How wonderful that you're here!

Image via WikipediaWe music therapists are always trying to define what we do. Or, more specifically, help other people understand what it is we do. We write books and articles about it, we blog about it, we put together podcasts- all in an effort to convey to the masses a sense of what makes us go into this profession that seems to defy description!


But, if someone were to have asked me yesterday "what is music therapy and how does it work?", I would probably have said that it's about inviting people to be present to each other, and we use the music to help make that happen. 


Mondays are long days. For me, I go into work a little later and stay a little later. And, I think we can all agree: it's hard for any of us to transition into a Monday, which is, for most folks, the beginning of the work week. And I would say that it requires even more fortitude to get into the Monday spirit of things after a particularly long Thanksgiving weekend, which, of course, marks the beginning of the (dreaded) holiday season.


While staff frantically decorate the cottages and prepare for Open Houses (where everyone's family is invited to come and visit and there's food and music and merriment and so forth), my clients prepare for the annual anxiety of "will my family be coming to spend time with me this year?" 


So, this is a bit of the sense I got when I showed up to work with the group yesterday (Monday) afternoon- "the group" being ten men and me. 


Oh, where to begin? 


Well, let's see. There was a whole lot of messing with chairs (that would be P), switching of seats (that would be R), tossing instruments, trying to pick up instruments and then getting stuck on the floor and needing help to get up (that would be T), repeatedly rearranging and fixing the curtains so the sun wasn't blinding us (um, well, actually, that would be me), coming in, turning off the lights, and then leaving (that would be K), coming in, crying and starving to death and then leaving (a different K who does use some speech), and on and on, all accompanied by a low moaning (courtesy of J), the periodic fist to the head (of B), and the festive crashing of the tambourine (P again).


Can I get a witness? Anyone? Anyone?


Uuuhmmm. Now what?! (And if any music therapist tells you they know exactly what to do when their clients are all freaking out at the same time...just so you know- They. Are. Lying!)


I managed (do not ask me how) to get my thoughts together enough to be aware of the fact that, while the guys were all there, they weren't really There. Nobody was listening to anyone else in the room, we were all kind of...everywhere, but none of us was present to the experience of being in music therapy. 


I pointed this fact out to the guys (who, God bless them, heard me above the drama-filled din), and I asked them, "Gentlemen. What can we do here? How can we use the music? How can we use our thinking, to get ourselves to be here in this room, in music therapy, together? Why don't we just work on that, so that if we do nothing else today, we'll know that we cared about each other enough, that we mattered enough to each other, to notice that we were all here together."


Enter music. 


I moved over next to B, because I didn't want him to be hitting his head, and offered him my hand (he took it). He had been vocalizing while he was hitting himself, in a kind of a hum. So, since I couldn't play guitar with only one hand, I invited the guys to find some kind of way to hum with B to help him settle down.


I started to hum (in B's general key), and it didn't take long at all before the men found ways to join in with their voices and actions. J moved his arm, every few measures, up and then down to the beat. P, in spite of his tambourine prowess (and he really does rock on the tambourine) used his voice- which has more of an "oh" and "ah" quality. Yet another K quietly chimed in on the cabasa he was holding. R stopped moving around and sat, listening, with his eyes closed, breathing deeply. 


B calmed down and kept singing (but stopped hurting himself), so I was able to make use of both of my hands again. I played a very simple progression on the guitar- kind of an Asus4, Cmaj7, to D/F#, B, E (sometimes major and sometimes minor), and I repeated it as we sang and came together.   


It was lovely. 


There was smiling. The moving around and in and out stuff stopped. There was presence. We were looking at and acknowledging each other. 


We managed to be present in the session and we used the music to make it happen. The definition of music therapy on a Monday afternoon. 


And what makes this way of using music so cool is that this particular piece of improvised music  could only have happened on this day and with this group for it to have had any meaning. Taken out of context, it might sound okay, but it will never have the same impact as it did yesterday afternoon as we all sat quietly, after we finished, even after we sang goodbye, nobody wanting to leave quite yet, watching the sun set together.

Eating a slice of humble pie

Image by shandopics via FlickrI knew if I waited a while, calmed myself down and thought about it in a peaceful state, I'd have a better idea of how to proceed with C. 


You may (or may not) recall that I wrote about the dreadful session I had with her a couple of weeks ago. I was feeling terrifically annoyed with myself (among other sources of annoyance) because I had allowed my anxiety about staff being upset with my "letting" C strip in music therapy (I mean, really?) cloud my therapeutic judgment. 


