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)

A musical portrait

Image by mommy peace via FlickrAt first I thought he was angry with me. He certainly looked quite solemn. True, I'd been away for a couple of weeks, but usually he's at least willing to stand up and go to the Music Room with me. 


So I pulled up a chair and sat next to him. "You don't want to go to your session?" I asked. He hung his head down. "Okay. Can I just sit with you for a little bit?" He looked up briefly and then face down again. 


We sat for a minute. "You can come and tell me in the music if you're upset about something." He was listening, but not moving. "You know, I'm going to just go get your jacket and hold on to it. If you still don't want to come with me that's fine. But if you do, we'll have your jacket. I don't know. Maybe we could just go for a walk. It's pretty nice outside." 


I went to the coat closet, fished out his, and went back to sit next to him. The guys in his group were all watching television, so I chatted about that. After a little while, he half-smiled, got up and reached for his jacket.  "Cool!"


We headed outside into the sunshine and walked slowly. I wasn't sure whether we were just walking or if we'd be going to do his session.  As it turned out, we made it to the Music Room. 


He moved the instruments I'd put out for him onto the bench at the end of the couch and proceeded to lie down so he was facing me where I was sitting at the piano. I could hear, from the way he was breathing, that his sinuses were really giving him a hard time. 


His facial expression was still quite serious, unsmiling. I sang a greeting and asked how he was feeling. He responded with a heavy sigh.


"I realize you may have some feelings about my having been on vacation. I wonder if maybe you're feeling angry with me." And I invited him to look my way if that was the case. He did not.


Oh. Hm.


"Feeling abandoned?" A little bit of eye-contact.


We stayed there, quiet. Where to go with this?


"I'm having a hard time figuring out what might be going on for you today. I'd like to play a musical portrait of what I think I might be seeing or hearing, maybe just sensing, from you right now. If you can, will you help me by letting me know if what I'm playing makes sense. Also if it doesn't sound right, can you find a way to steer me in the right direction? I'll do my best to listen."


I played, using the piano. It was halting, dissonant- really quite dissonant, and it didn't feel very grounded. I guess you could say it sounded like someone floating and unsettled. 


As I played, I realized I hadn't "heard" his initial response accurately. He wasn't angry. The music he inspired didn't sound remotely angry. It sounded, and felt, very sad. And it probably wasn't really about me. 


"I misunderstood. I'm sorry. I think, as I'm listening to the music, I might be hearing your sadness." Slowly he turned to face me. Wow. I felt his sadness too.


What now? Where to go with all this sadness? 


As I thought about how to respond, how to be present, I was reminded of my friend, Greg, who often quotes John McNeill to me: "If anyone is willing to enter my private hell and stay there with me, then there are grounds for hope."


I invited him to hum with me as I played. I started the music where I had left off- at the musical portrait. Gradually, the sounds on the piano became slightly- only slightly- more consonant. Eventually, I was just moving between A flat and B flat, humming quietly. 


I heard sounds from him- not a lot, because it was difficult to vocalize with his nose all stuffy as it was. I moved from humming to a quiet "ee" sound, thinking it might be an easier sound for him to make.


His eyes closed and he smiled briefly. I thought he might fall asleep, as he often does. But he didn't. He listened. And we sat together in the sadness and in the music.


It was time to go. I sang a quiet goodbye, reminding him I planned to be back on Thursday. I got up to get my sweater, and he followed me to get his jacket.


He took my hand and we walked back to his cottage in the sunshine. 

"Expectant waiting"

Image by thumeco via Flickr

I was reading an article this morning in an old issue of Unity Magazine (September/October 2005) describing  a Quaker meeting attended by the author, Mason Hayek.


Here's what he shared of his experience:

The Friends who have gathered have brought in their feelings from life as it is for each of them today...Each person has brought a bundle of feelings and sits clutching it. (p. 44)

Image via WikipediaAs time passes, the silence deepens, so that any sound  will seem like a rock breaking the window of one's mind. And yet, part of what we come for is the ministry, the message that we or others may speak. The ministry of presence is helpful and the strength that comes from meditation, contemplation, creative thought, or worship will reward our coming. But the words that arise from the honest and open searching for truth by others can open new paths for us. The words can catalyze our searching. (pp. 44-45)

From one's own worship and meditation, perhaps aided by the ministry of others, may come thoughts that are too strong to restrain. When the words beat against our brains irresistibly, we must speak.  (p. 45)

A Friends Meeting for Worship is a gathering in quiet, waiting and listening for the "still small voice within." (p. 45)

The essential elements of worship can all be practiced and experienced when one is alone, but Meeting for Worship has special qualities. It is a shared experience in searching for the truth, a religious experience enhanced by interaction with other persons. That interaction allows us to test reality. We can see our lives, wishes, and fears in better perspective when we interact with others under conditions where we respect our neighbors as well as ourselves. We feel joined to one another. (p. 45) 

In her online article, Silent Worship and Quaker Values, Marsha Holliday notes:

...Friends in the unprogrammed Quaker tradition base our worship entirely on expectant waiting. 

