"You are showing them that they exist"

Excerpt From the transcript of the On Being show in which Krista Tippett interviewed Michel Martin:

MS. MARTIN: What we are simply saying is, I see you. I mean, I know for example when — you know, when I was working for “Nightline,” and I went to Turkey after there was a terrible earthquake there, and like, you know, thousands of people were killed. And I was feeling really useless. Um, thinking, boy I wish I were a doctor. I wish I were a structural engineer. I wish I could do something more useful. But then people would come up to me and say, thank you for being here. And I would feel, like, wow, why are thanking me? And then I thought — and I called my — you know what we do at a time like this. You know, I called my husband, because [laughs] I really feel like so useless. What am I doing here? And he said, you are showing them that they exist. And I appreciated that, because I’ve held onto that. It’s like sometimes the best thing we can do for people is let them know that we see them.

MS. TIPPETT: Mm-hmm.

MS. MARTIN: And so sometimes, you know, other people’s bad news is, you know, their lifeline, and letting them be understood. In fact, this was the very first story I did when I was at The Post as a little baby reporter at The Washington Post, and I was sent out on the summer — it was one of those terrible stories that you hate to do because some little boy had fallen out the window of the projects.

MS. TIPPETT: Yeah.

MS. MARTIN: And I had to knock on the woman’s door to get a comment from her. And I kid you not, I walked around the block three times before I mustered the courage to knock on her door, because I knew I had to. And I felt like, you know, and I knocked on the door. And she — and I said, I’m so sorry, I heard about your son, I came to see if there was any — a comment that you had. And she said, where have you been? Because she felt that if someone from the media didn’t come, then this was invisible and it had no meaning. And she had things she wanted to say, like why weren’t there any safety screens on the windows, which there were supposed to be. So, I bring that up to say a lot of times, what sometimes what middle class people see as intrusion, other people with no power see as validating their existence.

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

This part of the conversation was so meaningful to me, particularly a day after sitting with my clients in their "I hate this place!" rage, fear, anxiety, uncertainty. Literally, from the first session to the last, I heard some variation on this experience of powerlessness. In the first cottage, one of the women was screaming about how much she "hates this place!" The person I actually went to pick up for her session was having a rough time of things, and I found myself feeling quite lost and powerless to be of much help to her. The person I worked with in the afternoon was clear in his wish that I would take him away, because he indicated a wish to leave the session space for a while and he directed me straight to one of the vans sitting in the parking lot. 

My last session was with a challenging group of men who live in an untenable situation- stuck in a room, all day long, dependent on whoever was coming in to support them, and angry, frustrated, powerless. One of the men, the youngest in the group at only 31, yelled and yelled and yelled, as he often does, but this time, even though he doesn't use words to speak, I distinctly heard, through his yelling, the words "I HATE THIS PLACE!! I HATE THIS PLACE!!" 

Our session had begun with one of the guys being pushed back into the room by his annoyed staff person. I knew he preferred not to be with us, and I had encouraged him to go and be in the other area, so instead of taking off his shoes, his shirt, his pants and grabbing at me, he kindly got up and walked toward the door. His staff person pushed him back in, because, she said, "he keeps going and leaving the day area and eloping, and we are so short-staffed, I can't watch him and all these other guys as well, so he's going to have to stay in here! Everyone gets frustrated that there aren't any staff, and then they call off!" She, too, was in an awful situation.

It was hard to know what to offer the men, musically, that could even come close to supporting them. All I could do was acknowledge it and let them know, "I hear you, and, yes, it is very hard to live here, and right now it's also very hard to work here. And I hear you saying you hate this place, and I'm sorry you're feeling so disrespected." 

And so, as I felt as if absolutely nothing I could do would be of any help to the guys, one of the most poignant moments was when the young man who was screaming came over to me, after four times, handing me my guitar case and seemingly letting me know he wanted me to leave, picked up a brush that was sitting on the table, and he handed it to me. I was holding my guitar, and I thought, "Whaaaa?" Until he pulled my hand to his head, and he kept a hold on me as he slowly had me brush his hair. 

So, Michel Martin, thank you for reminding me that what I do have to offer my clients is "show them that they exist."

"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. 

Well, what do you know?

