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?

Oh, THAT's why you're still standing!

It was gorgeous out today (in spite of my itching and sneezing and generalized whining)! TE was sitting outside with his group when I picked him up for his session. He was more than happy to flit along with me, because- well, because we go way back (we've been working together for almost twenty years now) and there was a really loud radio playing right near him. Noise is not his favorite thing (and, oy, can I relate!).

Anyway, we got to the Music Room, and he took off his baseball cap and put it carefully on my cart (which is where we usually put our outer gear when we arrive), but he didn't go and sit down (which is what he always does). 

I thought he might need a toilet, so we headed off the bathroom down the hall. I sent him on in, and I waited. And waited. There didn't seem to be anything happening, so I asked him to come out if he was finished. The door opened, and he appeared. We headed back to the Music Room. 

And TE was still flitting around the room, not sitting. Hm. 

"Maybe you don't want music therapy today? Perhaps a walk instead?" I was about to start heading for the door when it hit me. 

I bought TE a couple of big dog chew toys, because he likes, no, he needs to chew on things. When he doesn't have anything to chew on, he keeps a hand in his mouth or he chews on his shirt. 

Ergo, dog chew toys. 

Hey, they're big, they come in different textures, and he really seems to like them. And usually my neurons are firing, and I remember to leave them out for him when I set up the room before I go and pick him up from his cottage. It being Monday and such, I had forgotten. 

And evidently TE was kindly trying to remind me, "Um, something's missing here, lady."

I went to my desk, got them out, and brought them on over. As soon as I handed them over, he sat down.

"OK, Roia, now we can begin."

I love when I actually get it once in a while.

"After you've gone and left me crying..."

B jumped up (jumped, I tell you) to come over to me when I showed up in his group (I was feeling guilty, because I was a little bit late). He barely let me get his jacket (um, it's April, and there were snow flurries happening off and on today). Anyway, he barely let me get his jacket out of the closet and on to him before we stopped to get his meds. Then we were on our way.

He got to the Music Room, and somehow we missed the door to actually go in. Don't ask me why. We just kept turning around the corner and walking and heading in the wrong direction. Then when I got him back in the direction of the door, we missed it on the way back again. 

Okay. What?! Already! 

Somehow, I managed to veer him in the direction of "please get in to the Music Room, or I won't be able to pay attention to what you're apparently trying to tell me!" 

Alright. We are now inside the Music Room. Now I can focus. 

B was very upset. To the point where he was actually crying (I think). It was very sad. I decided the best thing I could do was to simply sit with him and wait it out. Try to give him the space to feel lousy, since that seemed to be how he was feeling today.

[Actually, his distress was a continuation of our previous session where there was a lot of instrument throwing, occasionally aimed at me. I reminded him that I would not be able to hear him very well if I was having things hurled at me, so he "agreed" to stop, but made sure to get in an obscene gesture to make his point. Got it. F--- you, Roia!]

When B is upset, there's a lot of moving. When he's more mellow, there's a lot of sitting. Today there was a lot of moving. He speed walked over to the office area, sat in the other music therapist's chair, whimpered, then dashed back over to the music part of the room.

Every so often, after he sat briefly on the couch (his usual hangout), he hopped up and went to look out the window, rocking from side to side as he did so. I noticed his rocking was kind of gentle and not all that fast, but everything else about him seemed to be in high speed.

I tried to figure out whether I should musically reflect the rocking (maybe it was a way for him to self-soothe?) or the agitation or both. I opted for a bit of both, and I think it ended up sounding like a bit of a mish-mosh. 

Even I was up and down a lot. I had decided the guitar was a better option for improvising than the piano, because I could follow him more easily if he happened to run out the door. Also I could turn and see him while holding a guitar.

B was also humming. It was actually a very beautiful and poignant hum, and I tried to follow along with the guitar and, at points, with my own voice. He'd hum at a particular pitch and then drop down an octave as he came to the end of a phrase.

Eventually, his movements came to a gradual settling down, and he (mostly) managed to assemble himself on the couch to catch his breath. I breathed in and out quietly with him.

"I guess underneath all the silence we were exploring two sessions ago you had a lot to say, B."

We sat together, back in the silence, and the lyrics that sang into my mind were: 

"After you've gone, and left me crying

After you've gone, there's no denying..."

I have learned over the years to pay attention to the lyrics that pop into my thoughts when I'm with a client. To me they're like messages sent from their consciousness to mine. 

These were the only lyrics I could remember, and I wondered if he was trying to let me know how hard it is for him to have to wait in between our sessions. 

Now, it may seem as if I came up with this from out of nowhere, but that's actually not the case. He has a very difficult time leaving sessions, and there is usually a lot of dawdling and trips to the bathroom and long pauses before the jacket gets put on when it's time to go. 

