5 Reasons Why You Need To Process in Music Therapy

I was off listening to a terrific podcast on processing over at the Music Therapy Round Table (and I highly recommend you go over and give them a good, solid listen). Well, I wanted to make a comment, but it turned out to be, like, six paragraphs, so, um, I figured I'd better head back to my own blog home and write it all out here and link it back to the hardworking Round Table folks: Kimberly Sena Moore, Rachel Rambach, Michelle Erfurt, and Matt Logan! 

As Michelle mentioned (either in the Round Table podcast or the Music Therapy Pro podcast), this business of processing (especially in clinical supervision) is kind of my "thing" (which makes it all sound a little...suspect) (but, really, it's not). I mean, if we're going to be honest (and I think we must), this whole blog is about me processing my experiences as a music therapist. 

I'm determined (determined, I say!) to convince the  music therapy world that we need to make processing a regular part of our work routine. And, yes, I'm sure I've probably said all this before, but I'm saying it again. And this time I'm going to try to be more succinct (stop snickering, I can do this). Okay. Here goes:

5 Reasons Why You Need to Process in Music Therapy:   

1. Processing helps you move your work to a deeper level.

Put simply: processing helps you move beyond observation to trying to understand what you’re seeing, experiencing, hearing, noticing in a session. Matt Logan wisely pointed out that a part of processing is looking at the relationships between the therapist, the client(s) and the music. It's so easy to get caught up in “what do I do? What should I do next?” and completely forget to look at what’s there in the session in a deeper way.

 2. It helps you gain a better understanding of what you're doing and why. 

Thinking through your sessions and trying to understand what happened in your sessions helps you get a stronger grip on the ever-present question:

 What is music therapy?

The longer you practice, the more your understanding of the work you do evolves and your answers to that question change and grow more meaningful. Processing asks you to consider: what is the role of music in my work? What is therapy? Who are the people I'm supporting? 

The more deeply you understand your work the better able you are to communicate why a client, a facility, an organization, a state, a country, the world needs music therapy.  

3. We all have feelings about our clients, and it's important to consider their impact on the therapy process. 

You have feelings about your clients, I have feelings about my clients. It's a normal part of therapy called countertransference. It doesn't matter who you work with (infants right on up through elders) and it doesn't matter how long you've been working and it doesn't even matter what approach you use. It's all part of the process. 

And the things is: just because you aren't necessarily having strong feelings or reactions you might think of as being "negative" (sad, angry, frustrated) it doesn't mean that your feelings aren't getting in the way of your clients' growth. Of course, I'm not saying that they are - just inviting your awareness that they have the potential to do so. 

I'll use myself as an example:

When I pause and reflect on the folks who are in my caseload, I notice there are some clients who stick with me all the time, because the work with them is difficult (or because they appeal to me in some particular way), there are some folks who I avoid thinking about, some who I forget about entirely, and some whose sessions I truly enjoy. 

Processing helps me step back and look at the larger picture of what’s happening. Otherwise, I can easily get bogged down in the "session notes version" of things (you know...what happened first, then what happened) and never move beyond it. 

Processing means I start to be curious and ask questions: 

Hm, why do some of my clients appeal to me more than others? Why do some not? What is it about some people that makes me completely forget about them until I see them in a session? Why is a particular client frustrating me so much? What's my role in this? Is s/he reminding me of someone else in my life? Is my complete joy in working with a particular group of clients making it hard for them to explore feelings of anger they may be feeling toward me (whether it's about me or not)? Is my discomfort about a specific topic obvious to my clients to the point that they're they avoiding looking at it to "please" or protect me? 

4. Processing helps you realize that music therapy doesn’t usually happen in one single session 

Well, okay, depending on where you provide services, sometimes it does. In general, though, processing helps you start to put things together (from one session to the next, over a period of time of working with someone, etc.). If you’re someone who tends to use an activity/therapeutic music experience approach, it’s important to think about what’s going on from moment to moment in a session that you might not have thought to look at. A process paper can help you do this and encourages you to ask questions, such as:

What happened? What patterns am I noticing in our sessions?  Then you move on to: What was I hoping to do with this particular person/group? How did it go? What do I think about that? 