I was minding my own business, journaling away last Sunday morning, listening to (yet another excellent episode of) On Being, where Krista Tippett was interviewing Lawrence Krauss, a theoretical physicist. The aspect of their conversation that caught my attention was this comment: 

Mysteries are what it's all about. In fact, not knowing is much more exciting than knowing, right? Because it means there's much more to learn. The search is often much more exciting than the finding. Mysteries are what drive us as human beings. 

He extended the idea by noting:

One of the values of science is to make us uncomfortable. Somehow that's supposed to be a bad thing for many people, being uncomfortable. Being uncomfortable is a good thing because it forces you to reassess your place in the cosmos. And being too comfortable means you've become complacent and you stop thinking. 

As I listened to him I realized something kind of interesting: I think not knowing is what has kept me passionately in this field for so long. 

Think about it a second. 

When we think we know (the answer, what's going on, what someone's problem is, how things should look, who someone should be, and so on and so forth) we are no longer learning, no longer curious. We stop at the surface, and, because we know then we presume there's nothing else to think about or to find out.

When we're new professionals we either think we know or we think we're expected to know most of what there is to know about music therapy. What we often don't realize is that all we know are the very basics- that there's a whole world of knowing we haven't even begun to come in contact with yet!

It took me a lot of years (and a lot of clinical supervision) to finally understand that my real job as a music therapist is to go out there and ask my clients what they need me to know and learn in order to better support them. 

So many times in my younger (pre-clinical supervision) music therapy days I went into sessions knowing what needed to be done to "help" my clients. I didn't ask, I wasn't curious about what was going on or why my clients might need to be or do things the way they were being or doing things. They were disabled. There was a list of things I knew about disabled people. There was a list of ways music was supposed to "help" disabled people. 

So I went in with my music therapy interventions, applied them, and waited for the activities to work. This is what I was taught (or at least this is what I understood of what I was taught). And when my interventions didn't work I was frustrated with my clients and wondered, "what the hell? Why isn't this working? This is what I was told to do!"

Somehow I had inadvertently stepped into the medical model of music therapy: "Here are the symptoms associated with a particular population of people. Liberally apply music therapy activities to alleviate said symptoms and to increase skills. Music is, after all, intrinsically reinforcing. Success." 

In other words, I'd go into sessions with the attitude of "I know what the problem is, and I know the solution." Except that I wasn't having a lot of success.

Finally I got myself some clinical supervision, and I learned about process-oriented, relationally-based music therapy. But when I stopped doing activities and began to use an improvisational approach, I was terrified! I had no idea what to do- ever. I was convinced I'd failed as a music therapist, because I didn't know anything any more! 

Add to that fact that I work in an institution, and institutions are notoriously entrenched in the all-knowing medical and behavioral model of understanding people. Sitting there quietly with someone (because I didn't always know what to do) and singing about what that person was doing or what I thought it might be about (as opposed to gathering everyone in a circle- or trying to- and forcing them to play instruments with hand-over-hand assistance) was an open invitation to criticism and "why are you just sitting there doing nothing, Roia?" 

But I trusted my clinical supervisor who told me "trust the process". 

As time went on, I discovered the joy in finding out who my clients actually were and began to appreciate the opportunity to get to know them in a more authentic and human way. I got more comfortable with the idea of going into a session and not knowing - not knowing what was going to happen, not knowing (yet) the person in front of me, not knowing exactly what music would be needed that day, not knowing if I was hearing my client properly, not knowing if what I offered was going to be accepted or even make sense. 

And that engaged me in the work of becoming and being a music therapist like nothing ever had! I began to understand music therapy from a whole new perspective: 

We are artists, and we are scientists, and art and science are not about knowing. They're about trying something out (an idea, a hypothesis, some direction) and discovering, or messing up, making mistakes, and figuring out better questions to ask. They're about not knowing, about wondering and curiosity, and finding out what we don't realize we don't know. 

That's amazing to me! And waking up every morning with the thought, "I wonder what will happen today with my clients," and being completely curious excited about that, is what drives my passion for music therapy. Even after doing this for 26 years!

To borrow from Lawrence Krauss again:

In fact, what's really beautiful is every time we make a discovery in science, we end up having more questions than answers.

Yes! 

Fifty shades of "no"

I've been sitting and stewing over the fact that one of my clients decided not to come to his session yesterday. Obviously, it's not the end of the world, and it's mostly likely he'll be back. But I know he's upset with me and he's struggling with a lot of feelings because of the difficult work we're doing right now.

