Asking for help (the hard way)

Some days I come home from work feeling as if my clients all hate me.

Now don't all jump in with the "oh, come on, they don't hate you! Why do you insist on seeing yourself that way? They appreciate you, why would you say such a thing?!" comments. 

Because that would be missing the point.

The things is: it was hard being a music therapist today. And, yes, I did (and always do) say to myself, "oh, come on, they probably don't hate you. Well, maybe they do, but probably it's not really about you." 

Here's what I'm thinking (hoping) (thinking and sooort of hoping, because, really, it's not a great thing to hope): I'm thinking my clients absorb so. Much. Hate. Every. Single. Day. And here I come in, Ms. Gosh-I'm-so-glad-to-be-here-guys-let's-listen-to-each-other-and-see-what-we-can-hear-in-each-other's-music. And there's crying and yelling and toileting accidents and more yelling and more crying and running around and trying to run out the door and handing me my guitar case and climbing on things and hitting each other and pulling and pushing and more toileting accidents.

And we sing, and we play about it, and we stop to get people cleaned up. Okay, well, usually I'm the one playing about it and singing about it, because my clients don't really use speech, and they are often too busy being overwhelmed. And I put it out there, "I know things have been really difficult for you, and it's a lot to cope with all the time." 

And I feel inadequate. I feel like one of those teeny little bandaids that keep falling off. My words and my music hardly cover any one of my clients' deep wounds. And I try to remind myself, "this is what chronic trauma and chronic grief look like. What can I offer in the music, in my words, in my presence? Will it mean anything?" 

Thanks to juliaf for the image!

Then I start in with the whole internal drama of "What if I'm just making assumptions? What if they just think I'm being a pain in the ass? And wrong? What if they wish I wouldn't come because I just remind them of what sucks in their lives and then I'm standing there singing and talking about it and happy to see them, for God's sake?"

So there I was driving myself home (and crazy) today, feeling kind of crappy. And I reminded myself of how much hatred my clients have internalized. How there's nowhere for it to...go! I mean, it just...sits there and festers in them. And my acknowledging it and hearing it is probably new and unexpected. And uncomfortable. 

Listening to the hatred many autistic people (especially those who live in congregate care) have been asked to hold over and over again is plain intense. And I leave sessions feeling as if my clients hate me.

Actually, though, after the initial "oh, woe is me" phase, I do manage to realize, "um, this is countertransference." And I start to wonder if what's really happening is that my clients are asking me to help them - to help them cope with the hatred they're having a hard time metabolizing. In their own way, I think they're asking me to hold on to the hate, to figure out what to do with it, say it out loud for them, and help them find a way to make sense of it. 

And the only way they can ask for that help is to get me to a point where I feel as if they hate me. And I have to be able to experience that awfulness. That terrible "nothing I do has any effect on you, I feel as if I have no power over my life" feeling.

Because until I've fully gone through the pain and rejection with them, they don't know that I've heard them. And until I go through it I don't know how they're feeling.

Next week, I will go back to them. I will sing about it, and I will say it out loud and give it a voice in the music. And hopefully the relationship will grow just a little deeper. Because I allowed myself to feel as if they hate me.


This is one of the songs that came up in the session. 

Fifty shades of "no"

I've been sitting and stewing over the fact that one of my clients decided not to come to his session yesterday. Obviously, it's not the end of the world, and it's mostly likely he'll be back. But I know he's upset with me and he's struggling with a lot of feelings because of the difficult work we're doing right now.

Occasionally, clients with whom I've developed a fairly stable relationship (and I can tell you, that has usually come after quite a long time of working together- usually years), who I can almost always count on to be there for their sessions, refuse to come to music therapy. 

And  when I say "refuse to come to music therapy" I mean I've walked over to their building, signed them out, collected their outer gear, walked in to the group where they spend their days (along with the rest of the people who live with them and along with their staff people), and asked, "would you like to come to music therapy today?" 

