Celebrating National Psychotherapy Day

It's National Psychotherapy Day today- the first one ever- and I'll be celebrating by heading, just as I do every other week, to my therapist's office. Why? Because I firmly believe getting my own therapy is an important part of my job as a music  therapist. 

Knowing who I am and what kind of emotional baggage I'm carrying around with me helps me be present and attentive to the clients I serve when I show up to provide music therapy.

When my clients do their best to avoid hearing me invite them to look at a belief they're strongly committed to (sometimes even going so far as to literally stick their fingers in their ears), when they fall asleep mid-session because something we're addressing feels way too overwhelming, when they fight mightily against change...I have a pretty good idea of what it's like. I've felt and done the same (okay, maybe I don't actually stick my fingers in my ears or fall asleep in therapy, but I can be pretty darned noisy if I don't want to know something). 

I'll be honest with you: I am uncomfortable recommending any music therapist I know who hasn't spent at least some time looking at his/her own issues in therapy. I mean, what are we communicating to our clients if we think we're above getting our own therapy? If we, essentially, perpetuate the attitude of stigmatization associated with taking care of one's emotional and mental health? 

One of the (many) reasons I loved the HBO show In Treatment was that the writers made sure the therapist, Paul Weston, went (even though he was kicking and screaming the whole way and was more of a pain in his own sessions than any of his clients ever were in theirs)  for his own therapy! 

Psychotherapy for therapists goes beyond the usual nice, self-care sorts of things we tend to talk about in music therapy circles (you know...the whole getting a massage, taking regular vacations, taking a bubble bath and the like). It's an ongoing commitment to self-discovery, a recognition that, yes, we can and do get in our own (as well as our clients') ways, and figuring out how to (much as we may bravely resist) make changes in our perceptions and ideas about our selves, our lives, and our relationships. 

So, good people, with a grateful nod to Ryan Howes (a blogging buddy who shares his insights over at the Psychology Today blogs as well as being a contributing editor at the Psychotherapy Networker), I invite you to consider how you might join in the acknowledgement and celebration of National Psychotherapy Day. 

After all, mental health and self-awareness are most certainly worthy of celebration!

1/12/10 Quote(s)- Music therapy and power

Image via Wikipedia

I think a lot about power in the music therapy relationship, to the point where I've even presented on the topic. 


So I was thrilled to find an article in the British Journal of Music Therapy by Randi Rolvsjord called "Whose Power of Music? A Discussion on Music and Power-Relations in Music Therapy" . 


She offers a thought-provoking perspective I hadn't even thought to consider. 


Well, I've probably considered it, but right now I can't recall when.


I've quoted her article rather liberally below, but the basic question I think she intended for me to ask myself when I finished reading the article was this: 


Are we taking away our clients' power when we attribute their progress to the "power of the music" or to the "power of our interventions"?


Just in case I'm not getting it right, I'll let Randi Rolvsjord say it in her own words:

In a contextual approach, the therapeutic outcome is primarily related to the client's ability to use the therapeutic context to make important changes in his or her life. With the therapist's help, the client uses the space provided in therapy to activate or mobilize resources for change (Bohart 2000: 130). In a contextual model, the specific "ingredients" (techniques and procedures) are not seen as the main source of change in the therapeutic process.  

She goes on to address music therapy more specifically:

A contextual approach impels us to shift our attention away from the therapist and the perceived inherent capacities of music, focusing instead on how clients make use  of music and music therapy in their efforts towards health and quality of life - and perhaps even towards music and musical experiences and activities. This does not require us to stop considering music as a powerful resource that can be used therapeutically: rather, it requires us to acknowledge the need for a client to make use of it, or relate to it. It also suggests that the client's own use of music is probably more important than the therapist's use of music, impelling us to consider how we can better nurture the client's own resources for health-related musicking. 

She notes:

When music therapy "works", it is primarily because clients are able to access music as a health resource. To support this process, it is necessary to hand back the "power of music" to our clients and enable them to use their musicality and musical competence, their musics, and their musicking to promote health and quality of life. 

And she repeats:

With a contextual approach to therapy, the focus of therapeutic effectiveness is shifted away from the expert-therapist implementation of effective interventions, and instead toward the client-therapist collaboration concerned with access to music, with enablement and empowerment. I have argued elsewhere (Rolvsjord 2004) that such a process of empowerment implies focus upon the nurturing and development of strengths in a mutual and collaborative relationship. 

