lot. And when it does (because it will), you go back to the support system you've developed. You re-connect with the community of fellow music therapists and allies. Because you will need them. 


10. In spite of it all, love what you do. Celebrate when your clients take little and big steps. Theirs are the faces you'll see in your mind as you tell people what it is you do. Feel a passion for getting to be someone who gets to connect with people and who uses and plays music for a living. Because that is living. 


And, ultimately, that's what it's all about!

How wonderful that you're here!

Image via WikipediaWe music therapists are always trying to define what we do. Or, more specifically, help other people understand what it is we do. We write books and articles about it, we blog about it, we put together podcasts- all in an effort to convey to the masses a sense of what makes us go into this profession that seems to defy description!


But, if someone were to have asked me yesterday "what is music therapy and how does it work?", I would probably have said that it's about inviting people to be present to each other, and we use the music to help make that happen. 


Mondays are long days. For me, I go into work a little later and stay a little later. And, I think we can all agree: it's hard for any of us to transition into a Monday, which is, for most folks, the beginning of the work week. And I would say that it requires even more fortitude to get into the Monday spirit of things after a particularly long Thanksgiving weekend, which, of course, marks the beginning of the (dreaded) holiday season.


While staff frantically decorate the cottages and prepare for Open Houses (where everyone's family is invited to come and visit and there's food and music and merriment and so forth), my clients prepare for the annual anxiety of "will my family be coming to spend time with me this year?" 


So, this is a bit of the sense I got when I showed up to work with the group yesterday (Monday) afternoon- "the group" being ten men and me. 


Oh, where to begin? 


Well, let's see. There was a whole lot of messing with chairs (that would be P), switching of seats (that would be R), tossing instruments, trying to pick up instruments and then getting stuck on the floor and needing help to get up (that would be T), repeatedly rearranging and fixing the curtains so the sun wasn't blinding us (um, well, actually, that would be me), coming in, turning off the lights, and then leaving (that would be K), coming in, crying and starving to death and then leaving (a different K who does use some speech), and on and on, all accompanied by a low moaning (courtesy of J), the periodic fist to the head (of B), and the festive crashing of the tambourine (P again).


Can I get a witness? Anyone? Anyone?


Uuuhmmm. Now what?! (And if any music therapist tells you they know exactly what to do when their clients are all freaking out at the same time...just so you know- They. Are. Lying!)


I managed (do not ask me how) to get my thoughts together enough to be aware of the fact that, while the guys were all there, they weren't really There. Nobody was listening to anyone else in the room, we were all kind of...everywhere, but none of us was present to the experience of being in music therapy. 


I pointed this fact out to the guys (who, God bless them, heard me above the drama-filled din), and I asked them, "Gentlemen. What can we do here? How can we use the music? How can we use our thinking, to get ourselves to be here in this room, in music therapy, together? Why don't we just work on that, so that if we do nothing else today, we'll know that we cared about each other enough, that we mattered enough to each other, to notice that we were all here together."


Enter music. 


I moved over next to B, because I didn't want him to be hitting his head, and offered him my hand (he took it). He had been vocalizing while he was hitting himself, in a kind of a hum. So, since I couldn't play guitar with only one hand, I invited the guys to find some kind of way to hum with B to help him settle down.


I started to hum (in B's general key), and it didn't take long at all before the men found ways to join in with their voices and actions. J moved his arm, every few measures, up and then down to the beat. P, in spite of his tambourine prowess (and he really does rock on the tambourine) used his voice- which has more of an "oh" and "ah" quality. Yet another K quietly chimed in on the cabasa he was holding. R stopped moving around and sat, listening, with his eyes closed, breathing deeply. 


B calmed down and kept singing (but stopped hurting himself), so I was able to make use of both of my hands again. I played a very simple progression on the guitar- kind of an Asus4, Cmaj7, to D/F#, B, E (sometimes major and sometimes minor), and I repeated it as we sang and came together.   


It was lovely. 


There was smiling. The moving around and in and out stuff stopped. There was presence. We were looking at and acknowledging each other. 