5. Processing with a clinical supervisor helps you see your blindspots.

You don’t see your blindspots. That’s why they’re called blindspots. You don’t know what you don’t know! And, like anybody else, you don’t think to ask yourself something you wouldn’t have thought or known to ask yourself.

And that's okay! That's why there's such a thing called professional clinical supervision!  Yaaay!

Processing with a clinical supervisor helps you begin to see things you might not have looked at before. It doesn't mean you're a bad therapist. It just means that having an extra set of eyes and ears (who happen to have more experience) will help you think about things you hadn't thought to think about before. (Shout out to Michelle Erfurt for your great point that you didn’t really look at stuff to the extent you did until you had supervision!)

So, lovely music therapists: What new and unexpected thoughts are you thinking about your clients and about your work? 

Music Therapy Show with Janice Lindstrom

I feel as if I've finally arrived in the land of music therapy. I've had an interview with the lovely and thoughtful Janice Lindstrom, the woman and music therapist behind the Music Therapy Show!


We talked about relationally-based music therapy, using a process (versus product-oriented) approach, countertransference, using music to listen to and reflect on what our clients present to us in sessions, and all kinds of nifty stuff.


If you'd like to give it a listen (and share your thoughts on these subjects) (that are near and dear to my heart), here it is!

Listen to internet radio with Janice Lindstrom on Blog Talk Radio

Journal Prompt #4- Uncertainty

Image by cowbite via FlickrOne of the hardest aspects of being a music therapist, at least for me, has been working to come to terms with the experience of uncertainty as I work with clients. I'm sure this won't come as a surprise to you, because I've written about it a number of times (here, here, and here- to name a few).


I think part of what makes it difficult to sit with the sense of "um, I'm not sure what's going on here" is this mythology we tend to buy into as music therapists (I guess as any kind of therapists, really) that tells us "you must always know what's going on with your clients and have the perfect intervention and/or response to address it."   


Even after doing this for 24 years, there's still a nagging sense of "I should know" in the back of my mind- even though I know (intellectually anyway) that I don't have to know, and even though I'm well aware my clients aren't always ready for me to know (or aren't ready to know for themselves), and even though I realize it's just a matter of sitting with the feeling and trusting the process.  


I understand that some of my uncertainty comes from the fact that I work with people who don't use the usual means of communication or ways of relating to people. Using a process-oriented approach (and not a product-oriented one) also increases the likelihood that I won't always know what's going on in my sessions. 


And, really, I'm okay with all of that. I'm just...very aware (shall we say) of a feeling of "hmm" when I'm faced with a situation and I'm not sure how to proceed. 


So, lovely readers, I invite you to join me in looking at this part of our work as you journal.


-Do you allow for a bit of uncertainty as a part of your music therapy practice? If you do, in what ways? If you don't, why not? 


-How do you approach uncertainty when it comes up in your work as a music therapist? Do you power through it on your own? Do you seek supervision or consultation? What kinds of questions do you ask yourself?


-How do your beliefs about what it means to be a "good music therapist" affect the way you deal with uncertainty? What does it mean about you, about your abilities as a music therapist, about how people might view the field of music therapy to "not know" what to do or how to approach a therapy situation? 


-What if the "perfect" song or intervention isn't coming to you and you're in the middle of a session? 


-What are some of the things you're doing in your music therapy practice that help you avoid the experience of uncertainty? How does that affect the therapy relationship? What might you be communicating to your clients?


I'd love to hear your thoughts about uncertainty (written out, sung, played as a piece of music, acted out as a play, whatever works for you), so please share them freely. 

How wonderful that you're here!

Image via WikipediaWe music therapists are always trying to define what we do. Or, more specifically, help other people understand what it is we do. We write books and articles about it, we blog about it, we put together podcasts- all in an effort to convey to the masses a sense of what makes us go into this profession that seems to defy description!


But, if someone were to have asked me yesterday "what is music therapy and how does it work?", I would probably have said that it's about inviting people to be present to each other, and we use the music to help make that happen. 


Mondays are long days. For me, I go into work a little later and stay a little later. And, I think we can all agree: it's hard for any of us to transition into a Monday, which is, for most folks, the beginning of the work week. And I would say that it requires even more fortitude to get into the Monday spirit of things after a particularly long Thanksgiving weekend, which, of course, marks the beginning of the (dreaded) holiday season.