I have to admit I don't know a blessed thing about the "contextual approach to therapy", but it sounds interesting, and I believe I'll have to go do some searching to find out more.


Anyone else out there have any opinions to register about this form of power within the music therapy relationship?

"Truly there is a healing force in meaning." (Viktor Frankl)

When I saw the title of the book in the library, I knew I had to borrow it:

"The Unheard Cry for Meaning: Psychotherapy and Humanism"

Not surprisingly, it's by Viktor E. Frankl, the man who famously wrote "Man's Search for Meaning".

I haven't gotten very far into it, and now I have to dash off to get to a gig in Massachusetts, but here are some quotes I wrote down so far:

"The patient had not been taken as a human being, that is to say, a being in steady search of meaning; and this search for meaning, which is so distinctive of man had not been taken seriously at its face value, but was seen as a mere rationalization of underlying unconscious psychodynamics. It had been overlooked or forgotten that if a person has found the meaning sought for, he is prepared to suffer, to offer sacrifice, even, if need be, to give his life for the sake of it. Contrariwise, if there is no meaning he is inclined to take his life, and he is prepared to do so even if all his needs, to all appearances, have been satisfied." (p. 20)

And...

"...I think that, rather than exhibiting mental illness, someone worrying about the meaning of life is proving his humanness. One need not be a neurotic to be concerned with the quest for a meaning to life, but one does need to be a truly human being." (pp. 28-29)

And...

"If we are to bring out the human potential at its best, we must first believe in its existence and presence." (p. 30)

One more...

"...while food is certainly a necessary condition for survival, it is not sufficient condition to endow one's life with meaning and thus relieve the sense of meaninglessness and emptiness." (p. 33)

I absolutely must dash out of here, but I wanted to send along these thought-provoking comments. I'm sure you can see how music therapy fits into this nicely. And, having worked in an institution for so many years, you can, I'm sure, see how I might recognize how directly Frankl's comments speak to the experiences of my clients.

I'd be interested to hear how other folks relate to these quotes as well. It certainly follows appropriately on the tails of my thoughts with regard to whether or not my clients feel they're getting something out of being in music therapy.

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.

"After you've gone and left me crying..."

B jumped up (jumped, I tell you) to come over to me when I showed up in his group (I was feeling guilty, because I was a little bit late). He barely let me get his jacket (um, it's April, and there were snow flurries happening off and on today). Anyway, he barely let me get his jacket out of the closet and on to him before we stopped to get his meds. Then we were on our way.

He got to the Music Room, and somehow we missed the door to actually go in. Don't ask me why. We just kept turning around the corner and walking and heading in the wrong direction. Then when I got him back in the direction of the door, we missed it on the way back again. 

Okay. What?! Already! 

Somehow, I managed to veer him in the direction of "please get in to the Music Room, or I won't be able to pay attention to what you're apparently trying to tell me!" 

Alright. We are now inside the Music Room. Now I can focus. 

B was very upset. To the point where he was actually crying (I think). It was very sad. I decided the best thing I could do was to simply sit with him and wait it out. Try to give him the space to feel lousy, since that seemed to be how he was feeling today.

[Actually, his distress was a continuation of our previous session where there was a lot of instrument throwing, occasionally aimed at me. I reminded him that I would not be able to hear him very well if I was having things hurled at me, so he "agreed" to stop, but made sure to get in an obscene gesture to make his point. Got it. F--- you, Roia!]

When B is upset, there's a lot of moving. When he's more mellow, there's a lot of sitting. Today there was a lot of moving. He speed walked over to the office area, sat in the other music therapist's chair, whimpered, then dashed back over to the music part of the room.

Every so often, after he sat briefly on the couch (his usual hangout), he hopped up and went to look out the window, rocking from side to side as he did so. I noticed his rocking was kind of gentle and not all that fast, but everything else about him seemed to be in high speed.

I tried to figure out whether I should musically reflect the rocking (maybe it was a way for him to self-soothe?) or the agitation or both. I opted for a bit of both, and I think it ended up sounding like a bit of a mish-mosh. 

Even I was up and down a lot. I had decided the guitar was a better option for improvising than the piano, because I could follow him more easily if he happened to run out the door. Also I could turn and see him while holding a guitar.

B was also humming. It was actually a very beautiful and poignant hum, and I tried to follow along with the guitar and, at points, with my own voice. He'd hum at a particular pitch and then drop down an octave as he came to the end of a phrase.