"Expectant waiting." I think that's such a lovely way to put it!


Two summers ago I attended a class at Pendle Hill, which is a Quaker retreat Center, where we were invited to participate in a Meeting each morning. 


I went once or twice, and I reflected then, as I did again this morning, on how similar it felt (to me) to the process of music therapy, especially when working with people who don't use speech to communicate. (I've written quite a few blogs- here and here, for example- about silence as an important aspect of music therapy.) 


In particular I was struck by the idea of presence within the silence and being present to the experience of silence.  


Unexpectedly (or maybe not), as I was thinking about this, I happened to read a blog, also this morning, about the experience of silence from the perspective of a person on the autism spectrum. 


Mike, the author of the blog Journal of an Autist reminds us:

Even silence speaks...Start by listening through all your senses, and you will hear us speak, even in our silence.

I'm not sure whether it's a taboo or not to talk about therapy and spirituality (I certainly don't see music therapy, or any kind of therapy, as a space to conduct one's religious agenda), but it's hard to not see the parallels. We create a sacred space within which the therapist, the client, and the music come together for the purpose of growth. There is complexity within these relationships and an effort to make sense of the complexity.  There is a joining together for a common purpose...all of these seem like deeply spiritual experiences to me.


I wonder what your thoughts are about this.

1/26/10 Quote- Developing a relationship through music with someone who doesn't use speech

Image by alles-schlumpf via Flickr

I am slowly reading through a book called, "Music Therapy: Intimate Notes" by Mercedes Pavlicevic (1999, Jessica Kingsley Publishers). It describes, of all things, what it's like to be a music therapist in relationship with one's clients. 

Hmm. Where have I heard that before...

Anyway, I'm not sure why I haven't looked at this book until now. It's been around for ten years. I guess books come in to your life when you're ready for them. 


So I just finished the first chapter. Each chapter seems to be organized around a particular story shared by a music therapist. Mercedes Pavlicevic then adds her comments. 


Which is great, because her comments are beautifully put.


Here, for example, are some excerpts in which she very nicely describes the process of building a music therapy relationship, clarifying for readers (presumably not music therapists) what has just been shared in the story and why it's significant:

How do you respond to a child who does 'nothing'? The void that he presents, and his absence from the music therapy room, challenges a deeply natural aspect of human communication: that for communication to happen between people, we need the responsiveness of another person, we need them to show their responsiveness, whether in speech, movements or facial expressions, and we ourselves need to have a sense of their sensitivity to our influence- to mutual influence. We cannot communicate with someone who does not show any signs of being susceptible to us, influenced by us; who appears vacant.

She goes on to say:

     Communication between Oksana and Daniel is a two way process: Daniel begins to vocalize and at first he makes occasional short sounds. Oksana vocalizes too, but not just in any way: she listens to the quality of his voice, how short the sounds are, how high or low they are, whether she can hear any rhythm, any shape in what he does. And she adapts her own vocalizing in a way that is related to him, to his sounds. This is the beginning of interpersonal influence. She is influenced by what he does and by how he does it- no matter how tiny and apparently haphazard his sounds are at first- and her sensitivity to him sounds in her voice. He hears this, and feels her awareness of him in the song that she is singing, and in session four, this triggers something in him. Suddenly, he begins to vocalize much more intensely: he makes longer sounds, and immediately she responds, matching his longer, more intense sounds. In these moments, Oksana and Daniel connect with one another in a way that they have not been able to until now. What is interesting here, though, is that Oksana does more than just match, or mirror what he does. She begins to extend what he does.

     This is crucial: in order for Daniel to extend himself, to grow, to develop, he needs to be shown where he can go with his voice. Now that he and Oksana have 'met', now that each has a sense of the other, through their vocalizing together, Oksana keeps close to what Daniel is doing: she continues to match his singing closely. In this way, he knows- he has a sense- that her singing is related to his. And when she does a bit more- sings for longer, or louder, or quicker- he then hears where he needs to go in order to remain connected to her. (pp. 20-21)

Is that not gorgeously and articulately said?


