"You are showing them that they exist"

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

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

MS. TIPPETT: Mm-hmm.

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

MS. TIPPETT: Yeah.

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

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

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

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

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

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

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

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

Journal Prompt #3 (When music therapists go bad)

Image by Esparta via FlickrYesterday, I felt like a bad therapist. 


I was tired from awful allergies (and the ends of a lingering cold), and I didn't feel great physically (and, let me tell you, there was some serious whining going on). And, yeah, okay, the truth is I just plain started out the day with an attitude. 


But I figured, "Come on, Roia! It's Saturday, you only have three sessions with three different guys. They're good guys. You really like working with them. It'll be fine. Stop your kvetching, and go do your sessions and you and your aches and pains will survive." 


Great. Pep talk done. Let's do it!


Maybe it was because it was a holiday weekend (with little hope of their seeing family members), maybe it was that it was a fairly nice day outside and they were all stuck indoors, maybe they all had allergies, maybe they thought my sunscreen smelled weird...I don't know what it was!  But my clients weren't exactly in jovial moods either. 


So. 


There we all were with our collective attitudes in the various sessions, and there I was just...not making sense, not saying or doing anything particularly- I don't know- therapeutic. I found myself wondering why the heck I was saying what I was saying.


And all I could think was "what is with you today, woman?"


I was so not being a shining example of music therapy and all the fabulosity that goes with it. 


Yes, I know that I probably wasn't as awful as I felt  I was being. And, yes, I realize that it's all "grist for the mill" (as my clinical supervisor has always said), and it's all part of a much larger process/context. And, sure, it's true that even a bad day of music therapy (when you live in an institution) is probably not as bad as all that, but I like my clients. I want to do right by them, and I felt kind of badly that I was less present than I would have preferred. 


And I was also annoyed that they were (at least in my perception of things) making me work so damned hard! Waaah! [We're whining...we're whining...]

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

So, perhaps you can journal (or sing, or play, or create some form of art, or develop your own whining rant) about a day (or, heck, a week or a month) when you felt as if you were having a hard time being the kind of  music therapist you like to think you are.

What are some of the idea(l)s/myths you have about who/how you "should" be as a music therapist? 

What are some of the idea(l)s/myths you hold in your mind about who your clients "should" be and how they should act/respond/deal with stuff when they're in music therapy with you?

And how do all these idea(l)s and myths affect how therapy goes some days? And how do you cope with days when you feel as if you are less than stellar?

Bring it on, my fellow bloggies!

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!

What is advocacy and why do we do it?- Part 1

Advocating for music therapy is, at its most basic, about telling people who we are, what we do, where we do what we do, with whom and how. It can be as simple as meeting someone at a party and responding to "what do you do for a living?" with "I'm a music therapist." And it can be as complex as working with legislators to get licensure for music therapists in your state. 

The reason we spend so much time advocating for music therapy is so that, when you and I are a lot older music therapists (and that's not to say that I'm not seriously getting to "older music therapist status" at a rapid rate here), when we say "I'm a music therapist," people will say "oh, my child is receiving music therapy services" or "I work with a music therapist in the hospital where I'm a nurse" instead of the blank stares that I used to get when I first started out back in 1987. 

In fact, the reason some of you younger folks (you know who you are) have even heard of music therapy is because there are a lot of us older folks (ahem) who've been talking about what we do for a long time.

Now, as more people are starting to learn about music therapy our focus as a profession has been turning toward gaining state recognition for what we do. After all, people who use our services (heck, sometimes music therapists use our services!) need to know they're receiving music therapy from someone who is trained, qualified, certified, and, in some states, licensed. 

Another thing we're working toward is third party payment. While there are some music therapists who are getting reimbursed by insurance companies, it is still extremely rare. Creative arts therapy providers will become a lot more accessible to those who need them when health insurance companies add "music therapy", "dance therapy" and "art therapy" to their lists of reimbursable services.

