"I Wish I Knew How It Would Feel To Be Free"

It started some months ago when I, quite by accident, discovered that one of the men I work with (he's autistic, he doesn't use speech to communicate) can indicate "yes" or "no" by pointing to (well, usually by grasping and releasing) one of two index cards. He doesn't need my help (other than to hold the cards in front of him). 

He doesn't always do it. In fact, sometimes he very pointedly chooses not to do it. Sometimes he crumples up the cards and tosses them aside. Which is why they're laminated.

I think, understandably, his feelings about communicating and being heard are deeply conflicted. Even if he were to begin pointing at more words and letters to communicate, the likelihood he'd be listened to is...well...slim. The people in his life are largely committed to seeing him as severely disabled. Period.  

We've been sitting in that unsettled, anxious, frustrated, what-the-hell-do-we-do-now state for a while. I can see he wants to say more. He picks up the letter boards I keep nearby, but he gets upset and then tosses them on the ground.

Aside from trying to come to terms with the whole idea of actually communicating with me and having me understand him- overwhelming in and of itself for him, I think- there's the fact that it probably won't change his life in any appreciable way. 

When it was time to stop we walked back to the unit and I dropped him off in his group (letting him know when I planned to return for his next session). I went into the office and signed him back in, and then I walked around so I wouldn't upset him by walking back through his group. He doesn't tend to like when we have to end.

But he knew I was there. So he left his group (much to the dismay of his staff) and wanted to follow me. He doesn't usually do this, so I sat with him for a little while in the back hallway. 

I wasn't sure what to say, but the words that ran through my mind were the title of a Billy Taylor song, I Wish I Knew How It Would Feel To Be Free. 

I didn't remember much of the song, and I wasn't sure it was something I could conjure up sitting there in the hallway. All I could think to offer him was the reminder that "nobody can take away who we are inside." 

We sat quietly as the shift changed and after a few minutes he got up and headed back in to his day area. 

Sometimes this work is really hard. Really, really hard. 

Last chance lost...

I noticed this song- "Last Chance Lost"-  running through my mind over and over again as we struggled to come to some kind of....okay-ness, an okay space today in our session. My client has some very strong feelings toward me, and although he knows "we don't have that kind of relationship" it's hard for him to hear it. Over and over.  

Yes, and it's hard for me to keep having to say it, because I feel cruel. I mean, I realize I'm not being cruel. I'm being truthful (and a therapist), and I know it would be more cruel to lie to him and pretend I don't see how much he wishes this weren't "just music therapy" and it was a better version of his life. 

And I'd be lying to you if I didn't say the rescue fantasies on my end can be intense. If I weren't so used to this happening it would be freaking me out. But this is something I go through, and it's more so with some people than with others. 

But here he was, this man who doesn't use speech, working so hard to be heard- using his voice even (which is rare)- and there I was...rejecting him again. 

When I step away from the session for a while and think about it, I have an idea of how to proceed and what we need to look at: Where are the feelings for me coming from? What might they be helping him to avoid feeling? What relationship(s) might he be trying to create or re-create in our sessions? And so forth. 

But...right there in the session...I feel like such a jerk. 

It's not that I'm afraid he'll be angry with me- although it would mean the beginning of the long period of anger. 

There always seem to be stages in the music therapy process- at least with the folks I work with individually. Initially there's a long period of "I don't trust you." That's usually followed by "okay, maybe you're not so creepy," which eventually works its way into "must we leave now?" Then we get into the "I like you/I can't let you know how much I like you" period which gradually becomes "I love you and you should never leave me!"  

I think my client and I are in that latter period right now. And I'm in the complicated "be firm but kind and figure out a way to reject without being rejecting/remember you're trying to help him realize how he's relating to people that's not really working for him/come on, Roia, you can do this" part of the work. 

And I know. The big anger is coming. Okay, so maybe I'm a little afraid. It's hard to give up being loved. Not that the anger indicates an absence of love. It's just easier, I'm sure you'll agree, when your client is in the "you totally rock" phase versus the "you rejected me and you are horrible and cruel" phase. 

Anyway. We struggled. He was sad. I was sad on his behalf. 

It was hard for him to return his instrument at the end of the session, and he insisted on carrying it back with him to his cottage- where he finally gave it back to me after a brief, gentle tug to make sure I understood he wasn't happy about relinquishing me or the instrument. 

The only part of the song I remembered as we worked through this session was "last chance lost". When I read the lyrics I was fascinated (for the hundredth time) by how our minds create musical connections with people, with moments and experiences. 

Last Chance Lost

by Joni Mitchell

Last chance lost

In the tyranny of a long good-bye
Last chance lost
We talk of us with deadly earnest eyes
Last chance lost
We talk of love in terms of sacrifice and compromise
Last chance
Last chance lost

Last chance lost
The hero cannot make the change
Last chance lost
The shrew will not be tamed
Last chance lost
They bicker on the rifle range
Blame takes aim
Last chance
Last chance lost


© 1994; Crazy Crow Music 

Music therapy at the boundaries

It happens I'm a part of a group on LinkdIn for psychologists, counselors and coaches. Not that I'm a psychologist, counselor or a coach, mind you... 