She so nicely captures why it's so important to have a relationship with our clients. Without the relationship, there is no investment or interest in, heck, no meaning to what we present in a session. 


The very last sentence says it perfectly: "...he [Daniel, the client] then hears where he needs to go in order to remain connected to her [Oksana, the therapist]." 


In other words, the relationship now matters to Daniel, and he now has a reason to learn new things and a context within which he feels acknowledged and heard so he can feel safe enough to venture outside of himself. 


And, that, my friends, is music therapy. 

"I want to be here."

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


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


Just. Sat. 


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


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


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


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


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


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


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


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


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


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


I knew he wasn't finished. 


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


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


Eye-contact. Bingo!


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


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


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


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


He thought about this for a while. 


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


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


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


I sat with him. 


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


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


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


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


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


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

Isn't that kind of messed up?

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

Image by nickwheeleroz (on holiday) via Flick

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


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


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

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

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

And it made me wonder. Why?


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


Okay. So.


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

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


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


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


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


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


And you'd be right. 

You don't know what people know when they can't tell you...

From the Daily Mail in the UK, here is yet another reason we can't decide we "know" what people who don't use speech know or don't. Thanks to Anne Barbano for tweeting it to my attention.

Patient trapped in a 23-year 'coma' was conscious all along

By Allan Hall
Last updated at 1:59 AM on 23rd November 2009
A man thought by doctors to be in a vegetative state for 23 years was actually conscious the whole time, it was revealed last night.
Student Rom Houben was misdiagnosed after a car crash left him totally paralysed.
He had no way of letting experts, family or friends know he could hear every word they said.

Rom Houben was trapped in a coma for 23 years and had no way of letting anyone know he could hear what they were saying (pictured posed by model)

'I screamed, but there was nothing to hear,' said Mr Houben, now 46.
Doctors used a range of coma tests, recognised worldwide, before reluctantly concluding that his consciousness was 'extinct'.
But three years ago, new hi-tech scans showed his brain was still functioning almost completely normally.

Mr Houben describes the moment as 'my second birth'.
Therapy has since allowed him to tap out messages on a computer screen.
Mr Houben said: 'All that time I just literally dreamed of a better life. Frustration is too small a word to describe what I felt.'
His case has only just been revealed in a scientific paper released by the man who 'saved' him, top neurological expert Dr Steven Laureys.
'Medical advances caught up with him,' said Dr Laureys, who believes there may be many similar cases of false comas around the world.
The disclosure will also renew the right-to-die debate over whether people in comas are truly unconscious.
Mr Houben, a former martial arts enthusiast, was paralysed in 1983.
Doctors in Zolder, Belgium, used the internationally accepted Glasgow Coma Scale to assess his eye, verbal and motor responses.
But each time he was graded incorrectly.
Only a re-evaluation of his case at the University of Liege discovered that he had lost control of his body but was still fully aware of what was happening.
He is never likely to leave hospital, but as well as his computer he now has a special device above his bed which lets him read books while lying down.
Mr Houben said: 'I shall never forget the day when they discovered what was truly wrong with me - it was my second birth.
'I want to read, talk with my friends via the computer and enjoy my life now that people know I am not dead.'
Dr Laureys's new study claims that patients classed as in a vegetative state are often misdiagnosed.
'Anyone who bears the stamp of "unconscious" just one time hardly ever gets rid of it again,' he said.
The doctor, who leads the Coma Science Group and Department of Neurology at Liege University Hospital, found Mr Houben's brain was still working by using state-of-the-art imaging.
He plans to use the case to highlight what he considers may be similar examples around the world.
Dr Laureys said: 'In Germany alone each year some 100,000 people suffer from severe traumatic brain injury.
'About 20,000 are followed by a coma of three weeks or longer. Some of them die, others regain health.
'But an estimated 3,000 to 5,000 people a year remain trapped in an intermediate stage - they go on living without ever coming back again.'
Supporters of euthanasia and assisted suicide argue that people who have lain in persistent vegetative states for years should be given the opportunity to have crucial medical support withdrawn because of the 'indignity' of their condition.
But there have been several cases in which people judged to be in vegetative states or deep comas have recovered.
Twenty years ago, Carrie Coons, an 86-year-old from New York, regained consciousness after a year, took small amounts of food by mouth and engaged in conversation.
Only days before her recovery, a judge had granted her family's request for the removal of the feeding tube which had been keeping her alive.
In the UK in 1993, doctors switched off the life support system keeping alive Tony Bland, a 22-year- old who had been in a coma for three years following the Hillsborough disaster.
Dr Laureys was not available for comment yesterday and it is not clear why he thought Mr Houben should have the hi-tech screening when so many years had passed.

