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. 

And how was your day, dear?

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On the plus side, nobody got hurt (although there were some brief reminders to the effect of "nobody really likes to get their head tapped unexpectedly, K."). On the not-so-plus side, I'm guessing it'll take kind of a while for my co-worker in recreation to sort through the two big stacks of paper from her desk that, um, well, er, ended up all over the floor when I turned my back for a minute to deal with L. 


I think I can safely say that this particular session felt like it was the exact opposite of the lovely one I described  to you a few weeks ago. 


Here's how this whole party started: 


I arrived in the cottage, fully aware that the women there were almost all sick with colds and stomach viruses (lovely). I had called earlier in the afternoon to ask if I should come over or skip it, and I was told, "well, people are running around with the sniffles and stuff, but..." (which I'm fairly sure was code for "Get your a** over here, lady! We've all been suffering through this, and you'd just better do your time!")


First thing, G (one of the more chatty ladies who live in this cottage) came over to announce to me that I should "stay away" from her because she's "sick as a dog," after which she proceeded to follow me around and ask me questions repeatedly until I finally got the women who are actually in my group assembled and closed the door with a firm "I'll see you later, G. Hope you feel better." [Insert heavy sigh here.]


Honestly, I was quite happy as we got started (although a bit nervous) because M had actually joined us. Her staff person walked her over (at my request), and she had miraculously managed to convince M to walk in to the session area with us! Usually I get her as far as the door to the room where we work, and she starts to hum loudly. Then she won't go in to the room with the other two or three women from the group, and she won't go back to her day area either. 


Inevitably, V gets annoyed because she is waiting for the session to begin, so she scoots (she moves on her knees usually- she has a wheelchair, but she tends to hop out of it when she gets to the room) out of the room where we work and sits on the floor, watching me and looking impatient (I'm sure if she were able to stand more comfortably there'd be foot-tapping involved). 


It took some doing for N to get in to the room, because her OCD was making it plain difficult to get through the door. We waited for her and she got in. The problem, however, was that K was sitting in the chair that N prefers to use. Stop. The. Presses.


So. N pushed and pushed (in spite of my requests that she stop doing so) at K (who, on any other day, prefers to wander around the room and throw everything she touches on the floor or across the room), trying to get her out of "her" chair. Having very little luck (K is pretty hardy), N (no slouch herself) took hold of K's shoulder and her behind and unceremoniously shoved her out of the chair. 


Oh, dear.


Somehow, I managed to get K moved to another chair at last (to the one that V prefers, God help me). Mercifully, V decided to stay in her wheelchair for a short period of time. 


Then I had to figure out what to do to get M settled, because she kept coming over to me with magazines that were in the room and insisting that I hold them. Finally, I got the message, tore out a page and handed it to her. That seemed to be what she wanted and she promptly found herself a chair and proceeded to rip paper peacefully.


For twelve blissful seconds, we were all sitting quietly (it was such a glorious moment) when we heard a loud crash at the door. 


"[Expletive deleted]! What now?!?" (I thought, loudly, and in a rather un-music therapist-like fashion.)


L arrived, right behind her giant walker (the thing that had crashed into the door), and she decided she needed to come in and sort through the plastic groceries in the faux grocery basket (that lives in the room we use) right now!  


And L, I need to tell you, is not exactly Miss Let's-Talk-About-This-Shall-We-America."


Dear Lord!


Of course, since we were all sitting (for those twelve brief, yet happy, seconds), this required rearranging everyone so L could get to the table (which was, of course, behind everyone). 


Well, not entirely unexpectedly, in the process of tending to L, and rearranging the furniture and the various people contained therein so nobody would get run over by L's giant walker, K got up to explore, and that's when we heard the two huge piles of paper from the recreation staff's desk hit the floor. 


Cheeeeeeck!!!!


I couldn't, for anything, get K to sit anywhere, so I gave up and tried to pick up the giant mess of paper and put it somewhere somewhat unreachable until after the session.


While I was dealing with the paper, V decided she'd had enough, so she headed out the door and sat in the hallway, chin in hand, waiting for me to chase after her. Since I'm not supposed to leave V alone (and I'm not supposed to leave M or K alone either), I put a chair in the doorway so I could keep an eye on the group and on V at the same time. 


V, in spite of my best efforts, turned tail and headed back into the day area (through the bathroom door that's across the hall from our room). And, much as I hate to admit it, by that point I just figured, "Okay, that's one less person to worry about right now. Amen."


K roamed around the room some more, tapping N on the head unexpectedly. And M continued her page tearing adventures, assembling the tiny pieces neatly on her lap. 


Now.


I'd love to tell you I was able to make a brilliant interpretation to the women in the group about their actions and how they seemed to be all about going from crisis to crisis, and there's all manner of "no, pay attention to me" and some sadistic teasing, all in conjunction with the  incredibly overwhelming way they interact with me and with other people in their lives. 


But no.


Heck, I'd love to say that there was even half enough emotional space left in the room so we could even start to look at that, but that is so not where the group is yet! 