But anyway.


We've been enjoying (okay, I've certainly been enjoying) a robust discussion with regard to the question of "how much of our personal selves do we share with our clients?"


To the best of my recollection (which is a bit, er, well, let's just say it's not what it used to be), Rachelle Norman has tackled this question (a couple of times, actually) in her blog, Soundscape Music Therapy. A while ago she wondered how much should she share regarding the birth of her baby (who is awfully darned cute, if you must know), and, in a more recent post, she talked about The Top 10 Rules to Break. A big hooray to you, Rachelle, for addressing this complex and apparently rather heated issue!

So, back to the conversation going on at LinkdIn...


I've been sort of surprised at how many counselors and therapists seem to believe, rather ardently, that the "rule" regarding the "therapist as blank slate" is too stringent. A large majority advocate sharing more of themselves as a way of "being authentic" with their patients. If I'm understanding them correctly, they seem to feel, "that's what our clients are really looking for- for someone to be authentic with them."

Interesting.

Among the questions that came up for me in reading comments along these lines was: are we really being inauthentic with our clients if we don't share on a personal level with them? And does being authentic with someone always mean being transparent? 

When I looked up the word, I learned that being "authentic" is associated with being genuine, or being truthful. Which is not the same as being self-revealing. Hm.

For me, I think the question of what and how much to share of ourselves boils down (as most things in the therapy situation seem to do) to another central question: whose need am I meeting in this situation?

As many music therapists are aware, simply because of the nature of our profession, we actually share quite a bit of ourselves through the music-making we do with our clients during sessions. Just as we learn about our clients through their musical expression, they learn an awful lot about us when we interact with each other musically.

Obviously, we do our best to keep to professional boundaries- for many legitimate reasons. One very large reason is the power inequity. It is (usually) a paid relationship. Therapy isn't meant to be a friendship, and, whether or not we choose a fairly egalitarian approach to our work as music therapists, we can't control (or ignore) our clients' perceptions that we have a certain amount of power, authority and influence in their lives. 

As an example, in my particular line of work (with people who have intellectual and developmental disabilities), I often remind myself of the fact that I have keys to my clients' homes, and they don't.

I wonder if, in the end, it's about coming to terms with the duality (maybe it's a plurality?) we are asked to hold as music therapists (or any kind of psychotherapist, I imagine). Yes, our clients often do come to us in pain and in a tremendous state of need- for, among other things,  friendship and for people to be 'real' with them. Simultaneous to that, we are bound to uphold our code of ethics, to maintain an awareness of our own unmet needs (and our rather human tendency to want to take care of those needs in all of our relationships- including those with our clients), and an awareness of the power dynamic that exists in the therapy space.

It certainly isn't easy to keep track of these various elements. Of course, as my supervisor often reminds me, "that's why they call it work."


What are your thoughts on boundaries and being authentic with clients? Does it depend on the situation? Or on the particular group of people receiving services? Are you likely to have more "flexible" boundaries with certain groups of clients and not as much with others? And what does that fact say in terms of the ideas and beliefs we hold about the particular groups of people we serve? 

Reflecting on feelings of powerlessness (a video blog)

I didn't say it specifically in the video, but I think my whole countertransference reaction was very much about feeling a sense of powerlessness - my own ("I can't fix it for you, and I hate that.") as well as what I believe was my client's experience ("I feel abandoned and forgotten and unable to change my life."). 

"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. 

How do we cope when our clients are in terrible emotional pain?

My supervisee brought up a very important question/comment in supervision tonight. We were talking about dealing with clients/patients who are extremely ill, or whose families are coping with very difficult medical news.

One of the most challenging aspects of being a therapist is that it's so hard to see our patients/clients in terrible emotional pain. We, with our images of ourselves as caring music therapists, and as people who tend to be sensitive to the turmoil in other people, want to fix it. We want to come up with the "right" music, the "right" words, the "right" intervention.

We want to do this, but we can't.

We can't always figure out how to be with, come to terms with, help, support our patients (and their families) when they are in the midst of dealing with devastating news, when they are coping with trauma, when we send them back to hellish living situations, and so on.

What I suggested was the usual:

1) We need to trust that what we have to offer may be helpful in ways we can't know.

2) We need to take care of ourselves musically, emotionally, so we can come to terms with this sort of thing.

3) Sometimes having a some sort of spiritual way of understanding things helps.

As I thought about it further (after my supervisee and I said goodnight), it occurred to me that we tend to think we know what our clients/patients need.

We forget that we only see them in a particular setting, in a particular venue, in one specific context, in a specific and painful moment in their lives. And we forget that we don't have the context of the person's whole life and all the many intricate elements that make up someone's complex relationships and experiences.

Because we don't have that, we can easily fall into the trap of thinking (along with our clients/patients) that this is the only moment they're going to have. This terrible thing, moment, or experience is what is going to define them forever and ever.

And, yes, it may. Some people do define themselves by their most painful moments.

