"He's not cranky- he's mischievous."

Her exact words were "he hasn't been cranky- he's been mischievous!" 


I was thinking about what she'd said the previous day about S as we started our session.  As his support staff, she probably was finding him to be rather frustrating. But, in my mind, there has to be a reason for it. 


What does it mean when someone's being mischievous? What if he's learning to assert himself? What if this means he now has enough of a sense of 'self' to assert? And he's not there yet, but he's trying to figure out what having a 'self' means?


That's kind of cool!

Now, back to S in his music therapy session. He was very quiet. His music was also quiet- contemplative, more interactive (in contrast to his usual energetic crashing and playing with great energy and a few brief pauses). He didn't play when I played. He was clear that this was a conversation, not a jam session where we play together. 


Self and other. Separate beings.


Wow. A major developmental step!

A modern chorus line (Photo credit: Wikipedia

A part at the very end of the first song from A Chorus Line ("I Hope I Get It") came to my mind as we stood together (a part which, frustratingly, they didn't include in the video I'm linking):

Who am I anyway? 

Am I my resume? 

That is a picture of a person I don't know. 

What does he want from me? 

What should I try to be? 

So many faces all around, and here we go. 

I need this job. 

Oh, God, I need this show.

I sang it for him, and I talked a little bit about the context for the song. It's sung by a man auditioning for a part as a dancer in a chorus line- which, to me anyway, seems to be a sort of anonymous group of dancers in a Broadway play- the goal of which is to be as uniform and in unison as possible. The character who sang this section of the song was thinking about his identity. I interpreted the lyrics as saying here's a man who is trying to come to terms with the face, the persona he has to present in order to get a job as a dancer.

I connected it to how I thought perhaps S might feel as a man with a disability who lives in an instituionalized setting. Having to put on a face (a persona), perceived by people, based on his behaviors and what is written about him in the institutional paperwork. 


Perhaps he too is wondering: who am I anyway? Who or what defines me? How do I define myself? And what does it mean in terms of safety, my identity as a man, as a disabled person?

Again, his musical responses (taps on the drum or tambourine) were very thought out and short.

We had about 5 minutes to go. I invited S to help me know if I'd been on the right track (by glancing my way) or if not (by making a sound). After a while, he looked my way, and he went slowly to the door and walked out.

Thinking he was done with me (and that either I was way off and misunderstood him- or he needed a bathroom, or maybe he felt a bit overwhelmed), I packed up my stuff. 


I was just about to follow him out, when he reappeared at the door!

He came back over, and I took out my guitar again. I sang a goodbye, in it telling him how excited I was for him. This is a truly important, although difficult, period in his life- one with the potential to offer him growth and a deeper self-awareness. He stayed until we finished, tapped the tambourine goodbye, and we walked slowly back to the day area.

Once we got there, he hovered near me (he doesn't usually). Then he reached into my instrument bag and borrowed the tambourine again, tapped it a few more times, put it back in the bag, and he headed off slowly in a different direction. 


See you later, S. 

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. 

Video journal #1 (So THAT's what Countertransference Sounds Like)

Seriously. What is with me and all this numbering? 

Anyway...

With all this conversation about trying different forms of journaling (okay, maybe there wasn't any actual conversation, but it's definitely something that's been on my mind), I decided I wanted to try a video journal. So I did an improvisation after a session. Here's what that looked/sounded like: 

After I listened to it, it occurred to me that it sounded sad and sort of poignant. I was struck by how extremely consonant it was as well. I didn't think it would be. I guess the point is that maybe on some level I did know what might have been going on in the session, but it just hadn't become conscious yet. 

Journal Prompt #2 (Who are you again?)

Image via WikipediaWow! First, let me thank all of you who were kind enough to join me in this path of self-reflection and exploration! It has been so neat to hear from you and read your thoughts and responses. I've truly been honored that you've taken the time to share your experiences, and I'm excited to hear/read/see more as we progress!


For my part, I have started to make short videos after some of my sessions (particularly with clients who challenge me or about whom I find I have a lot of feelings) in which I share my thoughts and reactions regarding the therapy experience on that particular day and then play a musical improvisation describing what it was like to be in the session.


It has been interesting for me to hear how being with different clients "sounds" (at least from my own musically and verbally expressed point of view). Of course, it's hard not to hear my own issues and musical patterns creeping into the music (oh, yeah, therapy 'til I'm dead, baby). 


