How to be together

We sat together yesterday, our group of seven, on a Monday afternoon. And the curtains in the room were open to the afternoon sun, closed as the sun blinded us, and then open again to watch the beautiful dark frames of leafless trees against the pink and yellow and blue sky as the sun began to set. And, with the early evening news as a background, we noticed, for ourselves and with each other, our music was made of...

...sound and silence,

terror and safety,

change and consistency,

feeling frozen and being in motion,

comfort and discomfort,

certainty and uncertainty,

sleeping and awake,

light and dark,

presence and absence,

judgment and acceptance,

loud and quiet,

intensity and gentleness,

curiosity and detachment,

containment and freedom...

And then, this morning, I read and listened to this gorgeous conversation between Krista Tippett and Ann Hamilton. When Krista asked her what questions we should be asking, without hesitation, Ann responded:

"...how to be together. I mean, isn’t that — that seems like the biggest question. How to be together." (Ann Hamilton) 

Yes! And yes again!

There are so many who believe music therapy sessions with people who don't use speech as their first language are about "playing for your clients." In fact, it is about

listening, 

noticing, 

playing,

 experiencing,

 being

 and wondering 

together.

"...when you’re making something, you don’t know what it is for a really long time. So, you have to kind of cultivate the space around you, where you can trust the thing that you can’t name. And if you feel a little bit insecure, or somebody questions you, or you need to know what it is, then what happens is you give that thing that you’re trying to listen to away. And so, how do you kind of cultivate a space that allows you to dwell in that not knowing, really? That is actually really smart, and can become really articulate? But, you know, like the thread has to come out, and it comes out at its own pace." (Ann Hamilton)

Well, what do you know?

I was minding my own business, journaling away last Sunday morning, listening to (yet another excellent episode of) On Being, where Krista Tippett was interviewing Lawrence Krauss, a theoretical physicist. The aspect of their conversation that caught my attention was this comment: 

Mysteries are what it's all about. In fact, not knowing is much more exciting than knowing, right? Because it means there's much more to learn. The search is often much more exciting than the finding. Mysteries are what drive us as human beings. 

He extended the idea by noting:

One of the values of science is to make us uncomfortable. Somehow that's supposed to be a bad thing for many people, being uncomfortable. Being uncomfortable is a good thing because it forces you to reassess your place in the cosmos. And being too comfortable means you've become complacent and you stop thinking. 

As I listened to him I realized something kind of interesting: I think not knowing is what has kept me passionately in this field for so long. 

Think about it a second. 

When we think we know (the answer, what's going on, what someone's problem is, how things should look, who someone should be, and so on and so forth) we are no longer learning, no longer curious. We stop at the surface, and, because we know then we presume there's nothing else to think about or to find out.

When we're new professionals we either think we know or we think we're expected to know most of what there is to know about music therapy. What we often don't realize is that all we know are the very basics- that there's a whole world of knowing we haven't even begun to come in contact with yet!

It took me a lot of years (and a lot of clinical supervision) to finally understand that my real job as a music therapist is to go out there and ask my clients what they need me to know and learn in order to better support them. 

So many times in my younger (pre-clinical supervision) music therapy days I went into sessions knowing what needed to be done to "help" my clients. I didn't ask, I wasn't curious about what was going on or why my clients might need to be or do things the way they were being or doing things. They were disabled. There was a list of things I knew about disabled people. There was a list of ways music was supposed to "help" disabled people. 

So I went in with my music therapy interventions, applied them, and waited for the activities to work. This is what I was taught (or at least this is what I understood of what I was taught). And when my interventions didn't work I was frustrated with my clients and wondered, "what the hell? Why isn't this working? This is what I was told to do!"

Somehow I had inadvertently stepped into the medical model of music therapy: "Here are the symptoms associated with a particular population of people. Liberally apply music therapy activities to alleviate said symptoms and to increase skills. Music is, after all, intrinsically reinforcing. Success." 

In other words, I'd go into sessions with the attitude of "I know what the problem is, and I know the solution." Except that I wasn't having a lot of success.

Finally I got myself some clinical supervision, and I learned about process-oriented, relationally-based music therapy. But when I stopped doing activities and began to use an improvisational approach, I was terrified! I had no idea what to do- ever. I was convinced I'd failed as a music therapist, because I didn't know anything any more! 

Add to that fact that I work in an institution, and institutions are notoriously entrenched in the all-knowing medical and behavioral model of understanding people. Sitting there quietly with someone (because I didn't always know what to do) and singing about what that person was doing or what I thought it might be about (as opposed to gathering everyone in a circle- or trying to- and forcing them to play instruments with hand-over-hand assistance) was an open invitation to criticism and "why are you just sitting there doing nothing, Roia?" 