Ugh!


So, as I was driving back from Michigan (which is quite a long drive when you're headed to New Jersey) to visit my friend (a music therapist turned music librarian, as it happens), I was thinking about the coming week. Naturally, my thoughts turned to Monday morning, C's scheduled time for music therapy. 


I had (yet) another twinge of guilt as I remembered our last session before I went on vacation (just for the record, it's not unusual to have a horrible session right before a vacation- in fact, it's one of the, er, perks of being a therapist). 


And let me just say, it was not one of my shining moments as a music therapist. 


As I was trundling along the Ohio Turnpike (where they have very nice rest areas, I must say), I wondered what I was supposed to do about the stripping. I didn't want to stop working with her, because, in spite of the exposure episodes, there were moments of actual connection in the music. 


I tried to perceive the situation from C's point of view (something I've tried to do before), considering the idea (again) that she may, in fact, feel exposed. 


Then it suddenly hit me! 


A forty-five minute session is way too intense for her! Sure she may appreciate parts of the experience, and she may even find herself engaged meaningfully with the music (maybe even with me), but she's not even close to being ready to deal with that kind of constant attentive interaction for that long of a period of time!


Of course!


I need to start out with very short sessions (five to ten minutes at most) and gradually learn when C is letting me know she's ready for more time. 


Honestly, sometimes I think I've been at this a bit too long that I could manage to forget something as basic as that. As basic as: can this client tolerate a 45-minute session, or should we start small and work our way up? 


So, today I showed up in the cottage feeling a little more confident (with regard to the staff), and I explained my plan. I'm not sure they were as enthusiastic about my plan as I was, but they were agreeable enough (which I appreciated).


The supervisor (for some reason) decided to get C, and we sat outside of the room where her group was meeting.


The first thing I felt I needed to do was to apologize to C for misdirecting my frustration in the previous session and aiming it at her. Then I acknowledged that I had not remembered that when someone is paying very close, unwavering attention to you for a sustained period of time it can be uncomfortable as hell. 


I told C my plan. "We'll start with a ten minute session. I'll practically be singing 'hello' and then 'goodbye' and then we'll stop, and I'll plan to be here next Monday again."


C, tucked under her blanket, tapped her hand against her leg. I sang "hello", she listened quietly, then I heard her giggle and vocalize with me a little bit. Then I asked if she needed anything else from the music before we ended for today. She vocalized a bit more. I sang "goodbye," put away my guitar, and I escorted her back to her group. 


She was smiling.

Are we willing to make our clients the "star ingredients" in a session?

Image via Wikipedia

I knew someday I'd find a way to link cooking and music therapy! (Can I get a "huzzah!"? Anyone? Anyone?)


Well, actually, Joanne Loewy, a fellow music therapist- who was one of my grad school teachers at  Hahnemann- always used food as a metaphor when she talked about music therapy. 


And this is sort of like that. But different. Follow me here. This gets a bit twisty. 


So. 


There I was dozing off on the couch with the television tuned to a PBS station, and I somehow woke up just in time to see the last ten minutes of Avec Eric, which is a foodie cooking show (we love food!). 


Eric, for those of you who are wondering, is a chef in New York, and he has a show on TV where he travels around and talks to other chefs and then shares his own recipes. 


Okay, are you with me so far? Good.


Well. I was half listening to the conversation between Eric and the chef he was interviewing for this particular show, David Kinch. David had made some fabulous food thing for Eric, and they were eating it (with great appreciation, I might add) and discussing what made it wonderful.


Here's where my ears perked up, and I thought, "Hunh!"


Eric had complimented David because he said he could really taste the vegetables he'd used in the dish. And (here's the really neat part) David responded by saying how, when he was a young chef, he was always looking to add one more  ingredient to the dish. As he's matured, he noted, he tries to keep the dishes as simple and basic as possible, always wondering what he can take away so that he can retain the essence of the main ingredients he has chosen. Eric agreed, saying it was indeed important to have "star ingredients".


"YES!!" (I thought loudly). That's exactly the process I experienced as I matured as a music therapist! 


When I was a young music therapist I was always looking for bigger and better activities. I remember having session plans with lists of things: first we'll do this, then we'll do a bit of that, then we'll work on this, then we'll look at that... On and on. It was a never-ending quest to come up with the perfect activity that would finally motivate my clients. If this activity didn't work, surely another one would.