We managed to be present in the session and we used the music to make it happen. The definition of music therapy on a Monday afternoon. 


And what makes this way of using music so cool is that this particular piece of improvised music  could only have happened on this day and with this group for it to have had any meaning. Taken out of context, it might sound okay, but it will never have the same impact as it did yesterday afternoon as we all sat quietly, after we finished, even after we sang goodbye, nobody wanting to leave quite yet, watching the sun set together.

Back off, lady, I've got this!

Image via WikipediaI tried a different approach with B today.  My usual tendency is to sit there, paying as close attention as I can (without being too obvious) and trying my best to figure out what he is (not) saying by asking him bunches and bunches of questions (and driving both of us crazy in the process). 


Yes, even I realize that asking tons of questions is annoying. 


And, no, he doesn't use speech, but when he truly needs to make sure I hear him, he is quite clever in his communicative style.


Well. He was reclining (as he does) on the couch in the Music Room, and he was very specifically looking off in the distance (read as: "I am not looking at you! NOT looking at YOU!"). Okay. Got it. We are not looking at me. Fine. Onward. 


I, of course, started to leap in with my usual round of questions ("Rough day? Too noisy in the cottage? Feeling off because we changed our session time last week? Blah? Blah blah blah? Blah, blah, and more blah?"). Okay, I'm not really proud of the fact that I did this, but I did. So. There it is. B's response? Stay the course. Keep staring straight ahead. 


Hunh. That was effective. 


I stopped (thank God). And I thought, "Try again, Roia. Settle it down, and try again."


So I said to him, "You don't really seem to be ready to be dealing with stuff right now. Why don't I just play piano over here, and when you're ready, you let me know."


I rummaged through the stack (really- there's a stack) of (countertransference) songs I've used in his sessions, and I pulled out the Beatles' song, "Don't Bother Me". I hemmed and hawed (internally) for a bit and decided to just play it on the piano rather than sing it. It didn't seem right to break the silence with words just yet. 


I played through. Aside from tossing the bells he was holding and then picking up the mallet, there wasn't much (visible) change. Moving right along. 


I rummaged some more, and I found "Out Here On My Own" (from the movie Fame). (Anyone else sensing a theme here?) I really wanted to sing the words, but it still didn't feel like it was time to do that, so I played through it with just the piano. 


I feel as if I need to explain two important things here:


One is that the songs I chose were intentional- not as random as it may seem when you read my writing. I wanted to reflect his need for some emotional space, but I also know that he's been struggling with trying to come to terms with what our relationship is and is not (which is a gentle way of saying that I'm trying to help him understand that "we don't have that kind of a relationship.") He has not been happy about that, and although I think that, on some level, he gets why it is the way it is, he still feels very abandoned by me right now.


The second thing is that B spends a part of almost every single session, pulling me to the door and flicking the light switch off and on (you may draw your own conclusions as to what that particular habit may be helping B to say to me). 


Great. So you're up to date. Back to the music...


This time the mallet was tossed, but B still sat quietly listening with his gaze firmly averted. 


I sat quietly for a while (even I can sit quietly sometimes) and waited. 


B leaned forward and tossed the maraca (which he uses to express anger) and tambourine (to express uncertainty) on the floor and was ready to hurl the cabasa (for conveying disappointment and sadness) as well, but I managed to stop him just in time (did I mention he can make sure he's heard when he has something to say?). 


"Maybe," I suggested, "I'll play the song I just played again, only this time I'll sing through it with the words. B, why don't you sing it with me. You can use your voice, you can pick the bells back up and use them, you can move...just pick a part of the song that feels right, and join in." 


So I went back to the piano and started (again) with "Out Here On My Own" 
(Lyrics: Lesley Gore, Music: Michael Gore; Copyright 1979)

Sometimes I wonder where I've been,

Who I am, do I fit in?

Make believing is hard alone, out here on my own.

We're always proving who we are-

Always reaching for that rising star

To guide me far and shine me home,

Out here on my own.

(Chorus)

And when I'm down and feeling blue

I close my eyes so I can be with you

Oh, baby, be strong for me, 

Baby, belong to me. 

Help me through. Help me need you...