While staff frantically decorate the cottages and prepare for Open Houses (where everyone's family is invited to come and visit and there's food and music and merriment and so forth), my clients prepare for the annual anxiety of "will my family be coming to spend time with me this year?" 


So, this is a bit of the sense I got when I showed up to work with the group yesterday (Monday) afternoon- "the group" being ten men and me. 


Oh, where to begin? 


Well, let's see. There was a whole lot of messing with chairs (that would be P), switching of seats (that would be R), tossing instruments, trying to pick up instruments and then getting stuck on the floor and needing help to get up (that would be T), repeatedly rearranging and fixing the curtains so the sun wasn't blinding us (um, well, actually, that would be me), coming in, turning off the lights, and then leaving (that would be K), coming in, crying and starving to death and then leaving (a different K who does use some speech), and on and on, all accompanied by a low moaning (courtesy of J), the periodic fist to the head (of B), and the festive crashing of the tambourine (P again).


Can I get a witness? Anyone? Anyone?


Uuuhmmm. Now what?! (And if any music therapist tells you they know exactly what to do when their clients are all freaking out at the same time...just so you know- They. Are. Lying!)


I managed (do not ask me how) to get my thoughts together enough to be aware of the fact that, while the guys were all there, they weren't really There. Nobody was listening to anyone else in the room, we were all kind of...everywhere, but none of us was present to the experience of being in music therapy. 


I pointed this fact out to the guys (who, God bless them, heard me above the drama-filled din), and I asked them, "Gentlemen. What can we do here? How can we use the music? How can we use our thinking, to get ourselves to be here in this room, in music therapy, together? Why don't we just work on that, so that if we do nothing else today, we'll know that we cared about each other enough, that we mattered enough to each other, to notice that we were all here together."


Enter music. 


I moved over next to B, because I didn't want him to be hitting his head, and offered him my hand (he took it). He had been vocalizing while he was hitting himself, in a kind of a hum. So, since I couldn't play guitar with only one hand, I invited the guys to find some kind of way to hum with B to help him settle down.


I started to hum (in B's general key), and it didn't take long at all before the men found ways to join in with their voices and actions. J moved his arm, every few measures, up and then down to the beat. P, in spite of his tambourine prowess (and he really does rock on the tambourine) used his voice- which has more of an "oh" and "ah" quality. Yet another K quietly chimed in on the cabasa he was holding. R stopped moving around and sat, listening, with his eyes closed, breathing deeply. 


B calmed down and kept singing (but stopped hurting himself), so I was able to make use of both of my hands again. I played a very simple progression on the guitar- kind of an Asus4, Cmaj7, to D/F#, B, E (sometimes major and sometimes minor), and I repeated it as we sang and came together.   


It was lovely. 


There was smiling. The moving around and in and out stuff stopped. There was presence. We were looking at and acknowledging each other. 


We managed to be present in the session and we used the music to make it happen. The definition of music therapy on a Monday afternoon. 


And what makes this way of using music so cool is that this particular piece of improvised music  could only have happened on this day and with this group for it to have had any meaning. Taken out of context, it might sound okay, but it will never have the same impact as it did yesterday afternoon as we all sat quietly, after we finished, even after we sang goodbye, nobody wanting to leave quite yet, watching the sun set together.

Exposed

Image by fabbriciuse via Flickr

I'd love to be able to explain why I haven't been writing any blog posts of late, but I'm not sure I could. It's not as if I haven't had things to say. I mean, I've got various notes in journals and on scraps of paper reminding me of thoughts I've had, issues I want to blog about. I've (mostly) accepted that I will write when I need or have to write. 


Today I'm feeling a need to write.


Yesterday morning I showed up for a session with a client I haven't been able to see for two weeks. There were some scheduling changes and then there were some scheduling conflicts, and that's the way it sometimes goes. 


Fine. 


I knew I had to be prepared for possible reactions to my absence. On the other hand, I wasn't sure how "real" I was to her as yet. C and I have only worked together since January. She seems to recognize me these days, but the relationship still feels fairly tenuous.