All to no avail. 


Then, when I started to receive clinical supervision, I learned that my clients are the "star ingredients" in a session. And I didn't need to focus on (or even do) activities. I just needed to learn as much as I could about the primary "ingredient" (my client) and to figure out which gentle seasonings (if you will) this person might need in order to truly emerge and shine.


Now I no longer do activities. Instead, I engage in the process of getting to know the wonderful flavors that make up the person sitting in front of me in a session. I use the music (as opposed to kitchen tools), sparingly at times, copiously at others, depending on how much is needed at a given point.


I have finally learned that it's not about how much I do in a session, but rather whether or not I was able to provide my client the space to be. 


~~~~~~~~~~
Here's a link to the actual show if you'd like to see it and be inspired as well. 

Beautiful voices

One of the things I didn't know I missed when I was away from work for the summer was the collection of little and big sounds that go along with my music therapy groups.  When I hush and listen (and sometimes I have to give myself a mental nudge to remind myself to do so) I can hear the voices and sounds made by the people who don't use speech to communicate.  

On Thursday afternoon, we had quite a crew gathered (I honestly don't know how so many people keep ending up in our group).  There were at least ten men, and we were all sitting (or standing) in a sort of long circle in various forms of chairs.  Everyone who wanted to use an instrument (well, all three guys) had their preferred objects to sound, and even though we looked (more or less) prepared for action, we couldn't seem to get any kind of a musical improvisation going.  

To be truthful, there was some unrest.  T, who was sitting next to me, was a bit agitated, and he was up and down a bit- biting at his hand and then taking my hand and pumping my arm up and down a few times.  The recreation person came in and asked if he could borrow one of the guys, so they left together.  B wanted to sit in the windowsill- which, on principle, I'm not against, but his staff have asked that I not let him do that, because he tends to urinate all over the windowsill area, and, well, you get the picture- so I usually ask him to not sit there.  P, who usually wants to be in the session before anyone else and stays longer than almost anyone else, decided to return the tambourine he likes to use and left the room entirely.  

I think it was in between dramas that I finally quieted down, uncertain as to how I should proceed, and that was when I noticed the sounds:  R's quiet, breathy "hah, hah, hah" (accompanied, as always, by his quick forward rocking motion), B's- also quiet- melodic humming (he usually uses a very small range, and it's often in a minor key), and S's consistent, somewhat higher pitched, "ee-mmm-aaahh-mmm-eee-aaah", punctuating his sounds with gentle clapping sounds placed at various intervals.  K had the seed pod rattle, and, as always, he held it tightly in one hand, making it difficult for the seed pods to actually rattle, and he used his other hand to tap at it very softly.   

I listened with such pleasure, suddenly aware of how much I'd missed these sounds and these moments.  I tuned my low and high E strings down to D (the sounds felt very open and D-ish to me), and I joined in with my quiet sounds too.  The energy in the room shifted, and we were all able to settle down and play together.   

Walking slowly together

On Saturday (I work on Saturdays) I went to pick up D from his cottage.  I hadn't seen him for two and a half months, and I wasn't sure how he would react when I showed up after all this time. I mean, I told him I'd be on a leave of absence, and I explained that I would be returning at the end of August, and we would resume music therapy.  Since D doesn't use speech, and he's rather a quiet man (at least he is when he's with me), I wasn't sure how he had experienced my announcement.  

Anyway, he smiled when he saw me this past Saturday, and I must admit I was glad to see him too.  He pulled me to the door, and we were off.  It was a quiet morning, and D tends to walk- more like an amble actually- very slowly and deliberately.  His heel always goes down firmly first and then the rest of his foot follows along in sort of a rolling motion, his toes always pointed out. He holds on to me- to my hand- with his right hand, and his left hand usually goes up and rests gently on his chest or on the drawstring from his jacket (or the drawstring on his shorts).

A good word to describe D's pace, I'd say, is "leisurely".  Very.  I have often found it difficult to walk with him because I have to slow down quite a bit in order to not end up dragging him along. The thing about this particular day was that I had just returned from taking my own "leisurely" break.  As we walked slowly together, I immediately noticed how much less hurried I was, and how it was so much easier than usual for me to adjust myself to D's gentle rhythm rather than indulging the tendency I have to move along at my usually frantic trot.  

As we strolled along D hummed quietly, and I enjoyed listening to his singing- not a particularly wide range, but he was very present and lovely to hear.  Nice... to slow down and pay attention.