The minute I started singing the chorus, B joined in! He got up, started to hum in a low tone and rock back and forth. Then he headed over to the light switches and started to flick the lights up and down in time to the music (I could tell, because he paused so he could stay with the beat)!!


He stuck with me- moving, vocalizing and light switch flicking- until I got to the very last words of the song ("out here on my own."), at which point he came over and stopped me from playing any more by pulling me to the door (not because he wanted to leave, but because he wanted me to stand with him). 


Wow. Just...wow. He was glorious.


Clearly, the strong feelings of loneliness and longing are still very present for him. The beauty of this profound musical moment (as I see it) is that B now feels safe enough to fully participate in the experience of actually making music. And I do need to point out that this has taken quite a lot of years. For much of the first twelve years of our work together, he largely avoided using music- often barely even allowing me to use music!


The fact that B was not only willing to sing with me (and in such a creative way), but to make sure it had meaning when he did it, is what makes this work so amazing!


I guess the question (for me) now becomes: knowing that when you back off and allow your clients to say what they have to say, they will not only do it but do it beautifully (and you don't need to worry them along), what's preventing you, Roia, from backing off so much of the time? And what is it you're afraid of hearing when your clients do "speak" to you through their music?

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. 

Who knows?

Image by kool_skatkat via Flickr

One of the things people always ask me when they learn that I work with people who don't use speech to communicate is this: "Yes, but, how much do they really understand?"


And I always respond in the same way: "Just because someone can tell me verbally that they understand what I'm saying doesn't mean that they do."


My policy (if in fact one can call it a "policy") has always been to treat people as if they're understanding me. I figure it's the most respectful approach. And I'd way rather err on the side of presuming competence than insult someone by assuming incompetence. 


Usually, for me anyway, the more salient issue is whether or not I understand what the people I call "my clients" are trying to say to me.


Last week, for instance, I could clearly see that B was trying to communicate something to me. He wasn't doing it in a particularly effective way, but he was clearly trying very hard and being quite patient. He'd stand up, repeating his action in almost exactly the same way each time, and then he'd pause, waiting for me to miraculously get it.  


I didn't. 


Well, really, I couldn't. He wasn't giving me enough information. 


It was obvious that B perceived my attempts to hear him, because when I said to him, "I'm not understanding you" he'd sigh, and he'd try again. 


I encouraged him: "Use the music to tell me." 


And he picked up and tossed the instruments on to the floor, retrieving them and throwing them again. Over and over.


After, I swear, ten or twelve times of making this effort with no hope of my figuring out what he was trying to say, we just sat there together. 


Frustrated.


Neither one of us could fix this. 


So we sat. In silence. And we felt fully how frustrating it is to not understand. To not be understood. To not know. And to not be known. 


I wondered, as I sat with him, if what he really needed me to understand is that this is his experience of silence. 

1/12/10 Quote(s)- Music therapy and power

Image via Wikipedia

I think a lot about power in the music therapy relationship, to the point where I've even presented on the topic. 


So I was thrilled to find an article in the British Journal of Music Therapy by Randi Rolvsjord called "Whose Power of Music? A Discussion on Music and Power-Relations in Music Therapy" . 


She offers a thought-provoking perspective I hadn't even thought to consider. 


Well, I've probably considered it, but right now I can't recall when.


I've quoted her article rather liberally below, but the basic question I think she intended for me to ask myself when I finished reading the article was this: 


Are we taking away our clients' power when we attribute their progress to the "power of the music" or to the "power of our interventions"?


Just in case I'm not getting it right, I'll let Randi Rolvsjord say it in her own words:

In a contextual approach, the therapeutic outcome is primarily related to the client's ability to use the therapeutic context to make important changes in his or her life. With the therapist's help, the client uses the space provided in therapy to activate or mobilize resources for change (Bohart 2000: 130). In a contextual model, the specific "ingredients" (techniques and procedures) are not seen as the main source of change in the therapeutic process.  