On another level, advocating for music therapy services is about creating jobs and opportunities for ourselves. We know why what we do is important, and we want to educate the people who could use our services. It also means helping the public to distinguish between music therapy, provided by a trained, board-certified music therapist, and the therapeutic use of music, provided by talented musicians who are sensitive to the needs of others.  Sometimes advocacy is about making sure we're appropriately compensated for the services we provide. The fact is that music therapists in many work situations are vastly underpaid in comparison to other allied health professionals. 

So, as you can see, advocacy is an important enough element that we need to, literally, build it into our work. In Part 2, I'll address some of the things I think are helpful as we engage in this process. 

The myth of the perfect music therapist or How I learned to stop worrying and love my mistakes

Back in 2006 my friend, Judy Belland (brilliant music therapist turned happy music librarian), and I presented at the Mid-Atlantic Regional music therapy conference in 2006 (which was in Pittsburgh that year- seems I keep presenting stuff in Pittsburgh...anyway) on "The Myth of the Perfect Music Therapist or How I Learned How to Stop Worrying and Love My Mistakes".


Recently, my blogging friend, psychotherapist Tamara Suttle (whose blog, Private Practice From the Inside Out is on my hit parade) wrote about making mistakes as a therapist. 


Reading her blog reminded me that I've been meaning (since January, for crying out loud) to post the handout Judy and I put together. So here it is, mistakes and all (just a little perfectionista humor there). Thanks, Tamara, for the reminder/encouragement! 


Note: The original version has a How To Write a Process Paper, which you can find here. 

Questions to ponder

• What is my fantasy of "The Perfect Music Therapy Session"? What does it mean when it doesn't go as I planned/hoped/fantasized?
• What does it mean when our clients fail (about us, about our clients, about music therapy)?
• What do I see as "the rules" for how a music therapist should be, what a music therapist should do, how clients should respond, etc.? (i.e., I should never become impatient with my clients or lose my temper, it's my job to make my clients happy)
• What is a mistake? What do I mean when I say I've made a mistake?
• What kinds of mistakes concern me most (i.e., verbal, musical, interpersonal, procedural, ethical)?
• How do I handle it when I make a mistake? Do I acknowledge that I've made a mistake? Do I even recognize when I've made a mistake?
• How have mistakes I've made affected the therapy relationship?
• What am I modeling for my client(s) when I make a mistake? (i.e., do I address it directly, do I deny that I made a mistake, do I apologize for the mistake?)
• What are my fears in terms of making a mistake? What are my fantasies of what could happen if I make a mistake?
• What might my clients think if I make a mistake? (In other words, what is my fantasy of what my client(s) (will) think(s)?) How do I believe my colleagues would react?

What if making mistakes not only isn’t the end of the world

but actually helps the therapy process?

o    Look at why a particular mistake is being made.  Do I have a pattern of making the same mistake?  (i.e., forgetting someone’s name all the time) What might that mistake be about?

o    Is my mistake related to countertransference (i.e., a client reminds me of my mother) or is it more related to the client (i.e., a lot of people in this client’s life find themselves making this “mistake” with or reacting in a particular way to him/her)?

o    What was going on in the session when this mistake occurred?  How was I feeling about the client(s)?  About how the session was going?  What made me respond in the particular way that I chose?

o    Did I have an expectation—about myself, about my client, or about the therapy—that I wasn’t aware of initially?

o    How can I use an awareness of my mistakes to further develop the therapy relationship?

o    What does it mean to me to be a “good enough” therapist?

Resources for Further Reading

Bruscia, K. (Ed.) (1998). The dynamics of music psychotherapy.  Gilsum, NH:  Barcelona Publishers.

Casement, P.  (2002).  Learning from our mistakes:  Beyond dogma in psychoanalysis and psychotherapy. New York:  The Guilford Press.

Casement, P. (1991).  Learning from the patient.  New York:  The Guilford Press.