But I trusted my clinical supervisor who told me "trust the process". 

As time went on, I discovered the joy in finding out who my clients actually were and began to appreciate the opportunity to get to know them in a more authentic and human way. I got more comfortable with the idea of going into a session and not knowing - not knowing what was going to happen, not knowing (yet) the person in front of me, not knowing exactly what music would be needed that day, not knowing if I was hearing my client properly, not knowing if what I offered was going to be accepted or even make sense. 

And that engaged me in the work of becoming and being a music therapist like nothing ever had! I began to understand music therapy from a whole new perspective: 

We are artists, and we are scientists, and art and science are not about knowing. They're about trying something out (an idea, a hypothesis, some direction) and discovering, or messing up, making mistakes, and figuring out better questions to ask. They're about not knowing, about wondering and curiosity, and finding out what we don't realize we don't know. 

That's amazing to me! And waking up every morning with the thought, "I wonder what will happen today with my clients," and being completely curious excited about that, is what drives my passion for music therapy. Even after doing this for 26 years!

To borrow from Lawrence Krauss again:

In fact, what's really beautiful is every time we make a discovery in science, we end up having more questions than answers.

Yes! 

So you want to become a music therapist...

Image by doug88888 via FlickrI, rather regularly, receive emails and blog comments from people who are interested in becoming music therapists.  And I regularly send back big, long emails with information I hope they'll find to be useful. Well, suddenly, one of my slower neurons fired, and I thought, "why on earth haven't you written a blog with this advice in it, so you don't have to keep repeating yourself?!" 


Somewhere a dog barked. 


Aaaand, we're back.


Okay. So you want to become a music therapist. Fabulous! And you want to know what it will take, what kind of advice I can offer, whether you'll ever have an actual salary, what to write for that research paper that's due in 13 hours...and so forth.


(Stand back. I'm about to jump into list-making land.) (Actually, even though my blog posts aren't usually in list form, I have a deep and abiding love of lists.) (But I digress.)


1. It helps to be a fairly good musician.That said, it also helps if you learn to play guitar and piano.
Different schools that offer music therapy as a major have different requirements. I think, ultimately, the more skill you have as a musician, the more you have to offer your clients. If you're busy focusing on yourself trying to play a song or a particular instrument, you're no longer focusing on your client, and that sort of defeats the whole purpose of therapy. You know? You don't have to know how to play guitar and piano before you go to school, because that is part of the music therapy curriculum. Those are, however, two instruments that are used an awful lot in the course of a music therapist's day/week/life, so it's worth getting to a point where you're relatively comfortable with them.


2. And, while you're at it, get comfortable with using your voice.
When I first started out as a music therapist I was really shy, and I found it difficult to sing in front of anyone. Mercifully, I managed to move beyond that. We don't have to be brilliant singers, but it's important to carry a tune and be comfortable improvising and playing around with vocal sounds. I still remember a client I worked with who tore up an entire room and threw my entire music cart on the floor. For a good solid year I had to go and do his sessions with nothing but me and my voice. 


3. Be careful of your "helpful" intentions. 
When you're trying to figure out what you want to do with your life, it's not unusual to think, "you know, I really want to do something that helps people." We all have our reasons for wanting to somehow be useful in this world, and they're all valid and important. When we come to a profession like music therapy, though, I think it's important to be mindful of the various implications of being "helpful" (in terms of power, control, what it means to be "the helped", etc.). Because Norman Kunc and Emma van der Klift said it a lot better already, I  highly recommend reading their article, "Hell-Bent on Helping: Benevolence, Friendship, and the Politics of Help". It will, I hope, give you a whole new perspective on being "helpful".


4. Learn to pay close attention. Notice stuff.  
So much of my job is about paying attention. Whenever I have students come to do their practicum experiences with me, I have them fill out an observation form that I developed. It's an insanely complicated form, because in a music therapy session there is so much going on at any given moment and on so many levels. You have to be aware of your client (s), the music, yourself, the environment, the history...there's a lot of stuff happening. This is what makes music therapy so completely fascinating! You can practice at an activity level and be quite effective, and you can also decide that you want to go deeper and explore the therapy relationship, the dynamics within it, and how it's all expressed within the music, and that's really nifty as well! 