Also, as I noted, he had been quite distraught in the previous session as well, and we had explored his frustration with me, because I'm not able to fix his life for him (which, I'm thinking, would take the form of my taking care of him outside of the institution). 

In the past month, we've been talking a lot about feeling abandoned, and I also used the Billie Holiday song "Left Alone" in one session (this version is sung by Abbey Lincoln).

When I commented to him that music therapy can be a mixture of deep gratification (it feels so wonderful to be listened to and acknowledged) and extreme frustration (because it's still therapy- it's not life) he immediately picked up the maraca and tossed it across the room (the maraca is the instrument we've designated to express anger and frustration). Score? I think so.

Heck, I sure wish I could tell you I had some brilliant piece of advice to offer him, but let's face it. The truth is, living in an institution is the pits. He knows it. I know it. I can't fix it for him. And, yes, it is frustrating. Insane-makingly so! On a lot of levels and in painful and never-ending ways. It's frustrating for him, and it's frustrating for me too. 

What to do? What to say?

He'd stopped running around by now, and he only got up every so often to punctuate a point I made (I think that's his way of saying, "you're getting it, Roia," but I'm not 100% sure; I never am). 

I told him I was glad he felt safe expressing his feelings to me, and he was welcome to keep doing so in music therapy. To be honest, I felt very honored and humbled by his trust in me. People don't expose that much emotion and pain in front of just anybody. 

I guess the best description of what I did today was to stick with B. I validated his feelings. I kept caring about him. I invited him to keep using the music as a container. I reminded him of when I'd see him next.

I noticed (in myself) how hard it was to end the session today. I knew we needed to go, but I felt awkward insisting (especially given how much emotion happened in the space), and when I tried to play something quiet about breathing, he started hitting his head. 

"Hurting yourself is not a solution, B. Showing up in music therapy every week [I actually see him twice a week] and using sound and movement to tell me how difficult this is for you is a better alternative."

He didn't look like he was buying it, but I had to get up and get the coats already. It was getting late. 

I put my coat on and held his out to him. He paused as long as he could, and he finally got up, took it from me, and put it on. 

When we got back to the cottage his staff greeting him warmly, and he went to sit down. He watched me as I hung up his coat, left the room to sign him in and then walked back through to wave "goodbye" to him. 

The lyrics were still floating through my mind as I walked back to the Music Room to tidy up and go home: 

"After you've gone, and left me crying

After you've gone, there's no denying..."

Sometimes being a music therapist feels like being one of the meanest people in the world. 

"That was so much fun!"

"That was so much fun!"  Well!  I don't usually hear that from the direct support staff who take part in music therapy groups with me.  Actually I don't usually have any staff with me when I'm doing music therapy.  Long ago I decided to work alone when I do sessions, because the direct support staff and I tend to...work in very different ways.  Ahem.  

As such, you may be wondering why I actually decided to include the staff when I started a new music therapy group with the women in Group 2.  Well, for one thing, this can be a pretty rough crowd- I've seen one of these women tear apart an entire bathroom, ripping down shower curtains, tossing clothing and bathing items asunder, and then shred her clothing in a matter of seconds (let me tell you- that's a talent).  Another woman tends to yank hair, scratch, and bang her head on the floor.  As you might imagine, having their support staff around could be a very good thing.  

Another reason I wanted the staff in this group to come with me is that they are consistently with that specific group on Monday evenings.  Most importantly (to me anyway), these three group leaders (as they are referred to in our facility) really seem to like the ladies they support (I'm not being nasty here- sadly, I don't always see this attitude in this line of work).  They were very enthusiastic when I asked them if they were interested in our doing a music therapy group.  

We agreed to move the ladies from their usual living area (a room with no outside windows, in the middle of the cottage, surrounded by a lot of noise from neighboring day areas) to a room across the hall where the recreation staff works.  It's generally a quiet room, it's contained, it has chairs (even though various members of this group like to be mobile or recline on beanbags), and we can use fewer lights (the fluorescent lights are quite horrible) because it has windows.  

I also wanted the staff to understand the point of music therapy- give them a context within which to interpret what they might experience in the sessions.  I wanted to give them an idea of what I'm doing, why I'm doing it, what I'm watching and listening for, and how I'm going to do what I do. So I gave each of them a copy of a detailed memo I wrote a long time ago for supervisors who periodically come to observe sessions.  

I also gave them the Music Therapy Observation Form I've been working on for quite a while.  It's a complex form which I usually have my practicum students fill out  on a weekly basis.  It asks a lot of questions meant to provoke thought with regard to what the music therapist is seeing, sensing, hearing, and musing about during the group.  It also encourages attention to the relational qualities and dynamics within the group and how these might be expressed (or avoided) in the music.  It also notes some of the elements which might be going on (or ongoing) for clients in addition to the experience of being in the music therapy group (illness, sensory issues, motor planning problems, traumas, family stuff, etc.).  