Chodron, P. (2002).  Comfortable with uncertainty:  108 Teachings.  Boston:  Shambhala .

Dileo, C. (2000).  Ethical thinking in music therapy.  Cherry Hill, NJ:  Jeffrey Books.

Epstein, M. (1998).  Going to pieces without falling apart:  A Buddhist perspective on wholeness:  Lessons from meditation and psychotherapy.            New York:  Broadway Books.

Figley, C. R. (Ed.)            (1995)            Compassion fatigue:  Coping with secondary traumatic stress disorder in those who treat the traumatized (Brunner/Mazel Psychosocial Stress Series). New York:  Brunner/Mazel.

Forinash, M. (Ed.) (2001).  Music therapy supervision.  Gilsum, NH:  Barcelona Publishers.

Gabbard, G. O. & Lester, E. P. (1995).  Boundaries and boundary violations in psychoanalysis.  New York:  Basic Books.

Hutto, B.  (2001).  Some lessons best learned from psychotherapy supervision.  Retrieved: 2/4/06 from http://www.psychiatrictimes.com/p010753.html.

Kottler, J. A. (2003).  On being a therapist (Third Edition).  San Francisco, CA:  Jossey-Bass.

Kottler, J. A. & Carlson, J.  (2003).  Bad therapy:  Master therapists share their worst failures.  New York:  Brunner-Routledge.

Lovett, H.  (1996).  Learning to listen:  Positive approaches and people with difficult behavior.  London:  Jessica Kingsley.

Mayeroff, M. (1971).  On caring.  New York:  Harper & Row.

Misch, D. A. (2000).  “Great expectations:  Mistaken beliefs of beginning psychodynamic psychotherapists”. American Journal of Psychotherapy, (54)2; 172-203.

Pope, K. S., Sonne, J. L. & Holroyd, J. (1993).  Sexual feelings in psychotherapy:  Explorations for therapists and therapists-in-training.  Washington, D.C.: American Psychological Association.

Saakvitne, K. W. & Pearlman, L. A. (1996).  Transforming the pain:  A workbook on vicarious traumatization. New York:  W. W. Norton.

Schlesinger, H. J.  (2005).  Endings and beginnings:  On terminating psychotherapy and psychoanalysis            Hillsdale, NJ:  The Analytic Press.

Skovholt, T. H. (2001).  The resilient practitioner:  Burnout prevention and self care strategies for counselors, therapists, teachers, and health professionals.            Needham Heights, MA:  Allyn & Bacon.

Van der Klift, E. & Kunc, N.  (1994).  Hell-bent on helping:  Benevolence, friendship, and the politics of help Retrieved 9/23/05 from http://www.normemma.com/arhellbe.htm.

Weinberg, G.  (1996).  The heart of psychotherapy:  A journey into the mind and office of the therapist at work. New York:  St. Martin's Griffin.

Yalom, I. D.  (2002).  The gift of therapy:  An open letter to a new generation of therapists and their patients. New York:  Harper Collins.

Yalom, I. D.  (1989). Love's executioner and other tales of psychotherapy.  New York:  Harper Collins.

When sessions go to hell (yes, Virginia, in a hand basket!)

Image by jamelah via Flickr

Damn! I was all set to wax lyrical about what a wonderful first session I had had with two new clients, C and J, two Saturdays ago. 


I'd even started the blog already. I had a nice little picture all picked out and everything. There was a little singing bird. It was downright idyllic, if I do say so myself.


Well. 


That little gloat-fest sure didn't last too long. 


When I showed up this past Saturday, it all went to hell. (Please observe said hand basket above and to the right.)


First, the room we'd used the previous week was completely unavailable. Apparently, it had just been painted and they didn't want anyone in there until the paint was dry.  It was a nice, relatively quiet room with space, with a big water-bed looking thing (that looked like a cross between this, this, and this), where last week C, who seems to experience a lot of sensory discomfort, tucked herself in under her blanket and her giant beanbag and sang along with her series of sweet little "bee bah" sounds. 