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I'd like to pause here to say what a vulnerable moment this is- for me anyway- as a music therapist. I mean, I'm standing there, exposed, and, honestly, it's like inviting someone out on a date in front of their entire family. Only it's therapy (which is just as intimate as a date, if not more so at times) and the other people in their group may have feelings about this particular person being invited to go to music therapy (when they themselves are not being invited) and their support staff who usually have their own feelings about the person who's scheduled for music therapy as well as a series of opinions about me and what I represent (sometimes good and sometimes not so much). Additionally, support staff have a series of beliefs and understandings (usually passed down from their supervisors) about their role in clients heading out to programs (such as music therapy). Commonly, those beliefs and understandings involve making sure the person is clean and tidy and goes and does what s/he is supposed to be doing. 

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

Now, most of the time, the folks I've worked with for a long time jump up and come over on their own and then pull me to the door. Others go and sit in their wheelchairs, waiting for me to take them out. Some people who have a harder time initiating actions or simply have a lot of physical involvement making it more difficult for them to stand and greet me, wait for me to approach them and let me know they want music therapy that day by making an effort to get up and go with me.

Over the years I've discovered a large (and important) part of my work is figuring out how my clients (most of whom don't use speech) communicate "no".  Some people (the ones who usually hop up to meet me) simply don't get up when I appear and remain seated. Some (who need more physical assistance) let me know by not allowing me- or just not helping me- to put on their coats. Others avoid going toward the door, and I've had a couple folks  pretend (vigorously) to be asleep. A few of my clients will come part of the way with me and then stop repeatedly or keep going in the "wrong" direction, and still others come to the session, wet themselves and have to return to their buildings to get their clothing changed. 

The gentleman I went to pick up yesterday is someone who usually gets up the minute he sees me and comes quickly over to take me by the wrist and pulls me toward the door. His "no" came after a particularly hard series of sessions in which I've been challenging his way of thinking about me and about the role of music therapy. 

His "no" started when he stayed seated, looking at me with a rather unhappy face, leaning his head on his hand. I wondered (out loud to him) if he had a headache (it was pretty loud) or if he was tired (sometimes he doesn't sleep too well). I waited a short time and then I told him I'd go out for a few minutes, come back and check again with him. "If you still don't want to come, that's fine, and I'll check in with you again next week."

So I went and stood in the hallway for three or four minutes and then tromped back in with my armload of sweatshirt, coat, gloves and a hat for him. He still didn't move. 

Mercifully, his support staff didn't tell him to "get up" (which is what usually happens, and, when they do that, he usually stands up and comes with me, but I'm well aware the entire time that he would not have been there had they not told him to be, which, I think we'd agree, is an awful feeling- for both of us). 

I offered to sit with him for a bit, because sometimes he actually needs some more transition time (or to just think about whether he really wants to skip music therapy that day- and it's very rare that he does), but he still didn't get up. 

Just as I was about to turn and leave, he got up and walked past me to the table (where there was more space for me to sit with him and also plastic blocks he likes to hold). He couldn't find any blocks (they were all zipped into a bag, and I guess he didn't want to mess with it just then), and he went to sit down in another chair. This time there was space next to him, so I sat down and pulled off my hat. 

I invited him to let me know if he wanted me to leave by looking toward me and if he wanted me to sit with him to indicate this by tapping my arm. He glanced my way, fleetingly, twice and made no move to grab my hand (which is what he generally does). 

"Okay then. I'll check in with you next week. I'm glad you let me know you didn't want to come today, and I'm glad you let me know you'd rather I don't sit with you right now."  

I wished the guys a decent weekend and headed out into the hall, kind of hoping he'd change his mind and come after me. He did not. 

I headed back to the Music Room, pondering the whole thing, reminding myself that he was likely wanting me to feel as rejected as he'd probably felt in our session. 

But then the inevitable worry began: Did I say something in the wrong way in his last session? Did I accidentally offend him? Did I hurt him by saying something he wasn't ready to hear yet? Is it irreparable? Will he give up and stop coming to music therapy? 