She goes on to address music therapy more specifically:

A contextual approach impels us to shift our attention away from the therapist and the perceived inherent capacities of music, focusing instead on how clients make use  of music and music therapy in their efforts towards health and quality of life - and perhaps even towards music and musical experiences and activities. This does not require us to stop considering music as a powerful resource that can be used therapeutically: rather, it requires us to acknowledge the need for a client to make use of it, or relate to it. It also suggests that the client's own use of music is probably more important than the therapist's use of music, impelling us to consider how we can better nurture the client's own resources for health-related musicking. 

She notes:

When music therapy "works", it is primarily because clients are able to access music as a health resource. To support this process, it is necessary to hand back the "power of music" to our clients and enable them to use their musicality and musical competence, their musics, and their musicking to promote health and quality of life. 

And she repeats:

With a contextual approach to therapy, the focus of therapeutic effectiveness is shifted away from the expert-therapist implementation of effective interventions, and instead toward the client-therapist collaboration concerned with access to music, with enablement and empowerment. I have argued elsewhere (Rolvsjord 2004) that such a process of empowerment implies focus upon the nurturing and development of strengths in a mutual and collaborative relationship. 

I have to admit I don't know a blessed thing about the "contextual approach to therapy", but it sounds interesting, and I believe I'll have to go do some searching to find out more.


Anyone else out there have any opinions to register about this form of power within the music therapy relationship?

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.    

"Feelings...nothing more than...feelings"

For the umpteenth time today, while I was with a client, I noted that the folks I work with who are on the autism spectrum are far from “removed” from their feelings.  

One of the men I work with was, to my eyes anyway, clearly struggling with his feelings a great deal when he arrived at his session.  For the record, he, as with most of the people I support as a music therapist, does not use speech to communicate.  

Truly, the fact that he even came to his session was a big deal, because he has been in his, let’s say... apparently ambivalent?  Yes, we’re experiencing his apparently ambivalent phase again.  He seems to want to come for his session, then he gets stuck (as in, stops moving and seems to want me to pull or prod at him) at every door (hmm, that whole getting stuck at the door thing is an interesting symbol in and of itself, eh?).  

Today, though, he agreed to put many of his beloved plastic objects into a clear plastic Ziploc bag I’d brought for him.  (That way he can have his stuff- mostly blocks and little plastic items- with him but not need to tap them all on the pavement outside in the middle of the road.  And he is still be able to see his objects, because the bag is clear.)  He came out the door with me, and we got to the Music Room alive and well, in spite of a few unexpected lurches forward as we walked.  

He immediately went to get the mallets so he could whack the xylophone and to whack at the piano with them.  He did this while I was trying to get my guitar strap over my shoulder and organize myself to play with him.  Too late.  By the time I got it together he was pretty much done with the playing, and he’d hidden the mallets (and a tambourine he found on the piano) in the other music therapist’s cart.  

As I watched him roam around the room (he doesn’t generally sit with me), I realized how hard of a time he was having with his feelings and trying to cope with them.  I had such a strong sense that he was doing everything in his power to be in that room with me, because it was important to him- even though it was also very difficult. 

I commented on this to him- this supposed disconnection from feelings that autistic people are “supposed” to have and how it seems as if the opposite is actually true- particularly in this moment we were sharing.

I told him a friend of mine, who is also autistic, has expressed envy of me on more than one occasion with regard to my seeming ability to “take it all in” (“it” being life and all the emotions which accompany life) and not seem phased by it (versus needing to take a long break from people just to process it all). 

His facial expression didn’t change much, but he did move to stand in the music-making area (where I was sitting) instead of hovering around in the office area.  The song that came to my mind was “Think in Colors”- a song I wrote.  I actually wrote it, because of a deep caring I was feeling for the folks I work with, but, for the first time, I wondered if it could be sung from my clients’ perspective instead.  

I didn’t sing it immediately, because I wasn’t sure it was time or if it was the right song.  When I did decide it was time and I played it, he came and stood in front of the chair I always put next to me, hoping that someday he’ll come and sit there.  As I played, I managed to reach over and move his bag of objects (which I’d put there when we arrived and which he’d ignored since we left his cottage) to the floor in case he wanted to sit.  

And he sat with me until I finished playing the song.