The trouble with "quality" when one starts to think about it for too long

In my quest to figure out whether or not I'm providing quality services to my clients (because at this point, let's face it, it's become something of a quest), a lot of questions and thoughts have emerged for me.

It all sounded so easy on paper...

Obviously, on one level, this is clear-cut, and there's no real need for a lot of thought. We ("we" being music therapists) have certain elements in place to make sure we are doing what we're supposed to be doing.

We start by doing an assessment, from that we develop goals and objectives, we provide music therapy, and we evaluate the outcomes. Then, presumably, we can articulate "yes, the client met this objective" or "no, the client did not meet this objective."

When the goals and objectives are met we, ideally, proceed toward termination. When they're not, we either have to re-think what we're doing in order to help the person to be more successful or we decide that the goals and objective we originally set may not have been appropriate and we adjust them accordingly.

You'd think that would be the end of the story, but if we're really talking quality, it's not.

For a lot of reasons.

Meaning what? Or what meaning?

First of all, If I used a straight behavioral approach or a skill development approach in my work, then, sure, when my client achieves an objective that hopefully implies the effectiveness of the music therapy intervention I used. But it doesn't necessarily mean my client is happy with the service I'm offering or feels that s/he made some change that was important to her/him. It just means that s/he performed a specific action based on a specific objective/goal which may or may not have meaning for him/her.

Here's why I say that:

I work with people who not only don't use speech, but they're not usually the ones who decide they'd like to receive music therapy ( at least not initially). Furthermore, they may or may not understand what music therapy is, how it can benefit them, what is the process, and what the point of it all is (again, at least not initially).

This is how my caseload evolved: I either inherited my clients from former music therapists who worked at the institution, or I ended up working with people because I was assigned to provide music to their whole group and at some point I realized this particular person could use some individual intervention, or the team (that would be the treatment team who writes the "person-centered plan") makes a referral and asks me to work with someone.

More often than not, my clients never "request" music therapy, at least not with a clear understanding of what music therapy is and what it isn't. (And, to be truthful, people are often referred to us for music therapy because they "like music".)

Who/what determines quality in this context?

So I'm left wondering how is "quality" defined when I am providing services to people with severe disabilities who live in an institution, and when I use a relationally-based music therapy approach, the focus of which is not necessarily on developing specific skills?

Whose definition of quality do I use? The institution's definition (which is usually based on the rules and regulations provided by funding sources as well as a series of "core indicators")? Or the clients' definition?

I'm inclined to use my clients' definition, but how do I go about determining, when my clients don't use speech and their ways of communication can be confusing, what their perceptions, understanding, and preference for quality is? How can I figure out whether they are satisfied with the music therapy they're getting? And, given their histories, are they settling for, or being satisfied by, less than they should be?

On the other hand, it's important to respect the standards set by the institution as well. I can't very well ignore the context within which I'm working. As such, it's necessary to take that aspect into account as I move forward in this process.

And let me not fail to mention that, as a Board-Certified music therapist, I am expected to provide services with an awareness of the standards set forth by the Certification Board for Music Therapists (CBMT for short) and the American Music Therapy Association (AMTA).

Obviously, there's still more to say about this subject. On to the next post, eh?

Is change a good thing?

The first good thing about last Wednesday was that J decided to go with me to his session. 

That may not seem like a big deal but for him it is. We've had a year and a half (maybe a bit longer) of his hemming and hawing about being in music therapy. Since he doesn't use words to communicate, "hemming and hawing" looks like his walking with me (for all intents and purposes looking as if he's planning to come to his session) only to get completely stuck and not move- unable to move toward the session area and unable to walk back to his day area. (Insert long pause here.)

Sometimes his "hemming and hawing" looks like pulling me (yes, literally) in various directions and not really going anywhere. Sometimes it involves my suddenly noticing that he didn't let me know he needed to use the toilet. (Insert more pausing.)

We had been using the Music Room for sessions.  I've worked with J for quite a few years now, and it had taken us a long time to get to the point where we could safely leave the cottage, walk to the other building, and get to the Music Room, not run out the door in the middle of the session without letting me know he needed to stop for the day (that also took some practice), and get back to the cottage without anything too dramatic occurring. 