As I was pondering these questions, yet again, this morning, I realized, not only is this the usual litany I go through when a client chooses to not come to music therapy on a given day, but my confusion- my wondering what happened, did I do something wrong, will this person leave- probably very much mirrors the feelings my clients have had with regard to their families placing them in an institution.

Perhaps (along with "no") I was "hearing" his (and many of my clients') experience of ambiguous loss,  which is a loss that doesn't have clear closure and around which there are questions and a great deal of uncertainty. It's often thought of in terms of families' feelings regarding a child who is disabled or mentally ill or a parent or spouse who has Alzheimer's (for example), but there is little, if anything, written about the experience of the person whose family sees them as "gone" or "lost" to them because of their disability. 

When I arrived back in the Music Room, I found myself singing the following song, and once again, I felt amazed at the way our minds speak to each other through music.

My life and times as a disappointing music therapist

The session that wasn't:

Walking to the session. Pausing to pull me toward somebody's car and tapping on the trunk:

"Um, no. We can not go in somebody's car. Please don't tap at it, or you'll set off an alarm and that would probably not be a good thing." 

Slowing down and sitting on a bench:

"Yes, I see that you don't want to go to do your session today, and you'd rather we sit outside on a bench."

Still on the bench:

"Yes, I realize I'm frustrating you, but music therapy is what I can offer. I can not take you for a ride, or for an escape, in someone else's car or in my car. I can, however, be your music therapist, and you can come to your session, and we can talk about it in the music."

In front of the Music Room door, but not going in:

"So, okay. You're not going to go into the Music Room."

Pushing past me and heading for the exit:

"I guess you're telling me we're not going to be doing music therapy today, and you'd rather go back to the cottage. Okay then. I'll try again on Wednesday." 

Heavy sigh. 

Music and countertransference

If you're a person who has been reading this blog, then you know I make liberal use of songs that emerge as a part of music therapy sessions (a couple of other examples can be found here and here). The way I think of these countertransference songs is as a form of unconscious communication that's going on between therapist and client- the stuff that's not being said.


Obviously, since the vast majority of my clients don't use speech, it would stand to reason that these songs are a particularly helpful (and necessary) aspect of the work. 


So, I've been thinking a lot about one of my clients who has been falling asleep in his sessions lately. He gets tired from his medications, I think, but he also doesn't tend to sleep particularly well (a lot of my clients don't). 


At any rate, it seemed to me as if there was more to it than just being tired (I'll explain in a second). I mean, sometimes he'd look fairly wakeful, want to come for his session, get to the room, go lie on the couch (I know, I know, how Freudian can you get?) and suddenly he was exhausted. 


Hey, man. I know how it goes. I've been there before when there's stuff I'm having a hard time looking at- I start journaling about some difficult issue, and suddenly...I need a nap. I get it.


Anyway, here's something that completely fascinated me about our sessions: for the longest time, whenever I played an improvisation in his sessions, I'd think, "Wow! That was gorgeous! I must write down some of those chords, because they'd be great to play around with when I'm writing a song!" And I'd quickly write down the chords, and then, after the session, I'd play them, and what the hey? They never sounded quite the same after my client left. They were nice, but there was something...missing, and it just...didn't sound right. 


After a while of this unusual musical situation happening over and over and over (hey- these things take time!) I started to wonder, "What is this about? Why the heck is this happening?" And I realized this was some kind of countertransference, so I started to talk about it with my client, trying to enlist his assistance in figuring out what he might be needing me to hear (through the music that was only beautiful during our sessions but never afterward). 


I've spent the last couple of months with the following working hypotheses: 
1) Maybe he feels like he has to put on a nice, happy face because somehow he's gotten the idea that this is what people in his life want from him (can't imagine where he could possibly have gotten that message).


2) Maybe he only feels as if he's "beautiful" when he's in music therapy.


Of course, I could be wrong about all of it, but these are what I started working with and bringing up in sessions. So, I started talking about this with him. And the more I talked about this, the more he'd get to snoozing! 


Think I hit a nerve? I think so.