I'm sort of wanting to share some of the videos, but I want to be sure I'm not violating any ethical rules and/or regulations in order to do so.

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

Meanwhile, it got me to thinking about Journal Prompt #2:


For most of us, during our busy weeks, we see lots of clients. And there are always the people we work with who stay with us and stick in our minds. 

But there are also clients we completely forget until we see them the next week.
And I started to wonder, why?

Who am I forgetting? Do I forget this person/group all the time? Or is there something going on with this particular client/group that I just want to avoid? Or that I don't like dealing with for some reason? 

What is this person triggering within me? Is it something about this person? Or is something going on with me? Why is it this person/group that I forget?

What is it about this person that feels "forgettable" to me? What might the fact that I'm forgetting this person/group be helping me know/learn/wonder about how this person perceive(s) him/herself? 

How does my forgetting this person/group have meaning in the context of this individual/group's life?

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

As you can (plainly) see, it was kind of difficult for me to formulate the questions, but, for me anyway, that's part of the process- figuring out better questions to ask myself. If you come up with a better question to ask (or simply find a better way to word the questions I already tried to ask), do tell.


As always, if you feel comfortable sharing, you're welcome to use the comments section to offer your thoughts or (if you blog) post a link to your blog post or You Tube video. Perhaps you might want to play contrasting musical portraits (a Ken Bruscia suggestion) of a client you think of often and a client you tend to forget, and either video or audio tape the improvisations. Or write a song about a client you've forgotten and share it with us. 


I so look forward to your latest installments!

The Act(ion) of Thinking

Image via WikipediaI've been thinking about RD of late (well, particularly today, because we had a session this morning). 


RD is a very sweet young man on the autism spectrum (he does not use speech to communicate), and he is very particular about things. And by this I mean that he seems to believe that all things should have a place (I think I can thank one of his family members for his excellent manners and his tidy nature.)


It so happens, that we work in a terrifically messy room in his cottage (oddly enough, it's the, um, "sensory room") (yes) (well). 


Anyway. 


No matter how much I try to clean up all the clutter in the place before I go and pick him up for his session, he still finds things to, er, tidy. 


He also likes checking out all kinds of objects. He has a collection of action figures with giant feet (I don't want to know!), and his staff people find him books and various things that have moving parts to them. He keeps them all in a big box with his picture on the front. Great! 


So. Back to the aforementioned "sensory room"...


Because this is, apparently, a full service sensory room, there are almost always broken battery-operated sorts of things lying around in varying states of function and dysfunction. This means that the batteries are lying around (lovely), and the little parts that keep the batteries quietly tucked inside the gadgets are also roaming about freely.


RD, being the tidying kind of guy he is, and being the kind of person who likes to bond with objects, has been picking up these little plastic parts that were supposed to hold in batteries. He just turns them over and over in his fingers and holds them close to his face so he can examine them.


While he's doing that, he sings. He hums little melodies (I've come to learn that he repeats specific melodies with small variations here and there). I either sing them back to him or play them on the guitar (with my own variations and chords). And while he's scurrying about the room arranging things, we sing and play back and forth with each other. 


The other thing you need to know is that, when he borrows an instrument from me (to check out as described) he often puts it back in the closet that's in the sensory room. As such, I have to go and retrieve the instrument quickly because otherwise it'll be there for all eternity (I have reached the official limit on my brain's memory card, and, let's face it: some things are just going to have to go!). 


Now, not only does he take my stuff and put it in the cottage closet, but he puts stuff he picks up in the cottage on my music cart or in my instrument bag. I am forever pulling things out of my bags (after his session) and putting them back in the room (back in circulation, as it were).


Okay.


So, as I mentioned above, I was thinking about RD, and I was wondering: why does he keep putting cottage things in my bags? And why does he keep putting my stuff in the sensory room closet? What's that about? Is there something he might want me to know? Or that I should be noticing about this?


And I thought, hm. So I mentioned to him during his session that maybe he needs to have me hold on to a small piece of him when I go (i.e., don't forget me, please). And maybe putting my stuff in the cottage closet is a way for him to keep a piece of me as well. 


When I gave it some more consideration, it occurred to me, again, that here's a guy who likes everything to have its own place- whether it's the "right" place or the "wrong" place. And I remembered that he himself grew up in a few different places, being sent around to various family members, because his mother died when he was an infant. 


And now here he is with us, in an institution.  