Eventually, his movements came to a gradual settling down, and he (mostly) managed to assemble himself on the couch to catch his breath. I breathed in and out quietly with him.

"I guess underneath all the silence we were exploring two sessions ago you had a lot to say, B."

We sat together, back in the silence, and the lyrics that sang into my mind were: 

"After you've gone, and left me crying

After you've gone, there's no denying..."

I have learned over the years to pay attention to the lyrics that pop into my thoughts when I'm with a client. To me they're like messages sent from their consciousness to mine. 

These were the only lyrics I could remember, and I wondered if he was trying to let me know how hard it is for him to have to wait in between our sessions. 

Now, it may seem as if I came up with this from out of nowhere, but that's actually not the case. He has a very difficult time leaving sessions, and there is usually a lot of dawdling and trips to the bathroom and long pauses before the jacket gets put on when it's time to go. 

Also, as I noted, he had been quite distraught in the previous session as well, and we had explored his frustration with me, because I'm not able to fix his life for him (which, I'm thinking, would take the form of my taking care of him outside of the institution). 

In the past month, we've been talking a lot about feeling abandoned, and I also used the Billie Holiday song "Left Alone" in one session (this version is sung by Abbey Lincoln).

When I commented to him that music therapy can be a mixture of deep gratification (it feels so wonderful to be listened to and acknowledged) and extreme frustration (because it's still therapy- it's not life) he immediately picked up the maraca and tossed it across the room (the maraca is the instrument we've designated to express anger and frustration). Score? I think so.

Heck, I sure wish I could tell you I had some brilliant piece of advice to offer him, but let's face it. The truth is, living in an institution is the pits. He knows it. I know it. I can't fix it for him. And, yes, it is frustrating. Insane-makingly so! On a lot of levels and in painful and never-ending ways. It's frustrating for him, and it's frustrating for me too. 

What to do? What to say?

He'd stopped running around by now, and he only got up every so often to punctuate a point I made (I think that's his way of saying, "you're getting it, Roia," but I'm not 100% sure; I never am). 

I told him I was glad he felt safe expressing his feelings to me, and he was welcome to keep doing so in music therapy. To be honest, I felt very honored and humbled by his trust in me. People don't expose that much emotion and pain in front of just anybody. 

I guess the best description of what I did today was to stick with B. I validated his feelings. I kept caring about him. I invited him to keep using the music as a container. I reminded him of when I'd see him next.

I noticed (in myself) how hard it was to end the session today. I knew we needed to go, but I felt awkward insisting (especially given how much emotion happened in the space), and when I tried to play something quiet about breathing, he started hitting his head. 

"Hurting yourself is not a solution, B. Showing up in music therapy every week [I actually see him twice a week] and using sound and movement to tell me how difficult this is for you is a better alternative."

He didn't look like he was buying it, but I had to get up and get the coats already. It was getting late. 

I put my coat on and held his out to him. He paused as long as he could, and he finally got up, took it from me, and put it on. 

When we got back to the cottage his staff greeting him warmly, and he went to sit down. He watched me as I hung up his coat, left the room to sign him in and then walked back through to wave "goodbye" to him. 

The lyrics were still floating through my mind as I walked back to the Music Room to tidy up and go home: 

"After you've gone, and left me crying

After you've gone, there's no denying..."

Sometimes being a music therapist feels like being one of the meanest people in the world. 

Borrowing Ryan Howes' Seven Questions

In response to my last post Adam suggested I answer the seven questions Ryan Howes posed to well-known psychotherapists.  That seemed like an awfully nifty idea to me, so I'm going for it.

1.  How would you respond to a new client who asks: "What should I talk about?"

Hmm, this is an interesting question for me, because the vast majority of the folks I work with don't use speech, and they all have some form of developmental/intellectual disability.  Also, since I'm a music therapist, I think the larger fear tends to be, "oh, my God, she expects me to know how to play music!"  Given that fact, I do spend some time talking about what music therapy is, some of the ways we'll be using music, and making sure to explain that music therapy is not meant to be for professional musicians (although there are music therapists who do work with people who fall into that category).  Then I do a lot of modeling and invite people to begin to play with sounds in a new way. 

It actually takes quite a while before my clients are able to grasp the concept of psychotherapy. In spite of their having experienced years of skill development activities and behavioral interventions, most of the people I work with have rarely had the experience of someone doing psychotherapy with them- let alone music psychotherapy.