As you can imagine, he and I have been stumbling along now, and somewhere back in May, we were in a session together, and I suddenly heard the lyrics of this song (Joni Mitchell's "Trouble Child") enter my mind. And, as always, as I mentally sang through the song, I thought, "Hunh! This is worth giving a joint listen." 


Interestingly, it's taken a while for us to actually get through the whole song in a session (did I mention he keeps falling asleep?). And as soon as I share the lyrics with you, you'll see why. 


[I debated whether to use my version of the song or the original, and I opted for mine- but linked Joni's version- because it's about the therapy and the use of songs to have a deeper understanding of our clients. I'd add a lot of disclaimers, but they're not going to be of much  use to any of us, so here it is. I had to cut out all of my blabbering because I talked for too long, so that's why it sounds as if I started in mid-sentence.]

Trouble Child

(Words and Music by Joni Mitchell, Copyright 1973 and 1974 Crazy Crow Music)

Up in the sterilized room where they let you be lazy,

Knowin' your attitude's all wrong, and you gotta change and it's not easy.

Dragon's shinin' with all values known,

Dazzlin' you, keepin' you from your own,

Where is the lion in you to defy him when you're this weak and this spacey?

So what are you gonna do about it, you can't live life, and you can't leave it.

Advice and religion you can't take it, you can't seem to believe it.

The peacock is afraid to parade, you're under the thumb of a maid.

And you really can't give love in this condition, still you know how you need it.

They open and close you, then they talk like they know you, they don't know you.

They're friends and they're foes too, 

Trouble child, breakin' like the waves at Malibu.

So why does it come as such a shock to know you really have no one,

Only a river of changin' faces lookin' for an ocean.

They trickle through your leaky plans, 

Another dream over the dam,

And you're lyin' in some room feelin' like your right to be human is goin' over too.

But some are gonna knock you and some'll try and clock you,

You know, it's really hard to talk sense to you,

Trouble child, breakin' like the waves at Malibu.

Okay. First of all, Joni Mitchell is...brilliant! (By the way, go and listen to her singing this song. I seriously don't do it justice.) Second, oh my God! Look. At. These. Lyrics! The experience of a man living in an institution? With a serious reputation for having been a major bad-ass in his younger days? 


I can't say it enough times- I marvel, again and again, at the amazing ways we human beings find to communicate with each other!

It's a (musical) process

As I thought further about Video Journal #1 I did some writing about it and this is the song that emerged from that bit of processing. 


I think I said everything else I needed to say on the actual video. 


I do, however, want to reiterate the fact that using music to process my sessions has been incredibly useful in terms of trying to understand what may be going on for the folks I see for music therapy. Since they aren't able to use speech (and even if they were, none of us are always completely aware of why we feel out of sorts, and that's what we have our therapists for), I try to use the countertransference material so that I have better questions to ask.

Here, as promised, are the lyrics (with my further hypotheses thrown in for good measure in between things). (Apparently I didn't say everything I had to say on the video.) (Oy.) Sorry if it gets a bit difficult to read:

Blowin' In the Wind 

(Thank you, Bob Dylan!)

How many roads must a man walk down before you call him a man?
     (So much in just the first line alone! Many of the initial countertransference songs with this particular person were songs sung by girls- not just women, girls. And I have had the sense, off and on, that trying to develop an identity as a man has been an issue for him. Living in an institution, not using speech to communicate, and being seen as a disabled person first doesn't exactly  enhance one's sense of self much either.)
Yes, 'n', how many seas must a white dove sail before she sleeps in the sand?
Yes, 'n' how many times must the cannon balls fly before they're forever banned? 
The answer, my friend, is blowin' in the wind, the answer is blowin' in the wind.
     (This may or may not be stretching it a bit, but I wonder if he feels as if he's "blowin' in the wind" without a real sense of direction/meaning/purpose in his life.) 