And it made me think about objects. And about having a place to be. And I wondered (out loud to him) if maybe it was important to him that he have a specific place to be. And what his thoughts are about being in the "right" place or the "wrong" place. And which one he feels the institution might be.


RD's response was to increase his singing. He and I sang back and forth for ten more minutes than usual today (we usually make it for 20 minutes, but today it was 30!) before he hopped up and began pulling the guitar off of me to indicate that we were finished.


So, I'm thinking this is veeeery cool. 


Definitely warrants some more thinking...

And how was your day, dear?

Image via Wikipedia
On the plus side, nobody got hurt (although there were some brief reminders to the effect of "nobody really likes to get their head tapped unexpectedly, K."). On the not-so-plus side, I'm guessing it'll take kind of a while for my co-worker in recreation to sort through the two big stacks of paper from her desk that, um, well, er, ended up all over the floor when I turned my back for a minute to deal with L. 


I think I can safely say that this particular session felt like it was the exact opposite of the lovely one I described  to you a few weeks ago. 


Here's how this whole party started: 


I arrived in the cottage, fully aware that the women there were almost all sick with colds and stomach viruses (lovely). I had called earlier in the afternoon to ask if I should come over or skip it, and I was told, "well, people are running around with the sniffles and stuff, but..." (which I'm fairly sure was code for "Get your a** over here, lady! We've all been suffering through this, and you'd just better do your time!")


First thing, G (one of the more chatty ladies who live in this cottage) came over to announce to me that I should "stay away" from her because she's "sick as a dog," after which she proceeded to follow me around and ask me questions repeatedly until I finally got the women who are actually in my group assembled and closed the door with a firm "I'll see you later, G. Hope you feel better." [Insert heavy sigh here.]


Honestly, I was quite happy as we got started (although a bit nervous) because M had actually joined us. Her staff person walked her over (at my request), and she had miraculously managed to convince M to walk in to the session area with us! Usually I get her as far as the door to the room where we work, and she starts to hum loudly. Then she won't go in to the room with the other two or three women from the group, and she won't go back to her day area either. 


Inevitably, V gets annoyed because she is waiting for the session to begin, so she scoots (she moves on her knees usually- she has a wheelchair, but she tends to hop out of it when she gets to the room) out of the room where we work and sits on the floor, watching me and looking impatient (I'm sure if she were able to stand more comfortably there'd be foot-tapping involved). 


It took some doing for N to get in to the room, because her OCD was making it plain difficult to get through the door. We waited for her and she got in. The problem, however, was that K was sitting in the chair that N prefers to use. Stop. The. Presses.


So. N pushed and pushed (in spite of my requests that she stop doing so) at K (who, on any other day, prefers to wander around the room and throw everything she touches on the floor or across the room), trying to get her out of "her" chair. Having very little luck (K is pretty hardy), N (no slouch herself) took hold of K's shoulder and her behind and unceremoniously shoved her out of the chair. 


Oh, dear.


Somehow, I managed to get K moved to another chair at last (to the one that V prefers, God help me). Mercifully, V decided to stay in her wheelchair for a short period of time. 


Then I had to figure out what to do to get M settled, because she kept coming over to me with magazines that were in the room and insisting that I hold them. Finally, I got the message, tore out a page and handed it to her. That seemed to be what she wanted and she promptly found herself a chair and proceeded to rip paper peacefully.


For twelve blissful seconds, we were all sitting quietly (it was such a glorious moment) when we heard a loud crash at the door. 


"[Expletive deleted]! What now?!?" (I thought, loudly, and in a rather un-music therapist-like fashion.)


L arrived, right behind her giant walker (the thing that had crashed into the door), and she decided she needed to come in and sort through the plastic groceries in the faux grocery basket (that lives in the room we use) right now!  


And L, I need to tell you, is not exactly Miss Let's-Talk-About-This-Shall-We-America."


Dear Lord!


Of course, since we were all sitting (for those twelve brief, yet happy, seconds), this required rearranging everyone so L could get to the table (which was, of course, behind everyone). 


Well, not entirely unexpectedly, in the process of tending to L, and rearranging the furniture and the various people contained therein so nobody would get run over by L's giant walker, K got up to explore, and that's when we heard the two huge piles of paper from the recreation staff's desk hit the floor. 


Cheeeeeeck!!!!


I couldn't, for anything, get K to sit anywhere, so I gave up and tried to pick up the giant mess of paper and put it somewhere somewhat unreachable until after the session.