2.  What do clients find most difficult about the therapeutic process?

I work with folks who live in an institution and who have major abandonment issues (often complicated by trauma and ambiguous loss), and I think the hardest things for a lot of my clients is saying goodbye at the end of each session.  I use a relationally-based approach, and it sometimes takes many years (I'm not kidding when I say "many"- it has sometimes taken up to 5 or 6 years) to develop a working relationship with my clients. Once that relationship is established, all of those painful, unexplored, unacknowledged feelings of being left surface with a vengeance. Termination isn't a lot of fun either, but that happens a lot less often than ending weekly sessions.  

3.  What mistakes do therapists make that hinder the therapeutic process?

I can speak to mistakes I made as a beginning therapist.  One major one (in the beginning) was making assumptions about what my clients knew/understood and what they didn't.  I always treated my clients (labels and all) respectfully, but it was a surface respect.  As I truly got to know them (and received good clinical supervision and learned how to really engage in the process of music psychotherapy) that turned into a deep respect for the wholeness and intelligence within each person.

Another mistake I made initially was not focusing on the relationship.  I spent a lot of time trying to get my clients to do musical things, so I ended up focusing on what they were doing/not doing and on the things that I wanted them to do instead of focusing on the process and the building of the therapy relationship.

Something that has challenged me (and students I've supervised) over the years is thinking I needed to know the answers, always know what to do in a session, and be the "perfect" music therapist.  I guess that's probably a familiar stumbling block for a lot of therapists. An extension of that is not taking vacations when I've needed them. 

An issue specific to music therapists is the need to know when we are avoiding using the music in the process and when we are using the music to avoid the process.  Something my clinical supervisor pointed out to me many years ago is that playing music through the whole session is like having a verbal psychotherapist talking the entire time and not letting the client say a word!

4.  In your opinion, what is the ultimate goal of therapy?

I would say that coming to terms with and accepting ourselves as we are in this lifetime and maybe not taking ourselves so seriously would be an ultimate therapy goal.  But I'd probably be projecting.  :-)  

5. What is the toughest part of being a therapist?

Institutions can be a hard place to live.  Knowing that many of my clients missed out on opportunities to grow up with their families because of now outdated beliefs about disabilities, knowing the continued overt prejudice and disrespect they continue to experience because people can't or choose not to be bothered to look beyond the outside appearances or question beliefs about developmental and intellectual disabilities, knowing how much abuse goes on, and, worse, knowing that, were my clients to move into a group home, their risk of abuse goes even higher, because there's even less oversight...these things truly hurt my heart in ways I can't even describe.

6.  What is the most enjoyable or rewarding part of being a therapist? 

There's a very specific moment I most love in my work.  If you read my blog, you know that I have to go pick up my clients from their buildings and walk them over to mine.  As I said, above, it can take a long time to establish any kind of rapport. The first time my client jumps up to meet me for his/her session is a special moment indeed, because it means that I've become a specific person to him/her, and it indicates to me that s/he is now invested in the work we're doing together.

7.  What is one pearl of wisdom you would offer clients about therapy?

I must admit this question has me a bit stumped.  I'd probably encourage my clients to not give up hope.  Also a lot of my clients don't quite get the "as if" part of therapy, and they seem to feel very frustrated with me for not being able to "fix" their lives by taking them away from their particular challenging life situation.  I remind my clients that their goodness, their happiness, and their worth doesn't come from being in therapy or from me (the therapist).  It's an inherent part of their being human.  They might discover those things about themselves in the context of music therapy, but they were already a part of them.  The challenge is to recognize those things in ourselves (because it's not only our clients who struggle with this) outside of the therapy space and to live from that truth.

"On the right track" versus "trying again"

I was just reading an interesting post by Dinah in the Shrink Rap blog about "What People Talk About in Therapy".  I had to click on it, because, as you know (if you regularly read my blog), I do music psychotherapy with people who don't use speech as their primary means of communication.  As you would imagine, I'm always wondering what my clients (many of whom are on the more involved end of the autism spectrum and all of whom live in an institution) would talk about if they could.  Of course, I also try to read what autistic people have to say (knowing full well that what one person has to say isn't what every person has to say) as well, since the internet has become a rather handy resource in that respect.  

I am, however, always curious to know what it's like to do psychotherapy with people who talk out loud.   

