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 

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."). 

Journal Prompt #5: A person of interest

Image by On Being via Flickr
...And are we not of interest to each other?


The very last line of Elizabeth Alexander's poem- to which I'd only been half listening as I prepared breakfast with the radio on- came into my consciousness in such a profound way that I literally tripped over the garbage can, knocking it over, on my way to the computer to go and find it and re-read the whole thing.   


And I again came to rest on the last line:


...and are we not of interest to each other?


How beautiful!


You are by now, I'm certain, well aware of my love of good questions. So, as you can imagine, on principle, I love Elizabeth Alexander's ideas about poetry and how it leads to inquiry. Here is what she had to say about the matter in the interview she did with Krista Tippett from On Being:


I was thinking about the act of asking real questions in poems as a kind of spiritual practice. I ask questions relatively often in poems and I ask them because I don't know the answer. And I ask them because I think that poems are fantastic spaces with which to arrive at real conundrum kinds of questions, to go as far down the road as you can of understanding something and then sometimes that road ends with a real question.


I wonder if one might describe the process of music therapy (and, indeed, maybe someone already has) as a form of collaborative poetry-making and inquiry- an effort to create an evolving piece of relational art- one that often ends with more questions than answers. And one that invites deep self-reflection and, as my mother (who is a poet) often points out, frequent editing. 


...and are we not of interest to each other?


Elizabeth Alexander elaborates:


[The question] ...to me isn't about, oh, you know, I like her shoes or ...he has a fascinating job. It's much deeper than that. Our human beings who are in community, do we call to each other? Do we heed each other? Do we want to know each other? And I think reaching across what can be a huge void between human beings.

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As you consider your work as a music therapist (and as a participant in life), you might ask, not only do we interact with each other, but how do we interact with each other, who are we to each other, and in what ways are we with each other?


More questions to ponder: 
*Are my clients "of interest" to me? In what ways are my clients "of interest" to me? As in, what do I mean when I think of someone as being "of interest" to me? How do I define "interest"? Is it as "you're an interesting person"? Or is it deeper than that? And how deep am I willing to go?


*Are my clients "of interest" in terms of how I am defined when I am with them? Are they "of interest" in terms of: "This is who I think you are in relation to me"? In other words, is the "interest" defined largely by the roles we play? And how willing/comfortable am I to look beyond the assigned roles?


*Does being "of interest: mean that I know certain things about you as my client? And how does that affect the power dynamics in our relationship? On another level, what and how much am I willing to know about you? 


*What do I, as your music therapist, want you, the person called my client, to know about me? Are there things I wish you could know about me? And whose need am I meeting in wanting that?  


*What if our clients don't hold our interest? What then? 


My deepest thanks to Elizabeth Alexander for her inspiring poem and to Krista Tippett for the willingness to "go there" in her interviews! 


You can read the entire poem and learn more about Elizabeth Alexander and her books of poetry here. And you can listen to (or read) the entire conversation (and many other engaging interviews) with Krista Tippett here.

Journal Prompt #3 (When music therapists go bad)

Image by Esparta via FlickrYesterday, I felt like a bad therapist. 


I was tired from awful allergies (and the ends of a lingering cold), and I didn't feel great physically (and, let me tell you, there was some serious whining going on). And, yeah, okay, the truth is I just plain started out the day with an attitude. 


But I figured, "Come on, Roia! It's Saturday, you only have three sessions with three different guys. They're good guys. You really like working with them. It'll be fine. Stop your kvetching, and go do your sessions and you and your aches and pains will survive." 


Great. Pep talk done. Let's do it!


Maybe it was because it was a holiday weekend (with little hope of their seeing family members), maybe it was that it was a fairly nice day outside and they were all stuck indoors, maybe they all had allergies, maybe they thought my sunscreen smelled weird...I don't know what it was!  But my clients weren't exactly in jovial moods either. 


So. 


There we all were with our collective attitudes in the various sessions, and there I was just...not making sense, not saying or doing anything particularly- I don't know- therapeutic. I found myself wondering why the heck I was saying what I was saying.


And all I could think was "what is with you today, woman?"


I was so not being a shining example of music therapy and all the fabulosity that goes with it. 


Yes, I know that I probably wasn't as awful as I felt  I was being. And, yes, I realize that it's all "grist for the mill" (as my clinical supervisor has always said), and it's all part of a much larger process/context. And, sure, it's true that even a bad day of music therapy (when you live in an institution) is probably not as bad as all that, but I like my clients. I want to do right by them, and I felt kind of badly that I was less present than I would have preferred. 


And I was also annoyed that they were (at least in my perception of things) making me work so damned hard! Waaah! [We're whining...we're whining...]

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

So, perhaps you can journal (or sing, or play, or create some form of art, or develop your own whining rant) about a day (or, heck, a week or a month) when you felt as if you were having a hard time being the kind of  music therapist you like to think you are.

What are some of the idea(l)s/myths you have about who/how you "should" be as a music therapist? 

What are some of the idea(l)s/myths you hold in your mind about who your clients "should" be and how they should act/respond/deal with stuff when they're in music therapy with you?

And how do all these idea(l)s and myths affect how therapy goes some days? And how do you cope with days when you feel as if you are less than stellar?

Bring it on, my fellow bloggies!

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. 