Okay. "So the room isn't available," I thought. I can work around that. I think.


Then, while I was checking out other room possibilities, I noticed that the other person in our small music therapy group, J (who became "the other person in our small music therapy group" simply because she kept walking in to the room last week, and I finally said, "why don't you just join us on a regular basis?"), was unavailable, because she was having some behavioral issue that required a lot of people to stand around her and look concerned. And not too happy. 


Hunh.


No problem, I'll just work with C in the vestibule where she's sitting (tucked under her blanket with her giant beanbag) (is anyone else noticing a theme here?). I'm flexible. I can do this. 


Two seconds into singing "hello" to her (after her staff kindly unplugged the radio that had been playing), C got up and left. 


And that was that.


After that we moved into a whole following around (me following C), pulling (C pulling me, because I guess my following her wasn't going the way she'd expected), stripping (C's, not mine, thank God), bathroom going (again, not me for a change), insisting I put the radio back on (you guessed it, C wanted the radio), irritated "BEE-BAH" sounding...thing. 


There were two (maybe two) blissful (okay, maybe it wasn't blissful, but we're talking comparatively here) minutes in which C sat and smiled as I played and sang with her. 


Then we were back off and running.


Heavy sigh.


A few years back (in 2006, I believe) my friend, Judy and I did a presentation at the Mid-Atlantic music therapy conference which we called "The Myth of the Perfect Music Therapist, or How I Learned to Stop Worrying and Love My Mistakes". 


I think this would definitely qualify as one of those bummer sessions that are more "part of the process" or "grist for the mill" (as the sayings go) than shining examples of moments in therapeutic gloriosity.


I suppose, if there's anything for me to have learned from this, it's that if we music therapists can't own and acknowledge our lousy sessions/days and accept them as part of life, then our clients won't be able to do that either. 


Not that it's any kind of easy.


Well. There's always next week.

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?

Supervision: Part II: Peer Supervision

(This is the second part of the article I wrote for NJAMT News on professional clinical supervision for music therapists. The first part is here.)

Supervision: Part II: Peer Supervision

Roia Rafieyan, MA, MT-BC

The previous article looked at professional clinical supervision, addressing common misunderstandings about the role of the supervisor and describing what one might expect when one seeks the services of a clinical supervisor.

Another avenue for growth as a professional music therapist is peer supervision. This article will discuss the benefits of this way of learning and offer the author's experiences with her peer supervision group as one example.

What is peer supervision? How is it similar to/different from supervision with a clinical supervisor?

In contrast to professional clinical supervision, where a therapist with more experience acts as a mentor to another music therapist or a group of music therapists generally for a fee, peer supervision refers to both formal as well as informal connections between therapists who draw on each other's strengths and abilities as a means of developing their competence and effectiveness as music therapists.

Peer consultation/supervision can be as simple as posting a request for information on a music therapy email list or having a conversation with a trusted fellow clinician about a particularly difficult case. Some music therapists choose a more formal option. This involves working with a consistent group of people setting aside a specific time and place, agreeing on areas of focus and having a mutual commitment to ongoing professional growth. This piece will focus on my experience as a participant in a formal peer supervision group.

Where does it happen?

Our group chose to alternate meeting at the work sites of two of our members. Having enough physical space and access to a variety of instruments was important to us because we all felt a strong desire to use music-making as a part of our process. Just as significant was the need to find a central location since the group was spread out over a large geographic area.

How often? How long?

While meeting once a week or twice a month would be ideal, peer supervision groups can meet as often as is practical. The best our group was able to accomplish was to meet once a month. Meeting for about an hour and a half seemed to be a reasonable timeframe for our group which ranged in size from three to five people. This allowed each person to present case material and look at issues and gave us an opportunity to use the music to explore various aspects of our selves which affected the way we work with our clients.