Here's a particular part of Dinah's post that I wanted to ponder:

Psychotherapy is often about finding and elucidating patterns for people. Have you noticed you always feel badly at this time of year? That you've been feeling worse since we stopped the medicine? How you talk about your boss the same way you talk about your mom? How you make assumptions about the reactions of strangers that keep you from even trying to get what you want? Maybe it resonates, maybe it doesn't, I can always try again.

Even though the folks I work with don't use speech, they certainly have very clear behavioral patterns and styles of interacting.  And I find I do the exact same thing (noticing and pointing out patterns) in my sessions. Of course, because it's music therapy we also have the added opportunity to notice patterns in music-making (or music-avoiding, or instrument-throwing, or dead silence, etc.). I also tend to pay attention to my own typical patterns of reactions to specific clients. Between the process of taking note of my issues and the "miracle" of projective identification, there is usually some illuminating moment somewhere (even if I'm not always sure which way to go in my work with a particular person).

The challenge, as always, is that my clients' behavioral patterns can just as often be related to motor planning difficulties, and they may not reflect what is actually going on in that person's mind. And, yes, just because someone is able to tell you what's going on for them, it doesn't mean that s/he is going to be accurate, talk about the "real issue", or be aware of what's going on internally, and so on. 

What I specifically appreciated about the above quote, however, was that she notes (with regard to her interpretations and observations):   

Maybe it resonates, maybe it doesn't, I can always try again.

Many people who come to watch me work (most of them are music therapy students sent to do observations or doing their practicum with me), or those I to whom I describe how I work, ask me "if your clients can't talk to you, how do you know you're on the right track?"

Well, the most obvious answer is that I don't always know whether I'm on the right track. I may be on the absolutely wrong track. And, as Dinah kindly points out above, "I can always try again." As I've continued to do this work I've discovered over and over again that therapy isn't usually about being "on the right track" as much as it is about "trying again."  Going back to Dinah's blog: 

In my past ramblings on psychotherapy, I made the comment that sometimes people seem to talk about trivial things that happen in their lives --I think I used the comparative price of beef as my confabulated example for my confabulated patient-- and they still find therapy helpful. I noted that therapy can work even if the patient doesn't come every week: help is where you find it and people have different needs and extract comfort & cure in different ways.

I may, at the end of a session, think, "wow, that was a whole lot of not much happening," and yet it's not unusual to have the following happen: I prepare to leave the client's cottage where I just dropped him off, and he suddenly comes running back over to me and wants to leave with me. Obviously, something in that session touched him, and he found some meaning in being there with me. Maybe it's because I generally do "try again" when I get it wrong.  Maybe it helps my clients know that they can try again too. 

Notes on power and control

The following is a handout from a presentation I did at Kardon Institute for the Arts in October of 2003.

Examining Power and Control in Music Therapy with

People who have Developmental Disabilities

In order to become more aware of the beliefs which you bring to your work, consider the following questions:

What are my beliefs about music therapy?

•What does my idea of the "perfect" music therapy session look/feel like?

•What is my expectation about what occurs in a music therapy session?

•How do I respond/react when reality doesn’t meet my expectations?  

•Do I choose to receive supervision?  When issues come up for me, do I address them in my own therapy?   

•What sort of theoretical approach do I use?  Do I use activities?  Do I use a behavioral approach?  A psychodynamic approach?  Am I product or process-oriented?

•Does music therapy “fix” people?

•What aspects of music therapy are healing?

What is my belief about the role of my clients?

•Should my clients always "listen" to me?  What if they don't?  What if they choose to not attend sessions?  How do I respond?

•What happens if my client is "acting out"?  How do I perceive it?  As manipulation?  As a way to gain control?  As a way to communicate?  Do I need to see it as being "good" or "bad"?

•What kind of language do I use to describe my clients- especially those who have severe disabilities (i.e., “I work with MR/DD’s” versus “I work with people who have developmental disabilities”)?  

•Do I talk about my clients in terms of their diagnoses and symptoms?  Or do I see my client as a person first?

•What if what my clients want for their lives is different from what I or their service team wants for them?

•How do I respond when a client has a “crush” on me?  Or wants to give me a hug?

•How do I feel about working with clients who are “clingy”?  How about those who are “hard to reach”?

•Do I arrive on time to sessions?  

•Do I start to speak in a higher-pitched “tone” (as if to a child) when I am addressing someone with a developmental disability?