But it also may be true that the pain, sadness, fear and struggle are exactly what that person needs to go through at exactly that moment in his/her life in order to become who they came to be in this earth. In order to evolve and grow in some important way.

I try to remind myself (when I'm in the midst of feeling as if I'm never going to do/be enough for a client) that I don't know what my client needs (within the context of his/her life),

But I can offer what I have to offer: my presence, my caring, empathy, music, compassion, and maybe even love (okay, a therapeutic love). And it's important that, on some level, I recognize that what I have to offer is enough, and it may be exactly what the person needed in that specific moment. No one else but me could have offered it in the same way.

By the same token, there will be other people in our clients' lives who offer them what they have to offer them.

For all we know, it could be that our clients' real need is to learn how to receive. Well, we don't know the answer to that. But we do offer ourselves and what we do know. That our clients matter to us.

And our presence matters to them. Somehow.

And so it goes.

"Don't let me be lonely tonight"

Dave Pitonyak has written a great deal about loneliness being the greater disability for folks with a lot of labels (in other words the people I work with every day).  It’s worth reading when you get some time to really think about what he’s saying.  

I spent much of the day running around, because there’s just so much going on at work that there doesn’t seem to be a moment to sit still and gather my thoughts.  Mercifully, my clients remind me to do so- usually simply by needing me to be still and listen.

The three men I see on Wednesday afternoons almost always leave a very strong impression on me.   All three guys have had music therapy with me for ten to twelve years, and our work is often intense.  

The last gentleman is still sitting with me many hours later.  During our session he was shoving away instruments.  He actually took them off the cart in order to shove them across the room.   I asked what or who he needed to push away, and he looked at me (oh.).  He’s struggling with a lot of feelings about me of late, and we alternate between his being very happy to see me and feeling very sad dealing with the limits of our relationship.   If this sounds familiar, it’s because I talked about the same person on September 12th.   

A (countertransference) song that has come up before in our work together is James Taylor’s “Don’t Let Me Be Lonely Tonight”- which is 1) a gorgeous song, and 2) has that wonderful tangle of emotions in it.   The part of the tangle that came to my mind as I watched my client pushing (and then re-pushing) the drum and mallet across the room was

“Go away then, damn you.

Go on and do as you please.

You ain’t gonna see me getting down on my knees.

I’m undecided, and your heart’s been divided.

You’ve been turning my world upside down.” 

© 1972, 1973, 1978 James Taylor

[You can give a listen- at your own risk- to what it sounded like below.]

I sang that part, and then I sang the whole song (I had to do it without my guitar, because I couldn’t remember most of the chords), and he started to move very quickly around the Music Room, pausing to “bump” into me a few times.  

Much of the session was spent with him appearing to want to leave- moving me toward the door, messing with the knob, and pushing my hand up to the door.  The effect, for the most part, was one of “You, Roia, are forcing me to stay here against my will.”   And I said to him, “You know?  We’ve worked together for the past ten years now, and this thing with trying to leave while we’re in our session has been an ongoing theme for our entire history together.  And here we are, ten years later, and I still don’t seem to have a very good idea as to why.  I feel perplexed and uncertain.  Like I’m always doing something wrong.”  And then I wondered “Do you feel that way sometimes?”  He looked away.  

When it was actually time to go he didn’t leap up immediately.   As we walked back he mostly chose to walk on his own (usually he catches my hand or a few fingers and holds on).   I reached out to keep him moving when I saw a car approaching us, and he pushed my hand away.  “I guess that would be another round of ‘Go away then, damn you’, eh?”  

When we arrived in front of his home, he quickly sat down at the table and chairs which are placed outside his front door.  He looked so utterly dejected, and I got such a sense of sadness that I understood at that moment that he really wasn’t pushing me away at all- just trying to cope with his unhappiness that our time for today was ending (and trying to make it last a little longer).  

I know I often talk about uncertainty in my work.  This particular moment, though, did not feel uncertain at all to me.  Obviously I couldn’t articulate the details of his feelings, but it was pretty darn clear that all that effort to “leave” the session was not really about wanting to leave.  

It took us a while, but he was eventually ready to go back inside.   

If I may...(since it is one of my favorites)

Do me wrong; do me right.

Tell me lies, but hold me tight.

Save your goodbyes for the morning light, 

But don’t let me be lonely tonight.

Say goodbye and say hello.

Sure ‘nough good to see you,

But it’s time to go.

Don’t say yes, but please, 

Don’t say no.

I don’t want to be lonely tonight.

Go away then, damn you.

Go on and do as you please.

You ain’t gonna see me getting down on my knees.

I’m undecided, and your heart’s been divided.

You’ve been turning my world upside down.

Do me wrong; do me right.

Go on and tell me lies, but hold me tight.

Save your goodbyes for the morning light.

But don’t let me be lonely tonight.

I don’t want to be lonely tonight.

© 1972, 1973, 1978 James Taylor

Gabcast! The Mindful Music Therapist #0 - "Don't Let Me Be Lonely Tonight" This is how it sounded.