5. Expect that this will be a life-long learning experience. 
Music therapy is a growing and evolving field. Because there's so much to know (and you can't cram it all in at school!), so much to pay attention to, and because you can work at a lot of different levels, there's always something new you can be learning. For that reason, getting professional clinical supervision in music therapy after you've graduated is extremely helpful to your growth as a new clinician. Moreover, there are lots of trainings that music therapists can take to deepen their knowledge/skill in specific areas (GIM, Nordoff-Robbins Music Therapy, Neurologic Music Therapy, NICU Music Therapy, Hospice Music Therapy, Austin Vocal Psychotherapy, and I'm sure there'll be more sooner or later). 


6. Get used to advocating for yourself. 
Music therapy isn't the huge mystery it once was. These days when I say I'm a music therapist, people are way less likely to say "a what?!" than they were back when I first started out. Now I'm usually greeted with something along the lines of "oh, how cool!" As nice as that is, people often think they know what we do, but they really don't. Co-workers who've known us for years may still not have a clear idea of what happens in a session. I'l be straight with you: It can be quite frustrating when you see that someone who hasn't gone through the years of training you have is calling him/herself a music therapist (or being called one by the media). It can be even more challenging when supervisors, colleagues, and various other people/organizations who fund our services (who aren't music therapists) feel compelled to tell us how we should do our job.  Having said that, I would still maintain (and I think my music therapy colleagues would agree) that being a music therapist still far outweighs the difficult stuff. 


7. You'll need to figure out a semi-quick way to explain what it is you do for a living. 
Given that you'll have to spend some time advocating for yourself and showing people what music therapy is, it's important to have your "elevator speech" prepared shortly after you graduate from your program. I usually tell people I use music to listen to people. That usually makes them curious enough to want to know more. Then, depending on how much time they're willing/able to spend, I can expound until they're sick of me. Ahem.  


8. It's not likely you'll be rich beyond your wildest dreams, but you can definitely make a living as a music therapist.
A few months ago, our Rabbi at work asked me, as nicely as he could, on behalf of one of his congregants, "can music therapists make a living doing this work?" I assured him that we could. We can find jobs (we've been doing a lot of advocating- trust me), we can get health benefits, and we can make enough money to live peacefully. We'll never get the kind of money that, say, a computer programmer or a financial analyst would make, but most of us aren't starving. And if this is truly what you want to do, then you should do it. [2024 Update: Having written this some time ago, I want to acknowledge that these days it may be a bit more of a challenge, given the financial realities of the current day. And a lot of younger music therapists have expressed dismay when they can't find full-time jobs, they can't afford housing, and they are often expected to have a Master's degree. This is decidedly problematic, and I will not deny the situation can be quite frustrating. At the same time, there are also a LOT more music therapist-owned businesses, and people are actually familiar with music therapy (or know a music therapist) (of have had their own music therapist) (or have at least heard of it). So, I believe, still, with some flexibility, you'll probably be able to find a job. It may not be where you hoped/expected to work, but it may end up being the right place. Or, like many people do nowadays, you can get some experience and move to an employment situation that feels more in line with who you are.]


9. Get used to not knowing what's going on and sometimes being uncomfortable or awkward. Or at least come to terms with it. 
I would have to say that it's rarely dull being a music therapist. Sometimes your clients will do unexpected sorts of things, or you'll find yourself dealing with really uncomfortable feelings. And sometimes you can go for a really long time and not be at all sure you're on the right track with a client/group. Again, this is what makes this work so fascinating and so completely worthwhile! It's difficult when your own issues are triggered, but, heck! Your issues will be triggered no matter what you do. You may as well have an interesting job within which to notice them. 


10. Consider getting your own therapy (or your own music therapy, if you can). 
Being a therapist is hard work. Being a client is also hard work. If you've never gone through  your own therapy, and if you've never struggled in a big way with your own problems and emotional baggage, it will be hard for you to have a real understanding of what it's like to see yourself in a new way (which is not always a pleasant experience at first). Making changes in our lives is something most of us resist mightily. Looking at our resistance- ugh! It's not always fun. It's a long, bumpy road. And we ask our clients every day to allow us to stumble along that bumpy road with them. We owe it to ourselves and to our clients to at least bring along the map we saved from our own journey (even if they decide to take a different route). (Okay, I'm getting a bit nuts with the metaphors here, but you get the idea, yes?)


So there you have it. That's the list I have going in my head when people ask me for advice on becoming a music therapist, and now here it is! In blog-land! And if any of you music therapists out there in the world have other advice to offer, bring it on!


The good news (well, to me anyway) is this: I worked as a music therapist for 34 years. Even on the worst of days, I have never regretted my decision to do this work! Much good luck to you as you go forth and consider whether or not the life of a music therapist is one you'd like as your own.

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.