Occasionally, clients with whom I've developed a fairly stable relationship (and I can tell you, that has usually come after quite a long time of working together- usually years), who I can almost always count on to be there for their sessions, refuse to come to music therapy. 

And  when I say "refuse to come to music therapy" I mean I've walked over to their building, signed them out, collected their outer gear, walked in to the group where they spend their days (along with the rest of the people who live with them and along with their staff people), and asked, "would you like to come to music therapy today?" 

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

I'd like to pause here to say what a vulnerable moment this is- for me anyway- as a music therapist. I mean, I'm standing there, exposed, and, honestly, it's like inviting someone out on a date in front of their entire family. Only it's therapy (which is just as intimate as a date, if not more so at times) and the other people in their group may have feelings about this particular person being invited to go to music therapy (when they themselves are not being invited) and their support staff who usually have their own feelings about the person who's scheduled for music therapy as well as a series of opinions about me and what I represent (sometimes good and sometimes not so much). Additionally, support staff have a series of beliefs and understandings (usually passed down from their supervisors) about their role in clients heading out to programs (such as music therapy). Commonly, those beliefs and understandings involve making sure the person is clean and tidy and goes and does what s/he is supposed to be doing. 

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

Now, most of the time, the folks I've worked with for a long time jump up and come over on their own and then pull me to the door. Others go and sit in their wheelchairs, waiting for me to take them out. Some people who have a harder time initiating actions or simply have a lot of physical involvement making it more difficult for them to stand and greet me, wait for me to approach them and let me know they want music therapy that day by making an effort to get up and go with me.

Over the years I've discovered a large (and important) part of my work is figuring out how my clients (most of whom don't use speech) communicate "no".  Some people (the ones who usually hop up to meet me) simply don't get up when I appear and remain seated. Some (who need more physical assistance) let me know by not allowing me- or just not helping me- to put on their coats. Others avoid going toward the door, and I've had a couple folks  pretend (vigorously) to be asleep. A few of my clients will come part of the way with me and then stop repeatedly or keep going in the "wrong" direction, and still others come to the session, wet themselves and have to return to their buildings to get their clothing changed. 

The gentleman I went to pick up yesterday is someone who usually gets up the minute he sees me and comes quickly over to take me by the wrist and pulls me toward the door. His "no" came after a particularly hard series of sessions in which I've been challenging his way of thinking about me and about the role of music therapy. 

His "no" started when he stayed seated, looking at me with a rather unhappy face, leaning his head on his hand. I wondered (out loud to him) if he had a headache (it was pretty loud) or if he was tired (sometimes he doesn't sleep too well). I waited a short time and then I told him I'd go out for a few minutes, come back and check again with him. "If you still don't want to come, that's fine, and I'll check in with you again next week."

So I went and stood in the hallway for three or four minutes and then tromped back in with my armload of sweatshirt, coat, gloves and a hat for him. He still didn't move. 

Mercifully, his support staff didn't tell him to "get up" (which is what usually happens, and, when they do that, he usually stands up and comes with me, but I'm well aware the entire time that he would not have been there had they not told him to be, which, I think we'd agree, is an awful feeling- for both of us). 

I offered to sit with him for a bit, because sometimes he actually needs some more transition time (or to just think about whether he really wants to skip music therapy that day- and it's very rare that he does), but he still didn't get up. 

Just as I was about to turn and leave, he got up and walked past me to the table (where there was more space for me to sit with him and also plastic blocks he likes to hold). He couldn't find any blocks (they were all zipped into a bag, and I guess he didn't want to mess with it just then), and he went to sit down in another chair. This time there was space next to him, so I sat down and pulled off my hat. 

I invited him to let me know if he wanted me to leave by looking toward me and if he wanted me to sit with him to indicate this by tapping my arm. He glanced my way, fleetingly, twice and made no move to grab my hand (which is what he generally does). 

"Okay then. I'll check in with you next week. I'm glad you let me know you didn't want to come today, and I'm glad you let me know you'd rather I don't sit with you right now."  

I wished the guys a decent weekend and headed out into the hall, kind of hoping he'd change his mind and come after me. He did not. 

I headed back to the Music Room, pondering the whole thing, reminding myself that he was likely wanting me to feel as rejected as he'd probably felt in our session. 

But then the inevitable worry began: Did I say something in the wrong way in his last session? Did I accidentally offend him? Did I hurt him by saying something he wasn't ready to hear yet? Is it irreparable? Will he give up and stop coming to music therapy? 