I found her at the other end of the cottage, and she smiled (which seemed like a pretty good start). She walked along with me and then pulled me toward the bathroom. I was hoping we wouldn't have a stripping issue, but her staff told me she might need to use the toilet. Okay then. 


Her staff accompanied her to the bathroom area, reminding C that she needed to be supervised (for a few reasons we needn't get into), and I waited in the empty day area where we'd be working. 


While I was waiting, K, one of the supervisors (who happens to be a former music therapist), came over to ask me how things were going with C. She was being nice, because I knew that it was code for "The staff are annoyed with you, because you 'let' C strip when she's in music therapy." To K's credit, she wanted to hear my take on the stripping. 


Apparently, I'm the only person who has this problem with C suddenly taking off her clothes (other than the afternoon shift).  


Great. 


I don't know exactly why C strips in music therapy. Maybe it's because I'm mostly new to her. Maybe it's because I only see her once a week (and even that can vary because of her schedule and mine) not every single day, and she doesn't know me that well. Maybe she's testing me. 


All I can say for sure is: I'm trying.  


So that was how I went in to the session.


C came on out of the bathroom with her staff person, and she was in good spirits, everything was going along, she picked up her giant beanbag to set it on her lap, sat on a comfortable couch, and we were off. 


She was vocal, I was reflecting, she was engaged, I was responding...all good things. She was bothered, for some reason, by a couple of binders sitting on the table, so I took those and put them in the next room, and we resumed our musical interaction.


Until...


C decided she needed to go to the refrigerator (there's a dorm sized fridge in the day area where we were working). Now, understand that: 


1)The last time we had dealt with the refrigerator, there was a lot of iced tea to be cleaned up. A LOT of iced tea. 

2) She has a very sensitive stomach, and I wasn't sure what she was safely allowed to have. 


3) It was 11 AM and not long before lunch when I knew she'd get something to drink anyway. 


4) I wanted her to focus on the session. Yes, that was my issue, but for that moment I decided it was a legitimate wish on my part.


Well. I asked her to wait until later, and that was when it all started to deteriorate. Rapidly. Suddenly, the jacket, pants, underwear, adult diaper, shirt and bra were on the floor. 


Crap!


I managed to get her into the bathroom area (and pick up the assorted clothing items) and then it just went from bad to worse. I was aggravated, C was freaking out, and it was argue, fight, fuss, refuse, be naked (not me), and consider becoming a hermit so I'd never have to deal with people again.


Finally, after about 10 minutes of achieving nothing I decided to ask for help.  


Her staff (the one who had helped her in the bathroom earlier) came in, and C set up a yell, but she got dressed.


Wonderful. 


I hung around in the bathroom for a while, trying to watch what her staff did to get her organized (wondering what I had done wrong, not thought of, why I went in to music therapy anyway). 


When they came out of the bathroom area (which is a big area, I must tell you, with a bunch of stalls, showers, a bathtub, and so forth), and C was dressed and calmer, I reminded C (and her staff) that I would see her in two weeks, and that I hoped we could find a way to have her stay dressed.


Her staff commented that "Oh, she'll be dressed when you get here. It's after that we're not sure about," which is code for "If you were a competent professional, my client would not be naked by the end of your session, would she?" 


"Thanks for your help."


I stewed about this for the entire rest of the day, feeling horrible and inadequate. 


And then I realized this morning that the thing that made me most angry about the situation yesterday was that I ended up acting from a place of anger and shame with regard to my reactions to the staff people and not from the perspective of a clinician. 


As such, I'm not only frustrated by the fact that the whole session went to hell suddenly, but I'm also bothered by the fact that I felt as if I allowed my feelings about staff's opinions about what I do/don't do/how I do it to get in the way of my being C's music therapist. 


Now, I'm sure that as soon as I settle myself down about all of this, I'll be able to use these new pieces of information I have (yes, also known as countertransference) in a more constructive way (you know...like, for one thing, using it to get a better understanding of what my client may be going through that she feels the only way she can communicate with me is by stripping).


Until then, I'm still annoyed and agitated about the whole thing. 

Are we willing to make our clients the "star ingredients" in a session?