While I was dealing with the paper, V decided she'd had enough, so she headed out the door and sat in the hallway, chin in hand, waiting for me to chase after her. Since I'm not supposed to leave V alone (and I'm not supposed to leave M or K alone either), I put a chair in the doorway so I could keep an eye on the group and on V at the same time. 


V, in spite of my best efforts, turned tail and headed back into the day area (through the bathroom door that's across the hall from our room). And, much as I hate to admit it, by that point I just figured, "Okay, that's one less person to worry about right now. Amen."


K roamed around the room some more, tapping N on the head unexpectedly. And M continued her page tearing adventures, assembling the tiny pieces neatly on her lap. 


Now.


I'd love to tell you I was able to make a brilliant interpretation to the women in the group about their actions and how they seemed to be all about going from crisis to crisis, and there's all manner of "no, pay attention to me" and some sadistic teasing, all in conjunction with the  incredibly overwhelming way they interact with me and with other people in their lives. 


But no.


Heck, I'd love to say that there was even half enough emotional space left in the room so we could even start to look at that, but that is so not where the group is yet! 


Evidently, the group's goal for right now is to (through their actions/interactions) convey as loudly and dramatically as possible, "Roia!! This is what it feels like to be here. To be us. To live life!!! Do something!!"


And, for now (I have learned) (rather slowly, I must add) that my job is to just listen and get through it. And show up next time and get through it again. And keep setting limits and keep trying to help them use the music or use the music myself.


At some point, they'll be ready to hear me talk about what I'm seeing/experiencing in that group, but not yet. 


Definitely not yet. 

Eating a slice of humble pie

Image by shandopics via FlickrI knew if I waited a while, calmed myself down and thought about it in a peaceful state, I'd have a better idea of how to proceed with C. 


You may (or may not) recall that I wrote about the dreadful session I had with her a couple of weeks ago. I was feeling terrifically annoyed with myself (among other sources of annoyance) because I had allowed my anxiety about staff being upset with my "letting" C strip in music therapy (I mean, really?) cloud my therapeutic judgment. 


Ugh!


So, as I was driving back from Michigan (which is quite a long drive when you're headed to New Jersey) to visit my friend (a music therapist turned music librarian, as it happens), I was thinking about the coming week. Naturally, my thoughts turned to Monday morning, C's scheduled time for music therapy. 


I had (yet) another twinge of guilt as I remembered our last session before I went on vacation (just for the record, it's not unusual to have a horrible session right before a vacation- in fact, it's one of the, er, perks of being a therapist). 


And let me just say, it was not one of my shining moments as a music therapist. 


As I was trundling along the Ohio Turnpike (where they have very nice rest areas, I must say), I wondered what I was supposed to do about the stripping. I didn't want to stop working with her, because, in spite of the exposure episodes, there were moments of actual connection in the music. 


I tried to perceive the situation from C's point of view (something I've tried to do before), considering the idea (again) that she may, in fact, feel exposed. 


Then it suddenly hit me! 


A forty-five minute session is way too intense for her! Sure she may appreciate parts of the experience, and she may even find herself engaged meaningfully with the music (maybe even with me), but she's not even close to being ready to deal with that kind of constant attentive interaction for that long of a period of time!


Of course!


I need to start out with very short sessions (five to ten minutes at most) and gradually learn when C is letting me know she's ready for more time. 


Honestly, sometimes I think I've been at this a bit too long that I could manage to forget something as basic as that. As basic as: can this client tolerate a 45-minute session, or should we start small and work our way up? 


So, today I showed up in the cottage feeling a little more confident (with regard to the staff), and I explained my plan. I'm not sure they were as enthusiastic about my plan as I was, but they were agreeable enough (which I appreciated).


The supervisor (for some reason) decided to get C, and we sat outside of the room where her group was meeting.


The first thing I felt I needed to do was to apologize to C for misdirecting my frustration in the previous session and aiming it at her. Then I acknowledged that I had not remembered that when someone is paying very close, unwavering attention to you for a sustained period of time it can be uncomfortable as hell. 


I told C my plan. "We'll start with a ten minute session. I'll practically be singing 'hello' and then 'goodbye' and then we'll stop, and I'll plan to be here next Monday again."


C, tucked under her blanket, tapped her hand against her leg. I sang "hello", she listened quietly, then I heard her giggle and vocalize with me a little bit. Then I asked if she needed anything else from the music before we ended for today. She vocalized a bit more. I sang "goodbye," put away my guitar, and I escorted her back to her group. 