A little over a year ago J got to the point where, when he walked with me to the Music Room, he flatly refused to go in, opting instead to pull me around the building, pull me around outside, and pull me to the canteen (never to the cottage). I finally had to say "enough. We need to go back to working in the cottage!" J is a good two heads taller than I am, and, frankly, I need the use of my hands and arms, Furthermore, if I wasn't feeling safe, neither was he (or maybe it was the other way around). 

So there we've been: in the cottage. 

J is clear that he doesn't want to stop music therapy. Even when he doesn't want to actually go to his session, he holds on to my hand tightly and pulls me to sit with him in his day area.

"See Roia? This is where I live."

It has felt frustrating, confusing, heartbreaking and maddening at various points.

Last Wednesday (which is where I started this blog) I found myself, again, wondering out loud to J about his intense ambivalence (a.k.a. "hemming and hawing") with regard to his use of the music therapy process. (Mind you, J has been ambivalent from the beginning, but we had at least worked to a point where he was decidedly certain of his wish to get himself to his sessions.)

I noted that one of the hardest things about going to therapy (any kind of psychotherapy), and I say this from my own experience as well, is that as we get healthier the people and situations in our lives sometimes look, well, a lot sicker. It's a lot harder to tolerate boundary violations, drama, and generally obnoxious behavior when you've made an effort to be more mindful in your interactions and to get your own dramas under control.

The average person can decide for themselves, "I no longer wish to be in this relationship" or "I need to make some life choices so I don't find myself frustrated by being in jobs that are not challenging to me" or some act that requires a sense of agency.

But a person who lives in an institution, whose life is basically organized for him by other people in so many ways, who doesn't have or see any real prospect for getting out of the institution may not be able to do that. 

Even if he makes a monumental effort to convey what is important to him (and many of my clients do!), most institutions don't have the capacity to listen.

To know this, to live this, is nothing short of tortuously frustrating. 

In effect, I could see that J may (quite legitimately) feel as if I have offered him a taste of something that he could only have when he was in his music therapy session. And he may feel angry, resentful and hurt by that. And, yes, he may feel quite ambivalent about wanting to continue this kind of work.

In effect, I feel as if I have supported him to grow within a system that isn't willing to grow. 

As I acknowledged all this to J, he listened, quietly walking around the room where we worked, the noise of television sets, blaring music, and people's voices forming a constant background to our makeshift therapy space.

J walked over to me with a sort of wailing sound (a sound he often makes) and pulled the guitar carefully over my head (it's attached with a strap), waited for me to put it down, and pulled me gently out the door and back over to his day area. 

He sat down in a chair and just watched me as his staff, mostly ignoring him except to verbally acknowledge his return, began to chatter with me. 

"See, Roia?" his eyes seemed to ask me.

Yes, J, I see.

I'm sorry.

This past Wednesday, he got up and came right with me to his session.

Listening

I was reading a book called “Practicing the Sacred Art of Listening: A Guide to Enrich Your Relationships and Kindle Your Spiritual Life” (by Kay Lindahl of the Listening Center) this morning, and I was thinking how odd it is that so many music therapy training programs seem (in my mind anyway) to spend way more time helping students learn to lead the group by coming up with effective activities to change behavior and meet goals than they spend in helping students learn how to listen. 

This seems sort of ironic, given that we’re music therapists. Ideally, much of our work consists of listening and responding and then making music in some way. Listening (if I may state the obvious), is probably the most crucial aspect of the work of being a music therapist. 

In retrospect, it occurs to me that my teacher did actually try to teach me to listen, but I was too young and self-absorbed (in the sense of worrying about what I didn't know) to be able to- er- listen to him at the time. Sigh.

One of the (many) things that, I think, creates a lot of anxiety for the music therapy practicum students who come to the developmental center where I work is wondering how on earth to go about listening to people who don't use speech to communicate. It's certainly a legitimate concern, and it doesn't have easy answers. 

It's a complicated enough subject that Herb Lovett (one of my heroes) wrote an entire book about it. He's not the only one who has addressed this issue, of course, but his was one of the first books I read which advocated paying attention and listening to people who don't have access to the usual means of communicating.

I think a lot about how to listen to my clients. Well, I should amend that to say I think a lot about how to hear my clients. After a lot of years of practice (No. Really. A lot of years!) I would say I've gotten better at listening (and also better at noticing when I'm not listening and think I have been). It's still awfully hard to know for sure whether I've heard my clients properly. 