Image via Wikipedia

I knew someday I'd find a way to link cooking and music therapy! (Can I get a "huzzah!"? Anyone? Anyone?)


Well, actually, Joanne Loewy, a fellow music therapist- who was one of my grad school teachers at  Hahnemann- always used food as a metaphor when she talked about music therapy. 


And this is sort of like that. But different. Follow me here. This gets a bit twisty. 


So. 


There I was dozing off on the couch with the television tuned to a PBS station, and I somehow woke up just in time to see the last ten minutes of Avec Eric, which is a foodie cooking show (we love food!). 


Eric, for those of you who are wondering, is a chef in New York, and he has a show on TV where he travels around and talks to other chefs and then shares his own recipes. 


Okay, are you with me so far? Good.


Well. I was half listening to the conversation between Eric and the chef he was interviewing for this particular show, David Kinch. David had made some fabulous food thing for Eric, and they were eating it (with great appreciation, I might add) and discussing what made it wonderful.


Here's where my ears perked up, and I thought, "Hunh!"


Eric had complimented David because he said he could really taste the vegetables he'd used in the dish. And (here's the really neat part) David responded by saying how, when he was a young chef, he was always looking to add one more  ingredient to the dish. As he's matured, he noted, he tries to keep the dishes as simple and basic as possible, always wondering what he can take away so that he can retain the essence of the main ingredients he has chosen. Eric agreed, saying it was indeed important to have "star ingredients".


"YES!!" (I thought loudly). That's exactly the process I experienced as I matured as a music therapist! 


When I was a young music therapist I was always looking for bigger and better activities. I remember having session plans with lists of things: first we'll do this, then we'll do a bit of that, then we'll work on this, then we'll look at that... On and on. It was a never-ending quest to come up with the perfect activity that would finally motivate my clients. If this activity didn't work, surely another one would.


All to no avail. 


Then, when I started to receive clinical supervision, I learned that my clients are the "star ingredients" in a session. And I didn't need to focus on (or even do) activities. I just needed to learn as much as I could about the primary "ingredient" (my client) and to figure out which gentle seasonings (if you will) this person might need in order to truly emerge and shine.


Now I no longer do activities. Instead, I engage in the process of getting to know the wonderful flavors that make up the person sitting in front of me in a session. I use the music (as opposed to kitchen tools), sparingly at times, copiously at others, depending on how much is needed at a given point.