She was smiling.

What's that you say? No clothes?

Image by gynti_46 via Flickr

Periodically, when I'm minding my own business and doing a music therapy session, I will have the experience of one or the other of my clients suddenly deciding that removing his or her clothing would, at that very moment, be the most effective means of communication. 


Ahem.


I mean. Really. Must you? 


I don't know about you folks, but I am fairly certain that this particular topic was never covered (if you'll pardon the accidental pun) in music therapy school. 


As long as I've been a music therapist (and, let's face it, it has been quite a long time), I've never quite come up with a response that I could really say I'm happy with when I'm faced with a naked person in one of my sessions. 


Obviously, my usual response (did I say "response"? I meant "reaction") is to remind the person that we keep our clothes on in music therapy, because it keeps us all safer. And, if the person is not actively attempting to get his/her clothing back on, I do tend to offer to assist. 


All of which  may or may not be the "right" thing to do, but that's how it usually plays out.


Okay. So we all know I'm not a behaviorist. And I don't do activities. And my approach as a music therapist is generally to try to understand what the heck is going on when my clients are using whatever action they're using in order to make their point (presuming, of course, that they have their own personal reasons for choosing this particular action) (thank you very much). 


And, being me, I try to pay attention to my own emotional responses, because my experience has been that people who don't use speech will often try to get me to feel what they're feeling so I "get" what they're trying to convey to me. 


In the past two weeks I've had one man yank down his pants and underwear mid-session, and I've had a woman remove her shirt and bra (several times) in her session.


And I'm trying to make sense of these things.


So, if you don't mind, join me as I stumble along through my thought process, trying to understand what all this nudity is about.


Generally, I start with: what is this person trying to say to me?


Sometimes it's "I need a bathroom, and you weren't picking up on any of my other cues." (That's usually the first thing I ask about, because it has to be the worst thing in the world to need a bathroom and to not be able to say, "Hey, excuse me, but I've gotta go. Now!")


It could be sensory discomfort. Reasonable enough, I suppose. But if the person wasn't trying to get naked every other time s/he was in music therapy, or wearing clothes...Well, it's hard to say. 


It could be anger. 


It could be a way to say, "I feel exposed in front of you, Miss Music Therapist, asking me all these questions and paying way too much attention to me!" 


Or, in other words, "You're making me uncomfortable with all this music therapy, lady! Now I'm going to make you uncomfortable. How do you like me now?"


I suppose it could also be a way to ask me a question, such as "how safe am I if I expose myself to you, Roia? Will you hurt me? Shame me? Ridicule me? Violate me?"


Or "how will you act toward me if I do something considered taboo (since I can't tell you with words about the difficult things that have happened in my life)?"


Hm. 


As it turned out, with the woman, she did need to use the bathroom. But I still think there was more to it, because I'm still quite new to her (we've only had three sessions). I know she has sensory issues, but she also may be trying to learn something about me.


I'm not so sure about the man's motivation for pulling down his trousers. He didn't need a bathroom (I asked). He doesn't like leaving his session when it's time for us to end. He does have strong feelings toward me. I know I frustrate him because I can't fix it all by taking him away in a car. 


Sigh. 


As is often the case, I'm left with "I don't know." Sure, I have ideas, but I don't know.


And, as always, I tuck the latest bit of information into my head (along with all my interpretations) and keep on going. 


Until maybe someday when another action occurs, I'll have another tiny piece of the puzzle to add to my understanding of the person standing in front of me. Exposed. 

People in pain

Image by Migraine Chick via Flickr

Monday.


I don't know what it was about this past Monday, but it seemed a day of pain for some of the women in my sessions.


Lately, having experienced a medical situation myself that causes a lot of physical discomfort, I've developed a far greater appreciation for the deep frustration and futility that goes along with chronic pain.


Both women were crying, each doing her best to cope with her body in the best way she could.


The first woman, C (I saw her first thing in the morning), is still fairly new to me. Some of her staff seemed to think the fact that she sat on the floor on her behind and scootched herself forward was (aside from being odd) because of my being someone new and unfamiliar.


OK. I guess the fact that C screamed and cried through much of the session, after throwing her shoes at me (boy, did I have a flashback to George W. Bush and the shoe throwing incident. But I digress.) but didn't try to leave may have been because I was new as well. But she certainly seemed to be hurting from what I could tell.