12/16/09 Quote- effortlessness, waiting, self-awareness

Image by jhave2 via Flickr

From an article by Wayne Muller, "Effortlessness", in Unity Magazine, May/June 2003, pp. 4-6:

Deep within all things there is a natural rhythm, a music of opening and closing, expansion and contraction. Our heart, our lungs, the seasons, the oceans- all life expands and contracts, opens and closes, softens and hardens and then goes soft again. This potent opening and closing cannot be forced to happen, nor can it be stopped. It is simply the way of all things.

We need only remain clear and awake to listen for how things really are, to feel how the smallest changes of energy and attention move in us, in our relationships, in our work. We can learn to follow the spaces between things. Not to fight and push and cajole, but rather simply to wait until the true way reveals itself easily and clearly in this moment. 

My thoughts as I read this:
This seems to me a wonderful (and poetic) reminder of why it's so necessary for us, as music therapists (as any kind of therapists), to examine and to be aware of our own issues and motivations in our work. If we're not aware then we run the risk of "pushing, struggling and cajoling" our clients into getting better (behaving better, functioning better) instead of simply being with them and trusting that they will move forward at their pace. 


When I notice myself reacting in a session with a sense of urgency and "I must do something right now"  this passage reminds me: sometimes I just have to wait and be with my client(s) until s/he/the group is ready to move forward.


When I'm not willing to do that I know my focus has shifted to myself and to my own fear that I'm somehow not fulfilling this idealized (and delusional) notion that I have to be "the perfect therapist who can fix it all for her clients."

Isn't that kind of messed up?

Those of you who regularly read my blog have probably come to realize that I'm not exactly someone who focuses primarily on behavior change as a goal of music therapy. (And, truly, I'm not trying to bash behaviorists here.)

Image by nickwheeleroz (on holiday) via Flick

My usual focus is on building the therapy relationship  and learning about my clients through interacting with them. Behavior change, I believe, comes about naturally because the person wishes to maintain relationships with other people.


As such, I spend a lot of time thinking about and trying to come up with some ways of understanding why certain "behaviors" (or ways of being) are so indelible and resistant to change. (Mind you, this is something I regularly try to hash out in my own life as well. But I digress.)


So I started to wonder whether some of my clients have gotten so accustomed to playing the role (in their families, in the institution, in their lives) of "the messed up one" or "the problem" because, on some level it affords them the opportunity (perhaps, from their perspective, their only opportunity) to be special? 

I'm not saying this in a mean-spirited way, believe me.

Here's the thing: a good large portion of the folks I work with often don't stop "doing behaviors" that get people grumbling at them (this in spite of years of behavior modification programs and, the ever popular in institutions, active treatment).

And it made me wonder. Why?


I know my clients always have some reason (whether or not the reason is obvious to me or to any of their other supporters) for choosing the actions and interactions that they choose. 


Okay. So.


In the absence of a clear or obvious reason as to why someone is acting in some unusual or less than sociable way (a reason such as physical discomfort that hasn't been discovered or addressed, or a reaction to something we may not yet know is happening- like hidden abuse), I ask myself (and my clients): 

What's preventing this person from moving beyond this behavior? What is it about this particular way of interacting, this way of being in the world, this way of behaving...that is working for this person in some way? Why might s/he be loathe to give it up?


So I come back to the question in my mind: what if this adopted behavioral style, or interactional style, is in some way fulfilling a wish to be "special"? 


And whose wish to be special is it fulfilling? Is it my client's wish? Or is it the wish of his/her family? By not playing out the role of "special" will s/he be disappointing her/his family? Or believe s/he will disappoint her/his family? 


Is it a way to be noticed at all? In an institution, unless you act out in some way, you run the risk of pretty much sitting quietly by yourself and not having much interaction with anyone, because you're essentially not getting on anyone's nerves. That's fine if you're not all that into interactions with people, but what if you're lonely. And your choice is to not be noticed at all or to be outrageous? Which might you choose?


Right about now you're probably thinking, "No wonder that girl doesn't get anything done all day, obsessing all over the place as she tends to do."


And you'd be right. 

Healing touch

I will not lie to you.  I went to work in a very unhappy state today.  It wasn’t anything to do with work, and I made every effort (as I always do) to keep my focus on the people in my sessions.  As you can imagine, by the end of the day, I was fading a bit, and it was sort of hard to stop my sadness.

My last session of the day is with two gentlemen (M and G, both of whom I like very much) who experience life on the autism spectrum.  We had had a tough time in the previous week, because M kicked G on Monday and then he kicked me on Thursday, and G and I were both sporting bruised shins.  G, on the other hand, tends to scream very loudly on occasion (with a tendency to be near one’s ears when he does so).  So, of course, when we started there were reminders to try to use words and musical sounds to express any frustration or distress rather than kicking and screaming as a means to make salient points (thank you very much).  [Hm, I just noticed that together M and G do, in fact, kick and scream.  They do this separately, mind you, but how interesting that they ended up in the same session together.   What a very nifty new thing to know.  Anyway...]

G has a hard time staying with us for the duration of the session (although he usually hovers nearby or returns to check back in to our space in the back hallway of the cottage).  M, on the other hand, likes to draw while we work (I think because it helps him to focus on the session more effectively and less directly).  

Well, something about G’s hovering today triggered the sadness with which I’d started the day, and I had to pause for a moment.   I rested both of my hands on the table and looked across it to M, who suddenly stopped what he was doing, put the pen down, reached out and enveloped both of my hands with his, looking at me quietly.  Then he went back to his drawing.  

It was such a sweet and kind gesture, and I knew that he understood that I was sad, and he wanted to offer me comfort (which he did).  I thanked him for his thoughtfulness, and we continued on peacefully for the rest of the session.