Evidently, the group's goal for right now is to (through their actions/interactions) convey as loudly and dramatically as possible, "Roia!! This is what it feels like to be here. To be us. To live life!!! Do something!!"


And, for now (I have learned) (rather slowly, I must add) that my job is to just listen and get through it. And show up next time and get through it again. And keep setting limits and keep trying to help them use the music or use the music myself.


At some point, they'll be ready to hear me talk about what I'm seeing/experiencing in that group, but not yet. 


Definitely not yet. 

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. 

"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. 

What does it all mean?

The movie, "Precious", is opening tonight in various major cities. I don't think it's playing anywhere near me. I've been listening to bits about it on NPR, on Oprah and it was reviewed on the evening news. It's based on the book, "Push", written by a woman by the name of Sapphire. 

Needless to say, it's been getting a lot of good reviews in spite of being a very graphic and painful film to watch. 


The thing is, I'm not sure I really want to see it. 


And I wondered, as I watched an interview with one of the cast members, "what does the fact  that I don't want to see this film mean about me as a music therapist?"


I work with a lot of traumatized people. People who have intellectual and developmental disabilities have often experienced severe and chronic trauma. I hate that my clients have and continue to suffer this way. I hate that anyone suffers, frankly. 


It made me wonder, "Am I obligated, as a music therapist, to go and watch a film that portrays a young woman who is brutally abused by her family?"


It's not as if I'm in denial that people are abused. 


I guess it's pretty obvious I'm having some ambivalence (and guilt- ah, yes, the ever-present guilt) about my decision to not see this movie. 


The best explanation I can give (not that anybody was asking for one) is that I can only bear witness to so much trauma. I have a larger obligation (if we're talking obligations here- and I seem to be) to not expose myself to so much trauma that I can't even function as a therapist to my clients. 


Anyone else want to weigh in on this? Or am I the only one who obsesses about such things? 

Battling inertia one session at a time

From the Random House College Dictionary Revised Edition (1984), the definition of "resistance" and "resist":

Resistance: n. 1. the act or power of resisting, opposing, or withstanding. 2. the opposition offered by one thing, force, to another....4. Psychiatry. opposition to an attempt to bring repressed thoughts or feelings into consciousness. 5. (usually cap.) (esp. during World War II) an underground organization working to overthrow the occupying power, usually by acts of sabotage, guerilla warfare, etc.

Resist: v.t. 1. to withstand, strive against, or oppose. 2. to withstand the action or effect of. 3. to refrain or abstain from, esp. with difficulty or reluctance.--v.i. 4. to make a stand or make efforts in opposition; act in opposition; offer resistance. --n. 5. a substance that prevents or inhibits some action, as a coating that inhibits corrosion.

I didn't think D was going to be attending music therapy today. When I arrived in his cottage to pick him up he was sprawled all over his chair napping. But, I'll be darned, he got up and put on the rain poncho with some help from me, and we walked over to the Music Room, even more slowly than usual. He seemed so sluggish it was watching someone moving through a vast and entangling substance.

When I saw him the previous week, he was so exhausted, I'd given up early and walked him back.

After removing his rain gear and handing it to me, he went to lie down on the couch, appearing quite beat.

I asked him what he needed from the music, inviting him to look toward me when one of my suggestions sounded right to him. Did he need the music to express something he was having trouble saying? Did he need music to soothe him? To energize him? He chose "energize him" (looking at me directly rather than looking away as he had done when I offered him the other options).

I played "We Are the Champions" for a couple of reasons: first, it starts out quietly and builds (following the mood-iso principle of matching the person's general state musically and moving the music in the emotional direction one is trying to achieve). Second, the lyrics (to me anyway) offer a powerful commentary about struggling to overcome difficulty and standing firm in one's truth.

The song didn't seem to do much for him (although he seemed to be listening behind his closed eyes).

"D, I'm not sure what to offer you. You're letting me know you're very tired. I don't know whether it's because you don't feel well physically, or if you're feeling downhearted. If you truly don't feel physically well, then please let me know by standing up and going to the door, and we'll go back to the cottage so you can rest. If you're feeling downhearted or depressed, it may help if you take the first step by sitting up."

I played an energetic riff on the guitar, and I improvised a song in which I presented him, again, with this choice: stop for the day or make an effort by sitting up. I pointed out that I can't make him stay awake, and if he wants my help he needs to meet me halfway (by not lying down and at least trying to engage in the session).

To my surprise, he did sit up as I sang, and he remained sitting for the final ten minutes of the session!

I invited D to use the instruments or his voice to give me an idea of what it's like for him to move right now (to go from lying down to sitting up). He chose his preferred instrument, the tube shaker, and picked it up and put it down a number of times. He began to use his voice, and there was a quiet, low, somewhat whimpering quality.

We (okay I) talked about resistance, and I congratulated him for pushing through his inertia to be able to sit up and take a (figurative) step forward.

Yet another way in which my clients amaze and impress me.