Most of the people I work with let me know I'm on the right track by changing something they're doing. For example, I may be working with someone who is throwing or pushing instruments around the room. What I often do in response (as long as instruments and people aren't getting hurt) is to hypothesize out loud as to what's going on (as in, why the need to use this particular way of communicating and why now?). 

What I'm doing is trying to find a way to verbally (and/or musically) state what my client may be trying to "say" to me with his action. "Are you telling me you're not interesting in music therapy today? Perhaps you are frustrated about something. (Some people don't respond as well to questions, so I try to re-phrase it as a statement instead.) Maybe something or someone has frightened you."

All the while I pay attention to my client's responses. Meanwhile, I monitor my own reactions and thoughts (simultaneously). I try to be aware of how I'm reacting to my client's action(s): with anger? With anxiety? With sadness? Frustration? Humor? Uncertainty? My reactions give me information about the interaction so that I can do the work of helping my client "talk" to me. 

In my work, the relationship is the focus, so whenever something is going on in the session, I relate it back to what is happening between my client and myself. As such, it makes sense to notice how I'm feeling in relation to what my client is doing, because, more than likely, s/he is trying to help me hear him/her in some way (granted, it's not always in the most helpful way, but I believe the intent is there).

So, back to how do I know when I'm getting it right: well, I don't always know. In fact, I will never (and have never) 100% Known.  This is what makes this work so difficult (as I've said before). The not knowing for sure. Ever. 

But when someone suddenly stops throwing things around when I ask if he's trying to tell me he's scared (and I never said "stop throwing things around" to him), I can at least start thinking about what might be making him scared and have a place from which to start hearing him. 

And, at the very least, I know he knows I've been listening to him.

Listening to the difference

Last Saturday, D and I waded slowly through the snow (since we were both fairly well-bundled, it was actually a pleasant and pretty walk), and we managed to get ourselves to the Music Room. 

Lately, he has been a lot more vocal during his sessions, and it's been exciting to hear his voice at long last, mixed in with his chuckling and rocking. 

Before I went on vacation for two weeks, I'd been using a lot of dissonant sounds on the piano with him, and he was quite responsive. So we had been playing back and forth, with D vocalizing, smiling, and tapping at the tubular shaker.  

This past Saturday was the first session after I'd been away.  What I began to notice as we made music together was how different my music sounded from what I usually play with D. Instead of the playful dissonance, I found myself using a ground bass. Very consonant. Very settled and very settling. Also very consistent.  I found myself using a lot of I-IV-V progressions- nothing particularly unexpected. In fact, it was downright predictable.

I usually ask my clients whether they have any feelings with regard to my absence that they want me to know about. Of course, since the majority of the folks I work with can't tell me with words, I am usually left to figure it out. Somehow. Well, "somehow" usually involves paying attention to the music. And how people are interacting with me (or not).  Mostly I try to notice what feels different.

I wondered (to myself first, and then out loud to D) whether he was feeling a need for me to be predictable in the music, because I had been away (which, in spite of my reminders, probably felt somewhat unexpected to him).  Perhaps he needed me to be more trustworthy, or simply present, within the context of the music.

Interestingly, consonant music usually comes back to the tonic chord- the I chord out of the I-IV-V progression. Maybe he simply needed to have me musically express that I had come back.

You see how it's sort of difficult to put the musical experience into words.  This is what makes music therapy so powerful.  It doesn't rely on words. 

Well, I wasn't sure whether I was on the right track or not.  D doesn't usually seem to be too bothered by my being away.  But here I was noticing that my musical interactions with him were different- even though his responses seemed pretty much the same as usual to me.  

So I waited and tried to pay attention.  There we were: D was doing his singing and tapping thing, smiling as I played my consonant chords on the piano, and we were going along just fine until I let him know we had about ten minutes before we had to say "goodbye".  His whole face changed, and the vocalizing sort of stopped. Hmm. 

"Roia, we were going along just fine in music therapy, and suddenly you weren't here."

I wouldn't have thought much of it, because he does do this sometimes, but it was so obviously connected to my saying it was nearing time for us to go.  And I did just get back from a vacation. And there was that whole playing different music thing.

It may not have been a perfect answer- or even a great interpretation, but it seemed pretty clear to me. I reminded him that I planned to be back the following Saturday.  Gradually his good humor (and voice) returned, and we finished the session peacefully. 

Guess we'll see what tomorrow brings...