How many times must a man look up before he can see the sky? 
     (Maybe this means something and maybe not, but his days are spent in a room that doesn't have any windows at eye level, and the windows that are there are, ironically, very high up and next to the very high ceiling.)
Yes, 'n' how many ears must one man have before he can hear people cry?
     (There's that whole sense of futility there and feeling unacknowledged and frustrated.)
Yes, 'n' how many deaths will it take 'til he knows that too many people have died?
The answer, my friend, is blowin' in the wind, the answer is blowin' in the wind.


How many years can a mountain exist before it is washed to the sea?
Yes, 'n' how many years can some people exist before they're allowed to be free?
     (I'm sure this line speaks- loudly- for itself, but it certainly connects to the feeling of being bound and stuck.)
Yes, 'n' how many times can a man turn his head pretending he just doesn't see?
     (I don't know about any of you, but this line always makes me sad, and it is particularly poignant in this context.)
The answer, my friend, is blowin' in the wind, the answer is blowin' in the wind.
     (Oh, I just realized that one of the struggles I've had in this man's sessions is this sense of "I don't know" and perpetual uncertainty. The answer, indeed, seems elusive!)


The answer is blowin' in the wind. 

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One last thought: I'm always amazed at how clearly my clients are able to convey to me when I am (finally) on the right track. There is such a sense of discomfort within me until I'm finally able to process (or at least start to make sense of) the feelings that come up as a result of projective identification. Once the processed material is shared with my client, and the response seems to be, "yes, you're understanding me," I experience a literal internal shift, and the discomfort eases almost immediately. 

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. 

"Rescue me!"

Image by cotton_man via Flickr

Okay, this may seem like a weird thing to blog about, but I'm doing it anyway. 


I was contemplating the fact that I have periodic rescue fantasies that involve my clients. 


I don't know what else to call them. And there seems to be an element of "Rescue me!" in them, so there you have it. 


I'm sure it has nothing to do with my clients who avoid leaving at the end of their sessions. Or find the longest and/or slowest way back to their cottages possible. Or the fact that as soon as I drop some people off after their sessions, they are pulling me back to the door to leave with me. 


No, I'm sure that's not it.


Cup of guilt anyone?


Anyway, I was thinking about the fact that the rescue fantasies that seem most prominent in my mind always seem to involve thinking about driving with my clients (not going anywhere in particular- just driving) and cooking for my clients (I spend a lot of time in the kitchen).


Escape from the life they have and being nurtured and fed.


I just thought that was interesting. 

What's that you say? No clothes?

Image by gynti_46 via Flickr

Periodically, when I'm minding my own business and doing a music therapy session, I will have the experience of one or the other of my clients suddenly deciding that removing his or her clothing would, at that very moment, be the most effective means of communication. 


Ahem.


I mean. Really. Must you? 


I don't know about you folks, but I am fairly certain that this particular topic was never covered (if you'll pardon the accidental pun) in music therapy school. 


As long as I've been a music therapist (and, let's face it, it has been quite a long time), I've never quite come up with a response that I could really say I'm happy with when I'm faced with a naked person in one of my sessions. 


Obviously, my usual response (did I say "response"? I meant "reaction") is to remind the person that we keep our clothes on in music therapy, because it keeps us all safer. And, if the person is not actively attempting to get his/her clothing back on, I do tend to offer to assist. 


All of which  may or may not be the "right" thing to do, but that's how it usually plays out.


Okay. So we all know I'm not a behaviorist. And I don't do activities. And my approach as a music therapist is generally to try to understand what the heck is going on when my clients are using whatever action they're using in order to make their point (presuming, of course, that they have their own personal reasons for choosing this particular action) (thank you very much). 


And, being me, I try to pay attention to my own emotional responses, because my experience has been that people who don't use speech will often try to get me to feel what they're feeling so I "get" what they're trying to convey to me. 


In the past two weeks I've had one man yank down his pants and underwear mid-session, and I've had a woman remove her shirt and bra (several times) in her session.


And I'm trying to make sense of these things.


So, if you don't mind, join me as I stumble along through my thought process, trying to understand what all this nudity is about.


Generally, I start with: what is this person trying to say to me?