What happens in a peer supervision group?

The group will develop its own rhythm. Ours gathered, checked in with each member, trying to find a common theme and come to a group consensus regarding the issues we wanted to focus on for that particular meeting. If no theme emerged, we did some musical exploring and improvising, starting with where we were and how we were feeling about our work. The music helped to initiate discussions through the act of listening to each other, analyzing our own musical experiences and observing the group process. Sometimes this would lead to more music-making with a more specific focus.

Different groups, because they are made up of different music therapists, will choose different approaches. While it could be a simple as a sharing of ideas and resources for music therapy experiences, it can also be a deep as supporting members to cope with profound feelings of helplessness or secondary traumatic stress and burnout.

How does this process help us increase our effectiveness as music therapists?

Music therapists have a unique opportunity to develop the skill of self-observation and to experience first-hand the dynamics and processes involved in group work when they engage musically and verbally in a self-examining peer supervision group with other music therapists.

By exploring our own feelings about and reactions to the work we do with our clients and our work situation(s) using music, we learn how to better engage our clients in a similar process. This enables us to become more effective in our work.

Helpful tips (based on our group's experience):

§ Let one or two people take responsibility for initiating, organizing and maintaining the group.

§ Meet in music therapy rooms in group members' workplaces (with permission) because it gives access to a variety of instruments (melodic and non-melodic) as well as freedom from distractions. It also provides the space needed to work.

§ Establish a date for the next supervision group before the end of each meeting (or set out a long-term schedule). This helps to create a commitment to the group and to the process. It is also helpful to send out email reminders.

§ Do not allow the group time to become a gripe session about how awful workplaces can be. Use music to explore and identify areas in which your own resistance may make it difficult to understand and support your clients.

§ Look for common themes in the stories that you share, or begin by improvising music based on what is currently being experienced by group members.

§ Watch out for the tendency to avoid using the music and to steer clear of difficult topics.

In summary a peer supervision group is one in which a group of professional music therapists come together on a consistent basis, and they use the skills they have to help each other grow as music therapists. By engaging in this process they are able to learn to be self-examining and may then, by extension, be able to take their work with clients to a deeper level.

Resources

Music Therapy Supervision (2001, Barcelona Publishers; M. Forinash, Editor) has three chapters describing peer supervision as well as experiential music therapy groups.

Chapter 12: Peer Supervision in the Development of the New Music and Expressive Therapist (E. Baratta, M. Bertolami, A. Hubbard, M. MacDonald, and D. Spragg) Chapter 14: Experiential Music Therapy Group as a Method of Professional Supervision (G. Langdon)

Chapter 15: Peer Supervision in Music Therapy (D. Austin and J. Dvorkin).

Additionally, of course, there are the many remaining chapters which focus on supervision of students during practicum experiences and internships, professional supervision, and institute training/supervision.

The Dynamics of Music Psychotherapy (1998, Barcelona Publishers; K. Bruscia, Editor) is a helpful read. While the chapters don’t specifically address clinical or peer supervision, there is a clear focus on the dynamic processes of therapy, and there are a number of chapters which focus on uncovering unconscious countertransference reactions to clients and working with elements of resistance within the therapist.

Online resources

“Models of Clinical Supervision” by George R. Leddick: http://www.ericdigests.org/1995-1/models.htm

“Peer Consultation as a Form of Supervision” by James N. Benshoff: http://www.cyc-net.org/cyc-online/cycol-0801-supervision.html

“Peer Group Supervision”- presents a model of peer supervision for those in the business world as well as in social services. It lists six phases of peer group supervision. Some of the ideas may be useful in getting your own peer supervision group started: http://www.peer-supervision.com/index.html

Specific to a particular approach to psychotherapy, but it could be very useful: http://www.contextualpsychology.org/running_a_peer_supervision_group