I have finally learned that it's not about how much I do in a session, but rather whether or not I was able to provide my client the space to be. 


~~~~~~~~~~
Here's a link to the actual show if you'd like to see it and be inspired as well. 

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.

What makes us great? And are we even as great as we think?

I've been obsessing about whether or not I'm providing meaningful and quality services to my clients of late. It started when I read an article in the Psychotherapy Networker on Supershrinks: What's the Secret of Their Success (written by Scott Miller, Mark Hubble, and Barry Duncan).

In 1974, researcher David F. Ricks coined the term supershrinks to describe a class of exceptional therapists—practitioners who stood head and shoulders above the rest. His study examined the long-term outcomes of "highly disturbed" adolescents. When the research participants were later examined as adults, he found that a select group, treated by one particular provider, fared notably better. In the same study, boys treated by the "pseudoshrink" demonstrated alarmingly poor adjustment as adults.

The authors did research, based on the work of K. Anders Ericsson, (a Swedish psychologist), trying to figure out how one becomes a supershrink, and they came up with this "formula for success":

(1) determining your baseline of effectiveness, (2) engaging in deliberate practice, and (3) getting feedback—depends on and is informed by the others, working in tandem to create a "cycle of excellence."

To me, this "formula" sounds a lot like quality improvement, which is something we really don't do a lot of- at least not consciously and deliberately- in the Music Therapy Unit at our facility.

The article further pointed out:

...you shouldn't be surprised or disheartened when your results prove to be average. As with height, weight, and intelligence, success rates of therapists are normally distributed, resembling the all-too-familiar bell curve. It's a fact: in nearly all facets of life, most of us are tightly clustered around the mean. As the research by Hiatt and Hargrave shows, a much more serious problem is when therapists don't know how they're performing or, worse, think they know their effectiveness without outside confirmation. Unfortunately, our own work in tracking the outcomes of thousands of therapists working in diverse clinical settings has exposed a consistent and alarming pattern: those slowest to adopt a valid and reliable procedure for establishing their baseline performance typically have the poorest outcomes of the lot.

Gosh. I started to wonder whether or not I was thinking I was doing a pretty decent job when maybe I wasn't. Hm.

So this has me thinking a lot about how I can go about determining whether or not I'm providing a service that's going to make a difference in my clients' lives in the long term.

A number of years ago I went to a workshop at a music therapy conference given by Richard Scalenghe (who is both a music therapist and a quality assurance professional) called, "So You Think You Provide Quality Care? Quality Improvement for Music Therapists". I found it thought-provoking then, and as soon as I read the supershrinks article I rummaged through my collection of papers and handouts so I could look at this subject again.

I'm going to do some more reading and see where I can go with all this. In the meantime, if you are a music therapist (or a psychotherapist or a person who has experience with quality assurance/improvement), I'd love to hear what approaches you've used to determine the effectiveness and quality of the services you're offering.

More on "not knowing"

I have been slowly making my way through Mindful Therapy: A Guide for Therapists and Helping Professionals by Thomas Bien. I have mixed feelings about the book, but every so often I come upon some passages that seem quite relevant to me. This is one of them:

An attitude of not knowing is, I believe, extremely valuable for the mindful therapist, as it is in Buddhist practice. When you think you know, you stop being open. Not knowing helps us remain open to the patient before us, seeing this person as a unique individual in a unique situation rather than another 'case' of depression, or anxiety, or marital difficulties. Not knowing, while the opposite attitude from what we learned in our education, is our best friend in the therapy room. The wise therapist respects not knowing, is comfortable with it, and even cultivates it. We cannot understand if we think we already know. And to know you don't know, taught Confucius, is the beginning of knowing. (p. 138)

I write a lot about uncertainty. It seems an integral part of my work. I've also written about the state of "I don't know" and about getting lost. 

I suppose it all boils down to different ways of acknowledging, with some humility, that we music therapists often don't know, in a session, what's best, what's going on, and how to proceed. But we are present, and we trust the process and the music.

Supervision: Part I: Professional Clinical Supervision

Here's the first part of an article I wrote for the 2009 Winter edition of the NJAMT News (NJAMT is the New Jersey Association for Music Therapy):

Supervision: Part I: Professional Clinical Supervision

Roia Rafieyan, MA, MT-BC

 What is “clinical supervision”?

“The focus of the supervision relationship is to address the complexities involved in helping supervisees in their ongoing (and never-ending) development as competent and compassionate professionals.  Supervision is a relationship, one in which both supervisor and supervisee actively participate and interact.  It is a process of unfolding- not simply following a recipe, but engaging in a rich and dynamic relationship.  Supervision then is also a journey, or odyssey of sorts, in which supervisor and supervisee learn and grow and from which both will very likely leave transformed in some way.”  (Forinash, 2001, “Overview” p. 1, in Music Therapy Supervision (Forinash, Ed.); Gilsum, NH:  Barcelona Publishers)

 We all receive some form of clinical supervision when we are students- either in our field placements or as a crucial element in our internships.  Many of us, however, are unaware of the benefits and availability of clinical supervision once we are finished with our schooling and begin our professional lives.