I sat with her and nearly cried myself as I musically accompanied her frustrated tears and sounds. She reached her hand out to me once or twice, and I did my best to move over (we were sitting on the floor) to be within her grasp.


C then went back to stripping off her clothes. Of course, she first made a sign that looked like "toilet" with her right hand. We managed to limp out the door and into the hallway (where she sat down and proceeded with the stripping process again). I managed to get her dressed and we hobbled into the bathroom area where she completely stripped down. At which point I got someone a bit more familiar with her to get her dressed again.


She then went to sit at the table and seemed mellow and cheerful. That was when her staff let me know that C was just messing with me because she doesn't know me. "See? She's happy!"


Yeah. 


In the second situation, V, when I arrived was restrained because she had been thrashing her head into various hard objects (the floor, the wall, the door, the wooden sides of the chairs...), and her staff felt freaked out (who wouldn't freak out seeing someone do that to their body?). 


One look at her, and it was clear (to me anyway) her sinuses were bothering her. A lot. Her nose was running furiously, and her eyes were swollen shut. (This is a person I've known for a few years, and she is always stuffed up and particularly unhappy when allergy season is in full swing. I also had had a headache the entire day from the shifting weather patterns, so I didn't come up with this thought out of the clear blue, as it may appear.)


Anyway, she came out of restraints in time for the music therapy group to start (thank goodness). We were attempting to make the trip from the day area to the room where we have our session, and that became a whole drama unto itself.


V couldn't seem to organize herself, so her staff got her wheelchair for her. S wanted to run around (and when she runs around it usually involves many curtains being torn down and a general swath of destruction in her wake). M started to vocalize in an angry-sounding way and looked as if she was about to take a bite out of whoever was standing or sitting too close to her. L appeared in the hallway, naked (evidently naked is popular on Mondays...who knew?). 


Music therapy anyone?


The staff took the person who was naked and the person who was all set to run down the hallway with her to get them reassembled, and I took the rest of the ladies in with me. V was still quite distraught, and yanking at my clothing with a death grip. M was still vocalizing loudly and approaching me (and V, who was now clinging to a handful of my shirt and pulling me down toward her), sounding a bit desperate. N was vocalizing, somewhat less loudly, as she attempted to settle herself in a chair (sometimes it takes her a while; she has a bit of the OCD).


M ended up walking out the door and went with her staff person (who told me she needed to shower the person who'd been naked). 


Okay. O....K....We're breathing.


I went back to V, held on to her hands and joined her distressed vocals with my voice, attempting to find a soothing, but reflective, simple vocal pattern (not an easy task, given the circumstances). She let me move behind her wheelchair so I could give her some deep pressure input to her shoulders and arms. V began to rock and very slowly settled down.


Gradually, the rest of the group came in, and we were able to finish the session with some minor semblance of order. 


But, yeah. Pain. Not fun. 

"I want to be here."

I noticed the word "here" came into my mind rather loudly as I accompanied W's breathing on the piano. Then..."I want to be here."


He was sitting in his usual partially reclined position on the couch and staring straight ahead. No eye-contact. Ignoring the instruments (although I think he tossed a mallet on the floor at one point). 


Just. Sat. 


I knew he was still not feeling all that well. We both had colds this past week. But he had been very clear that he wanted to come to his session.


"Breathe in; breathe out." I sang quietly, accompanying myself on the piano.


He waited until I was finished, and then he quickly tossed the maraca and the bells in rapid succession. 


Obviously something was bothering W. And as I watched him the song "Wish You Were Here" came to my mind. I found it in my folder, and I was all set to start playing when he stopped me, pushing my music folder to the floor.


Okay then. Kill the music. Better stick to just listening. 


"I'm wondering what's upsetting you so much today." 


W pushed the rest of the instruments off the bench next to his seat, making sure to send them into the distant regions of the Music Room. He watched them as they rolled off in various directions. He turned to me and tried to make sound with his voice. It came out as a quiet, brief hum. He waved his arms in frustration, unable to make me understand.


"I can't imagine how frustrating it must be for you to have so much to say and so few ways to say it. Can you go back to the music and use the instruments?" 


W got up and gave a few of the closer instruments, the ones he'd already sent to the floor, a shove with his foot, pushing them even farther away.


I looked at the clock and realized we only had five minutes left before the session ended. I let him know we would have to end shortly. 


I knew he wasn't finished. 