•What are my “triggers” (i.e., the things to which I tend to react strongly)?

What are my beliefs about myself as a music therapist?

•What do I believe my role as a music therapist is?

•What does it mean about me if my session doesn't go as I planned?

•How do I deal with my agency's expectations and ideas about what my role should be?

•What time of day do I function most effectively?  What time of day do each of my clients function most effectively?

•How do I feel about having power?  Do I like to be in charge?  Do I avoid being in charge?  

•How do I feel about compliance and non-compliance?

•Where do I stand/sit in relation to my client(s) during the session?

•How much (physical) assistance do I offer (i.e. to clients who are unsteady?  to hang up coats?  In toileting?, etcetera)?  

•How frequently do I intervene (i.e. When someone is struggling with feelings?  When clients are aggressive toward themselves?  Toward other group members?)?  Do I have a need to “make it better”?  

•Do I feel pressure from my clients to “make it better”?

•How do I handle days when everything seems to be going wrong? (In my sessions?  In my life?)

What is my belief about the role of the music in the therapy session?

•Do I see music as the therapy?  Or do I see music as a way to develop and express the therapy relationship?  Or do I see music as a separate entity to be projected upon?

•Do I recognize that a relationship exists between the client and the music, as well as between myself and the music, both of which are crucial relationships to address, acknowledge and analyze?

•Is it important to me to plan out the entire session?  Or do I have a general idea of where I want to go within the session (i.e. based on goals for my client and how the particular person uses music)?  Or do I follow my client's lead most of the time?

•How do I feel about silence?  Can I tolerate my client's need to not make music?

What is my belief about the experience of making music during the session?

•Do I play the whole time?  Or do I leave musical space for my client?  Who is doing most of the playing?  What if my client wants to play the whole time?  Without me?

•How does it feel for me when my client expresses very strong feelings in the music (or in words)?  And if the strong feelings are directed toward me?

•Are my own musical needs being met outside of the therapy session?  Or am I inadvertently getting my musical needs met within the session(s)?  Do I know what my musical needs are?

•Are there certain types of sound/music I avoid?  Are there certain sounds I gravitate toward?  

•Do I have a need for the music to sound a certain way?  

•How comfortable am I in my own music making? Do I always use the same instrument?  How do I feel when I use an instrument to which I am less accustomed?

•How do I feel about improvising?  How do I feel about my voice?  

Interesting things to read:

The Dynamics of Music Psychotherapy Edited by Kenneth Bruscia;  1998;  Barcelona Publishers;  Gilsum, NH;  ISBN#:  1-891278-05-3

Cognitive Counseling and Persons with Special Needs:  Adapting Behavioral Approaches to the Social Context by Herbert Lovett ;  1985;  Praeger Publishers;  Westport, CT;  ISBN#:  0-275-91651-0

Violence and Abuse in the Lives of People with Disabilities:  The End of Silent Acceptance?  by Dick Sobsey;  1994;  Paul H. Brookes Publishing Co.;  Baltimore, MD;  ISBN#:  1-55766-148-0

Power Tools:  Thoughts about power and control in service to people with developmental disabilities by Dave Hingsburger;  2000; Diverse City Press Inc.;  Eastman, Quebec, Canada;  ISBN#:  1-896230-18-0

The Ethics of Touch:  Establishing and Maintaining Appropriate Boundaries in Service to People with Developmental Disabilities by David Hingsburger and Mary Harber;  1998;  Diverse City Press, Inc.;  Eastman, Quebec, Canada;  ISBN#:  1-896230-12-1

  

Handbook of Mental Health Care for Persons with Developmental Disabilities-  1999 Revision by Ruth Ryan, MD;  1996;  The Community Circle Publications,  1556 Williams Street,  Denver, CO  80218;  (303)316-8794

Thinking About Institutions:  Milieux and Madness by R.D. Hinshelwood;  2001;  Jessica Kingsley Publishers;  London;  ISBN#:  1-85302-954-8

Interesting Internet Resources

http://disability-abuse.com/cando/

http://www.normemma.com/arhellbe.htm (Where you can find the article “Hell-bent on Helping:  Benevolence, Friendship, and the Politics of Help” by Emma Van der Klift and Norman Kunc)

http://thechp.syr.edu/ (The Center for Human Policy has interesting articles.)

http://www.quuxuum.org/~greg/journal/contents1.html (Where you can find the Pennsylvania Journal on Positive Approaches)