Sometimes it's "I need a bathroom, and you weren't picking up on any of my other cues." (That's usually the first thing I ask about, because it has to be the worst thing in the world to need a bathroom and to not be able to say, "Hey, excuse me, but I've gotta go. Now!")


It could be sensory discomfort. Reasonable enough, I suppose. But if the person wasn't trying to get naked every other time s/he was in music therapy, or wearing clothes...Well, it's hard to say. 


It could be anger. 


It could be a way to say, "I feel exposed in front of you, Miss Music Therapist, asking me all these questions and paying way too much attention to me!" 


Or, in other words, "You're making me uncomfortable with all this music therapy, lady! Now I'm going to make you uncomfortable. How do you like me now?"


I suppose it could also be a way to ask me a question, such as "how safe am I if I expose myself to you, Roia? Will you hurt me? Shame me? Ridicule me? Violate me?"


Or "how will you act toward me if I do something considered taboo (since I can't tell you with words about the difficult things that have happened in my life)?"


Hm. 


As it turned out, with the woman, she did need to use the bathroom. But I still think there was more to it, because I'm still quite new to her (we've only had three sessions). I know she has sensory issues, but she also may be trying to learn something about me.


I'm not so sure about the man's motivation for pulling down his trousers. He didn't need a bathroom (I asked). He doesn't like leaving his session when it's time for us to end. He does have strong feelings toward me. I know I frustrate him because I can't fix it all by taking him away in a car. 


Sigh. 


As is often the case, I'm left with "I don't know." Sure, I have ideas, but I don't know.


And, as always, I tuck the latest bit of information into my head (along with all my interpretations) and keep on going. 


Until maybe someday when another action occurs, I'll have another tiny piece of the puzzle to add to my understanding of the person standing in front of me. Exposed. 

"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. 

Why, yes, yes I DO know it all! Why do you ask?

Image by Barnaby via Flickr

I have finally come to the realization that every single one of us has the private belief that we know the right way to do things. And everybody else who does what we do (or something not even remotely similar to what we do)  does not know the right way to do things.

One would think having worked in an institution for, oh, almost twenty-two years now, that I'd have made this discovery a good solid age ago. But...no.


And how is it (you may well be asking yourself) that I have come to this awareness and chosen to share it with you all here? Now? In this very moment?


Hmm. There must be a way to express this kindly and gently.


Let's just say that it astonishes me how frequently non-music therapist co-workers feel inclined to tell me exactly how and what I should do to be a "proper music therapist" to the clients in their care. 


I can, of course, only presume that the advice is offered in the spirit of being helpful. (If only these same people would be so helpful as to tell me a client has a horrible cold before I invite the person to come to music therapy.)


So there I was yesterday, feeling all kinds of "Humph! Who the hell do you think you are!?" and so forth, having had yet another of those sorts of interactions with a staff member. And I had to stop.


Yes. I simply had to stop.


Because, as much as I hate to admit it, I harbor the same exact rotten belief. I am just as strongly convinced that I know better than she does. 


And it's not as if I don't go around regularly making all manner of judgments with regard to how people are interacting with my (yes, my) clients, harping on about what they should be doing  with the guys and how they should be doing it, and on and on. 


And it's not as if I haven't opened my big yappy mouth about it often enough either. 


[Insert uncomfortable silence here.]


Well. 


So. There we are. 


More therapy anyone?


[In the spirit of common decency, I have to say that I also work with a lot of very supportive and cool people who seem to respect the way I do my job and expect me to know what I'm doing. But I still maintain that in our secret identities as "the one who knows", we all entertain this belief in some way or another. Which was really my point.]

When we are injured by our clients

One of the scarier things about being a music therapist is that sometimes we get hurt on the job by our clients.

This is something I've been meaning to write about for some time now, but I've been procrastinating. I mention it now, because, recently Todd Henry, a man identified as a music therapist, was actually killed by one of his students.

It's a real issue when we provide services to people who are not always able to control their behavior. Or those who have gotten used to using violence as a means of communication. Or who have serious mental illnesses and aren't able to distinguish between what is reality and what is generated in the mind.