Taboo Topics in Music Therapy- Part III- The List (so far)

Here's a list of taboo topics I generated. I found I had to keep adding to it as I went along. I also included many of the offerings of the conference participants. Feel free to comment and add your own. I dare say there are quite a few taboos to be found in music therapy as yet. 

Taboos (I have known and loved)

1. Sexual feelings and/or arousal

a. for clients

b. dreams about clients

c. our clients feelings about us

2. Fantasies

a. that we will be the one person who makes a difference in our clients’ lives (or that we are the be-all and end-all in their lives)

b. sexual fantasies

c. fantasies of taking clients home and taking care of them, also known as “rescue fantasies”

d. dreaming about clients

3. Mistakes on the part of the music therapist

4. Fee disasters/money/financial transactions

5. Hatred for/anger toward a patient

a. hating a patient’s music

b. clients who are hurting/frustrating us

6. Getting sick and not being able to do your job for a while

a. can include mental illness as well as physical (i.e., needing to take a break from work)

b. music therapists who have mental illness

c. fear of getting sick when working with clients who have communicable diseases

7. Feelings of incompetence

a. not knowing what to do in a session

b. feeling lost

c. feeling uncertain musically

8. Feeling that we need to be all-knowing, all loving (a.k.a. “Music Therapist Syndrome”- the belief that we must always be nice and cheerful, and that it is our job to make our clients feel better, and that we should never be “mean” and confront them or push them in any way or to talk about “sad” subjects.

9. Feeling bored or tired/sleepy during sessions

10. Clients who gross us out or offend us

11. Therapist’s fears/terrors

12. Therapist’s personal issues around shame/guilt

a. May include therapist’s own abuse history

13. Being fired

14. Issues with staff/co-workers/clients’ families

a. having to report staff/clients’ families for abuse/neglect/etc.

b. fears of retaliation should we report abuse

c. dealings with staff regarding clients (having differences of opinion)

d. staff undermining our efforts as therapists

15. Being uncomfortable with the system within which we work

a. disagreeing with the way client services are provided

b. having to represent a facility we don’t always feel comfortable with

16. Boundary violations

a. treating clients or their families as friends

b. hugging/touching clients as a matter of course

c. violating client confidentiality

17. Guilt over terminating/guilt over not terminating

a. “I should have tried harder.”

b. not working on closure

c. difficult endings

d. ending because we don’t know what else to do

18. Fear of violent clients or those who act out in other ways

a. constant anxiety when having to go and work with a particular client

19. Clients who fall asleep in sessions

a. leading to fear that we are inept or ineffective therapists

b. that we’re doing something wrong or boring

20. Having favorites

a. when we admit it we’re less likely to act on it than if we deny it.

b. also the belief that we have to love all of our clients

21. Fear that a client may commit suicide

a. along with the fear that we will miss the warning signs and it will be our fault

b. and the corresponding fantasy that we will be the one to save this client

22. Being in the role of “helper”

a. discomfort with being in the role of ‘helper’

b. not being aware of the power difference between client/therapist

23. Seeing clients as more disabled than they are

a. sometimes leads to an attitude that “they don’t understand what we’re doing, so it won’t hurt them” (this is the kind of belief that can lead to situations like the one with Corey Brown, the music therapist who molested his clients)

24. Working with someone your own age

a. Or working with someone you’ve known in a different context (including survivor guilt)

25. Running into clients outside of the therapy context

a. Clients who want to connect through various online social networks

b. Clients asking for sex/marriage/personal phone numbers

c. Clients who grope themselves/who try to grope the music therapist

26. Clients who are better musicians than we are

27. The myth of music as a “non-threatening” medium

28. Guilt over privilege

29. Assuming our clients are heterosexual, or identify as a particular gender

30. Hating a particular style of music and/or refusing to learn or play a particular style in music therapy sessions

31. Clients dying or getting seriously ill (sometimes in the middle of a session)

32. Racism, sexism, able-ism, heterosexism (in all of their infinite varieties and forms)

33. Music therapists who do not dress in a professional manner (i.e., whose dress is seductive or overly casual)

Why we don’t talk about these things (some of these reasons are taboos in and of themselves, I would say):

• We don’t always know the answer
• We don’t want to look unprofessional/bad
• Ashamed/embarrassed/fear of being blamed
• Music therapy students who are over-protected/over-directed
• Not always recognizing countertransference
• Helplessness
• Not wanting to deal with repercussions
• Competition between colleagues
• Not having a supervisor/mentor/safe resource
• The need to constantly “prove” that music therapy is a valid therapy
• Wanting to be a good example
• Diminishing the impact of an issue (i.e., making light of a difficult topic)
• Fear of being seen as a fake/incompetent