I recalled our previous session in which he kept picking up the bells when it was time to go (seemingly to let me know he wanted to take the instrument back to his cottage with him- like a transitional object). He didn't seem to feel finished then either. 


I asked him if perhaps his current upset was related to not wanting to let go of the bells and leave last time.


Eye-contact. Bingo!


"It is hard to leave a place where it's quiet and where you've developed a sense of safety. I know how much it means to you to be here."


Because I felt his helplessness, I went on and on. 


I reminded him that his worth does not come from me. That music therapy helps him remember and recognize his worth and value as a person. That we work toward his being able to go out in the world with the awareness that he is a worthy and valuable human being. 


I added that I realized this wasn't an easy task. We all struggle with it. "But, W, you have survived living in an institution for over 25 years. And you still care about people. Relationships still matter to you. That's a miracle!" 


He thought about this for a while. 


I gently noted again, "W, we need to stop for today." I got my coat on, brought his coat and hat over and began helping him get into his outer gear.


He paused midway through the process, flapping his left arm in his coat sleeve, not quite finished putting it on. In a second, he took off the coat, took off the hat, handed them back to me and pushed me gently backward in a clear gesture of "No."


He was staying "here". "I want to be here, Roia!" was what he seemed to clearly be stating with his actions.


I sat with him. 


"What do you think is making it particularly difficult for you to leave today? Is it that it's the holidays? Is this an anniversary date for you that I'm unaware of?" He paused and looked up and to the side to consider this.


"Perhaps you're feeling particularly lonely." Eye-contact.


We sat quietly, breathing together. "Loneliness is hard."


After a while he got up to push my tissue box off the piano. I brought him his coat again, and I let him know I thought he'd be okay. He is, after all, a survivor.


He hesitated, but he finally put on his coat and we walked out. 


Here is the song, "Wish You Were Here", that I would have sung for him in our session- mistakes, clunky piano keys and all. 

Isn't that kind of messed up?

Those of you who regularly read my blog have probably come to realize that I'm not exactly someone who focuses primarily on behavior change as a goal of music therapy. (And, truly, I'm not trying to bash behaviorists here.)

Image by nickwheeleroz (on holiday) via Flick

My usual focus is on building the therapy relationship  and learning about my clients through interacting with them. Behavior change, I believe, comes about naturally because the person wishes to maintain relationships with other people.


As such, I spend a lot of time thinking about and trying to come up with some ways of understanding why certain "behaviors" (or ways of being) are so indelible and resistant to change. (Mind you, this is something I regularly try to hash out in my own life as well. But I digress.)


So I started to wonder whether some of my clients have gotten so accustomed to playing the role (in their families, in the institution, in their lives) of "the messed up one" or "the problem" because, on some level it affords them the opportunity (perhaps, from their perspective, their only opportunity) to be special? 

I'm not saying this in a mean-spirited way, believe me.

Here's the thing: a good large portion of the folks I work with often don't stop "doing behaviors" that get people grumbling at them (this in spite of years of behavior modification programs and, the ever popular in institutions, active treatment).

And it made me wonder. Why?


I know my clients always have some reason (whether or not the reason is obvious to me or to any of their other supporters) for choosing the actions and interactions that they choose. 


Okay. So.


In the absence of a clear or obvious reason as to why someone is acting in some unusual or less than sociable way (a reason such as physical discomfort that hasn't been discovered or addressed, or a reaction to something we may not yet know is happening- like hidden abuse), I ask myself (and my clients): 

What's preventing this person from moving beyond this behavior? What is it about this particular way of interacting, this way of being in the world, this way of behaving...that is working for this person in some way? Why might s/he be loathe to give it up?


So I come back to the question in my mind: what if this adopted behavioral style, or interactional style, is in some way fulfilling a wish to be "special"? 


And whose wish to be special is it fulfilling? Is it my client's wish? Or is it the wish of his/her family? By not playing out the role of "special" will s/he be disappointing her/his family? Or believe s/he will disappoint her/his family? 


Is it a way to be noticed at all? In an institution, unless you act out in some way, you run the risk of pretty much sitting quietly by yourself and not having much interaction with anyone, because you're essentially not getting on anyone's nerves. That's fine if you're not all that into interactions with people, but what if you're lonely. And your choice is to not be noticed at all or to be outrageous? Which might you choose?


Right about now you're probably thinking, "No wonder that girl doesn't get anything done all day, obsessing all over the place as she tends to do."


And you'd be right.