With the advent of licensure and an increased need for accountability, along with a desire to deepen understanding of music therapy and the various approaches which make up this complex field, supervision has begun to be recognized as a necessary and important part of the process of becoming a practicing music therapist.  

Common misperceptions about supervision:

§       The clinical supervisor will criticize me.

Some music therapists see supervision as being a continuation of their school experience, and they are concerned with being judged (i.e., expecting an encounter similar to that of being graded in school on their skills).  This is an unfortunate misconception. In fact, clinical supervision offers less experienced music therapists the chance to explore and develop their own professional identity. 

§       I’m finally on my own, and I want to try out some of my own ideas. My supervisor will expect me to do exactly what s/he does/says.

Supervision often involves learning from a music therapist whose work is admired and, at least initially, emulated.  Ideally, however, the supervisee is supported as s/he begins to discover and try new or different approaches that are adapted to his/her own personality and style. 

§       My supervisor will give me activity ideas.

In fact, the supervisory relationship is a rich resource, well beyond that of simply sharing ideas for new activities and music experiences.  A skilled clinical supervisor will help the music therapist to process difficult sessions (or relationships with challenging clients) by actively engaging the supervisee in music-making and self-examination.  The use of music during supervision serves as a way to model different ways to use music therapeutically.   

§       My supervisor will have all the answers.

Clinical supervision often follows a developmental process (not unlike the process found in providing music therapy) in which the supervisor offers guidance, not criticism.  It’s a relationship, and it develops in much the same way any therapy relationship develops; however, the focus is somewhat different than in therapy.  It is not uncommon for music therapists to wish for or hope that their supervisor will be able to offer them answers to their most challenging work situations.  One of the ways the clinical supervisor will help is by validating the music therapist’s experiences, reframing a particular problem, or, at the very least, helping to formulate new questions.

(Note: The chapter “Parallel Experiences” by J. Dvorkin and R. Rafieyan [in Inside Music Therapy: Client Experiences, edited by J. Hibben; 1999, Barcelona Publishers] describes the developmental process in the supervisory relationship as it parallels the music therapist’s developing relationship with one of her clients.) 

Who gets clinical supervision? How does one go about finding a clinical supervisor? 

Students get clinical supervision as a part of their schooling.  Professionals, at any point in their work, may choose to receive supervision.  Generally, the supervisory relationship is one in which the supervisee pays the supervisor for the service s/he provides.  Some music therapists work within a creative arts therapy department in their facility.  As such, they may receive clinical supervision within the context of their job.  Others may work under social workers, psychologists, psychiatrists, or psychotherapists.  Again, they may receive ongoing supervision as a benefit of their employment. 

Most music therapists, however, tend to feel somewhat isolated in their workplace, often being the only person providing this specialized service.  Furthermore, while professionals outside of the music therapy field may respect and even be intrigued by this specialized form of work, they may not fully understand what it entails, and they may not be able to offer the kind of support which may be needed. 

Some clinical supervisors advertise their availability in regional and state music therapy newsletters.  Another way to find a supervisor is to contact a music therapist whose work you admire and ask if s/he would be available to provide supervision.  Fees are generally negotiable, and most clinical supervisors will charge about the same fees a music therapist receives for providing private individual music therapy services.  

Additionally, there are ongoing music therapy supervision groups. These are different from peer supervision groups in that they are led by a clinical supervisor who is paid to offer this service.

Who provides clinical supervision?

Clinical supervisors are generally music therapists who have advanced training and experience.  Within the music therapy field, there are a number of specialization areas (Music Psychotherapy, GIM, Nordoff-Robbins, Neurologic Music Therapy), and those seeking further training in these areas will often have supervision as a component of the learning. 

It may be helpful to note that clinical supervisors explore countertransference material which the supervisee brings to the supervision session. At times an issue may warrant further exploration which may go beyond the boundaries of the supervisory relationship.  When this happens, an effective supervisor will refer the supervisee to seek his/her own personal psychotherapy (some opt to receive music therapy from another therapist), thus maintaining the boundaries of clinical supervision.

 What does clinical supervision look like?

As you would imagine, clinical supervision is meant to be an interactive process.  Ideally, when supervision is done live, the supervisee is able to explore the clinical issues using music. Generally, the supervisee brings material from his/her work to the session (this may include, but is not at all limited to, work with particularly challenging clients, uncertainty as to how to proceed with a group, strong angry reactions to a co-worker or client, fears of burnout, secondary traumatic stress reactions, difficulty using music, finding oneself attracted to a client, etc.).  

The clinical supervisor helps the supervisee by creating a therapeutic framework within which to understand what s/he is experiencing as a therapist, what her clients(s) may be experiencing, how the music can be used, etc.  How this happens depends, of course, on the needs of the supervisee.  This is why the supervisory relationship is of such importance.  Without the relationship, which provides a solid base, it is difficult for the supervisee to feel safe in exploring all aspects of the work of therapy. 

The second part of the article (which I'll need to finish writing soon) will address peer supervision for music therapists.