We've had three sessions so far.  If all of the group members (minus their staff) show up we have seven women- which may end up being a lot, but we'll see how it goes.  The best we've managed so far is to have six women and two staff people. Sometimes the ladies decide to go to bed early, sometimes they head out with the teachers, and sometimes they need a break from the group and want to do their own thing.  

All but one of the women in the group are somewhere along the autism spectrum.  And, again with the exception of the one woman (who is dealing with mental illness along with her developmental disability), none of the ladies use speech to communicate.  They are, however, women with voices.  Quite a range of voices, I might add.  From low and gruff to high and sweet.

One of the things I noticed with regard to the group leaders is that they tend to chatter almost constantly with the women in their group.  This is actually, in many ways, a very good thing.  So I didn't want to discourage their natural tendency to want to interact, but their conversation, while animated and pleasant for the most part, was making it awfully hard to actually hear the group members.

Last night three of the women were present in the group.  I gently invited their support staff to listen- reminding them, "this is your opportunity to hear the ladies you work for in a completely different way."   They were quiet, and they listened. And it was great!  

I offered V a maraca.  She had come in to the room using her wheelchair, because her staff, M, was concerned she'd grab at and scratch everyone (and, indeed, she did seem headed in that direction as she began to pull roughly at M's shirt).  V held the maraca, evidently curious enough that she was able to settle herself down. In fact, she didn't grab anyone else for the rest of the session.

K was awake (last week she slept on a cushion we had brought for her- this time she had a big long beanbag and a blanket).  K is often asleep during the day, because, from what I can gather, she doesn't sleep well at night. I sang a greeting to her (and to her housemates). I invited her to turn toward each woman in the group (she is also visually impaired), asking them to alert her as to where they were located in the room by making some form of sound (her staff included).  She listened quietly as each of us made a sound or greeted her with a "hi, K" and turned her head to acknowledge that she had heard us.  

M switched chairs a number of times, making sure to stay near me, even maintaining visual contact.  She sang through much of the 30-minute session, quietly, a high-pitched and delicate collection of short little four and five note melodies and bursts (for lack of a better word).  

At one point, L agreed to come in to join us.  She still had a cold, but she accepted the tube shaker from T (her staff), and she shook it vigorously for about 30 seconds, set it down, picked it up to give it one more good shake, and handed it back to T and left.  

V eventually decided she wanted to get out of her wheelchair and sit on the beanbag with K (apparently they like each other well enough and are used to sharing this space).  There was no scratching or grabbing.  K decided to stand and move to the music (I too got up to sing and rock across from her while I followed her rocking on the guitar).

It was hard to have to sing "goodbye" to them all, because it truly was enchanting to watch the group transform into this lovely music-making collective.  T was astonished and excited (having assured me when we began that she had read all the papers I'd handed her the previous week and found them fascinating).

As we sang "goodbye" V, who had been holding the maraca so quietly, decided to join in with her voice.  Indeed, "that was so much fun."

     

Walking slowly together

On Saturday (I work on Saturdays) I went to pick up D from his cottage.  I hadn't seen him for two and a half months, and I wasn't sure how he would react when I showed up after all this time. I mean, I told him I'd be on a leave of absence, and I explained that I would be returning at the end of August, and we would resume music therapy.  Since D doesn't use speech, and he's rather a quiet man (at least he is when he's with me), I wasn't sure how he had experienced my announcement.  

Anyway, he smiled when he saw me this past Saturday, and I must admit I was glad to see him too.  He pulled me to the door, and we were off.  It was a quiet morning, and D tends to walk- more like an amble actually- very slowly and deliberately.  His heel always goes down firmly first and then the rest of his foot follows along in sort of a rolling motion, his toes always pointed out. He holds on to me- to my hand- with his right hand, and his left hand usually goes up and rests gently on his chest or on the drawstring from his jacket (or the drawstring on his shorts).

A good word to describe D's pace, I'd say, is "leisurely".  Very.  I have often found it difficult to walk with him because I have to slow down quite a bit in order to not end up dragging him along. The thing about this particular day was that I had just returned from taking my own "leisurely" break.  As we walked slowly together, I immediately noticed how much less hurried I was, and how it was so much easier than usual for me to adjust myself to D's gentle rhythm rather than indulging the tendency I have to move along at my usually frantic trot.  

As we strolled along D hummed quietly, and I enjoyed listening to his singing- not a particularly wide range, but he was very present and lovely to hear.  Nice... to slow down and pay attention.

"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.