Having an effect

I have been thinking about a session I had last week with one of the men I work with who is on the autism spectrum.  He and I have worked together, first in a small group and now individually, for the past ten years.  I have noted that I often feel quite lost in his sessions.   While it seems to be very important to him to have an opportunity to get out of his living area and walk to the Music Room (which is in another building), he generally just sits quietly when he gets there.  Occasionally, he’ll reach out and take one of the instruments I place near his chair (he is clear that he does not want to get up and come to the piano or explore any of the other instruments around the room), putting it back shortly thereafter.  He doesn’t use speech to communicate, although occasionally he may vocalize quietly.  So quietly, in fact, that I can barely hear him. 

I have been slowly making my way through Music Therapy with Adults with Learning Disabilities (Watson, ed., 2007), and I admit I felt relieved when I read the following: 

“The music made with adults with learning disabilities will be varied, as with other clients, but there may be particular characteristics.  The therapist may find that she is working with very little material (for example, when working with clients with profound and multiple learning disabilities).  This demands that the therapist is able to wait and listen, avoiding playing to fill the silence rather than in response to the client.  Other clients, whilst bringing music, may find it hard to initiate or lead music, leading to fragility in the contact between the therapist and client, where the therapist may feel as though they have complete responsibility for sustaining the music.”  (Watson,  p. 28)

I frequently feel as if I’m doing most of the musical work in my sessions at the institution.  Obviously there are a lot of reasons for this.  For one thing, the people I work with have movement challenges, making it very difficult (as Watson comments) to initiate and/or sustain interactions, musical and otherwise.  Another likelihood is that living in an institution for many years can bring about an intense case of learned helplessness.   I think, also, there tends to be an idea that I’m the one who knows how to make music, so it’s sort of left to me to do the main music-making.  Put another way, this is a setting that lends itself strongly to maintaining specific roles.

At any rate, during this particular session, I had a strong image of the notes from the music I was playing just bouncing off of my client and falling quietly to the floor.   I mentioned it to him, and then I let my mind wander around with that thought for a while.  If you read this blog regularly, you know that I am a firm believer that the feelings (and songs) that come up for me (and all therapists) while in the middle of a session are important pieces of information.  Naturally, it occurred to me to wonder (out loud) whether he too might be feeling a sense of ineffectiveness- in other words, of not having an effect on his life, on the people around him- a powerlessness in the face of the unfixability of...his life?  His surroundings?  His body (he has been going through some health issues lately and really has difficulty with medical type people)?

He didn’t make any clear overt response to my suggestions that day, but, as it happened, the following week, on our way to the Music Room, it was snowing out, and he was actually singing!  He had a quiet little melody which he was humming (with enough volume so I could hear that it was an improvised tune), and, while it was difficult to make out, it was clearly melodic.  Of course the minute we got to the Music Room he stopped singing, but he did add a few vocal sounds to the session.  Maybe it means something, and maybe it doesn’t...but it was nice to hear him sing.

References

Watson, T. (2007).  Music Therapy with Adults with Learning Disabilities:  Sharing Stories.  In T. Watson (Ed.), Music Therapy with Adults with Learning Disabilities (pp. 18-32).  Great Britain:  Routledge.

Who's responsible for this?

In my very first session this morning (assuming I can remember back that far) I found myself working with my client’s resistance.  He has been receiving music therapy from me for...gosh...a lot of years now.  And while we have a strong relationship he avoids the music-making aspect of things quite a bit.  

He has some movement issues (mostly around organizing his body to move in a specific way), and he does not use speech to communicate, but he has a strong voice, he can be remarkably clear in letting me know what he wants, and he’s quite capable of choosing an instrument and making some sort of sound with it.  But...he doesn’t.  

So I pointed this out to him (because, apparently, being a music therapist means being in a position to point out the obvious) and I invited him to think about it with me:  What prevents him from finding his own musical sounds (rather than relying on songs I choose for him)?  What if he did play his own music/sounds?  What would it sound like?  Is there something he’s afraid to hear?  Is he afraid his sounds won’t be “good enough”?

As I pondered these things I became aware of the fact that, by not playing his own music, by not choosing his own sounds- his own musical voice, he avoids being heard in this world.  Not just by himself but by anyone else.  And if he’s not heard, then he has no power.  

Powerlessness.  Now there’s an issue he and I have addressed in our sessions.   And, without diminishing the reality of how hard it is to live in an institution, I asked him whether he thinks he may have been giving everyone else in his life (me, his staff, his family) the responsibility for his life- for expressing his feelings, for organizing and getting his behavior under control, for his happiness...heck, for his very existence.  

He made a quick sound to indicate “yes” and I honored the courage it took for him to acknowledge that difficult possibility.  It’s not easy for any of us to make that kind of a realization, and his brow became rather furrowed as we continued.  

No one wants to hear that we play an important role in our own lives, and we’re not helpless victims.  Making everyone else responsible for him makes it easy for my client to be angry with everyone for not meeting his needs, for boring him, for not being there when he wanted them to be, for picking the wrong music, for making incorrect assumptions about what is important to him (the list is endless of course).  

What a gift to recognize that we do have a choice, and we are not, in fact, so powerless in our lives.