I've been hurt at times by my clients. I've been smacked, bitten, scratched, had my hair yanked, my fingers squashed, I've been head butted, grabbed, in a headlock, pushed, kicked, and pinched. Depending on the day, the situation, the context, and how violent the situation was, I've felt varying levels of distressed.

In general when I get hurt, my immediate reaction is that I feel uncomfortable, angry, frightened, ashamed, uncertain, violated, powerless, and with a general sense of not being sure how to proceed after it has happened (other than to say, "we need to stop the session for today.").

Because I work the way I do (using an object relations approach), I absolutely believe that the feelings I experience in reaction to getting hurt are more than likely the feelings my clients either are, or have, experienced in their lives (hello, projective identification).

As such, part of moving forward with my clients after violent behavior is addressing what happened in the following session(s), talking about how it impacted me and what I think my client may have been trying to communicate to me (i.e., that s/he was feeling powerless, ashamed, angry, frightened, etc.).

I work with people who live in an institution. By that very fact alone, they have experienced trauma. Never mind the many other forms of physical, sexual, emotional trauma they've likely endured over the years. When a person doesn't use speech, and doesn't feel as if s/he's being listened to, and s/he is fresh out of coping skills, violence is sometimes the result.

This issue isn't talked about much, if ever, when we're in school and learning to become music therapists. It's also not a topic that I see coming up in music therapy conferences either.

One of the reasons I don't usually bring it up is that it scares people. Another reason is that I don't like the idea that people see my clients' violent behavior as being a factor of their disability. I don't think most of my clients are violent (and not all of them are) because they have autism or some other intellectual or developmental disability. I believe it's usually a result of their life and not having learned better ways to cope with extremely challenging situations.

So I'm bringing it up today. And I'm wondering what your experiences (whether you're a music, creative arts, or other sort of therapist or supporter/caregiver) have been with this issue.

Sick and tired

Lately I've noticed myself absolutely dragging through my sessions with a group of guys I've been working with for a long time. There are five men in the crew, and they range in age from their late 40s to mid 60s. None of them use speech to communicate. Now, what you need to know about this group is that, when we started to work together (it's got to be almost 15 years now) they were horrible. No. Really. Horrible. They'd all take turns throwing their hands in their pants and were merciless in their teasing. They'd vocalize so frequently and so loudly I couldn't get a sound in edgewise. I used to leave their sessions in tears. Sometimes I didn't even make it to the end of the session before I found myself about to bawl in frustration. What finally helped? Well, after I spent a long time (a. very. long. time.) singing about what they were doing- and nothing seemed to change ever- I asked them one day if maybe they felt as if they were being tormented and teased in their lives and wanted me to understand how powerless and futile they were feeling about it. The usually noisy group was suddenly silent. DING!!! That moment changed everything. From that day on we were a music therapy group. We slowly worked up to being able to use the music so the guys could express their hopelessness and rage, and I was able to help them contain and frame the feelings within the music. These gentlemen have become "the teaching group" when I have music therapy students from the local university. They take their role as teachers very seriously, and together we've taught our practicum students a lot about building relationships, paying attention, and how people who don't use speech and have trouble playing instruments use music. But, as I said (way back when I started to write), lately I find myself experiencing this heavy, leaden feeling in the group. The other thing to know is that, of the five guys, four of them have had some serious health issues in the past month or so- pneumonia, the need for a colonoscopy, unexplained weightloss, repeatedly falling (leading to cracking of one's head)- not good stuff. I sat with them on Monday, wondering why I was suddenly feeling like I needed to take a nap. R accepted the tambourine I offered, apparently only to toss it unceremoniously to the side and look at me. Thanks. A thought that came to me was: they feel sick and I feel tired. Hmm. I wonder if they might be feeling sick and tired... They'd all been dozing off or watching me quietly. I started to improvize the "I'm feeling so sick and tired" blues. I invited them to find a way to let me know if this made any sense to them. If this might be how they were feeling. They sang with me. Boy, did they sing with me. Poor guys. If you think of it, send along some good vibes their way.