As I was pondering these questions, yet again, this morning, I realized, not only is this the usual litany I go through when a client chooses to not come to music therapy on a given day, but my confusion- my wondering what happened, did I do something wrong, will this person leave- probably very much mirrors the feelings my clients have had with regard to their families placing them in an institution.

Perhaps (along with "no") I was "hearing" his (and many of my clients') experience of ambiguous loss,  which is a loss that doesn't have clear closure and around which there are questions and a great deal of uncertainty. It's often thought of in terms of families' feelings regarding a child who is disabled or mentally ill or a parent or spouse who has Alzheimer's (for example), but there is little, if anything, written about the experience of the person whose family sees them as "gone" or "lost" to them because of their disability. 

When I arrived back in the Music Room, I found myself singing the following song, and once again, I felt amazed at the way our minds speak to each other through music.

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."). 

A musical portrait

Image by mommy peace via FlickrAt first I thought he was angry with me. He certainly looked quite solemn. True, I'd been away for a couple of weeks, but usually he's at least willing to stand up and go to the Music Room with me. 


So I pulled up a chair and sat next to him. "You don't want to go to your session?" I asked. He hung his head down. "Okay. Can I just sit with you for a little bit?" He looked up briefly and then face down again. 


We sat for a minute. "You can come and tell me in the music if you're upset about something." He was listening, but not moving. "You know, I'm going to just go get your jacket and hold on to it. If you still don't want to come with me that's fine. But if you do, we'll have your jacket. I don't know. Maybe we could just go for a walk. It's pretty nice outside." 


I went to the coat closet, fished out his, and went back to sit next to him. The guys in his group were all watching television, so I chatted about that. After a little while, he half-smiled, got up and reached for his jacket.  "Cool!"


We headed outside into the sunshine and walked slowly. I wasn't sure whether we were just walking or if we'd be going to do his session.  As it turned out, we made it to the Music Room. 


He moved the instruments I'd put out for him onto the bench at the end of the couch and proceeded to lie down so he was facing me where I was sitting at the piano. I could hear, from the way he was breathing, that his sinuses were really giving him a hard time. 


His facial expression was still quite serious, unsmiling. I sang a greeting and asked how he was feeling. He responded with a heavy sigh.


"I realize you may have some feelings about my having been on vacation. I wonder if maybe you're feeling angry with me." And I invited him to look my way if that was the case. He did not.


Oh. Hm.


"Feeling abandoned?" A little bit of eye-contact.


We stayed there, quiet. Where to go with this?


"I'm having a hard time figuring out what might be going on for you today. I'd like to play a musical portrait of what I think I might be seeing or hearing, maybe just sensing, from you right now. If you can, will you help me by letting me know if what I'm playing makes sense. Also if it doesn't sound right, can you find a way to steer me in the right direction? I'll do my best to listen."


I played, using the piano. It was halting, dissonant- really quite dissonant, and it didn't feel very grounded. I guess you could say it sounded like someone floating and unsettled. 


As I played, I realized I hadn't "heard" his initial response accurately. He wasn't angry. The music he inspired didn't sound remotely angry. It sounded, and felt, very sad. And it probably wasn't really about me. 


"I misunderstood. I'm sorry. I think, as I'm listening to the music, I might be hearing your sadness." Slowly he turned to face me. Wow. I felt his sadness too.


What now? Where to go with all this sadness? 


As I thought about how to respond, how to be present, I was reminded of my friend, Greg, who often quotes John McNeill to me: "If anyone is willing to enter my private hell and stay there with me, then there are grounds for hope."


I invited him to hum with me as I played. I started the music where I had left off- at the musical portrait. Gradually, the sounds on the piano became slightly- only slightly- more consonant. Eventually, I was just moving between A flat and B flat, humming quietly. 


I heard sounds from him- not a lot, because it was difficult to vocalize with his nose all stuffy as it was. I moved from humming to a quiet "ee" sound, thinking it might be an easier sound for him to make.


His eyes closed and he smiled briefly. I thought he might fall asleep, as he often does. But he didn't. He listened. And we sat together in the sadness and in the music.


It was time to go. I sang a quiet goodbye, reminding him I planned to be back on Thursday. I got up to get my sweater, and he followed me to get his jacket.


He took my hand and we walked back to his cottage in the sunshine. 

What do I (think I) know?

Gosh, it's been an absolute age since I posted. Ack! Hopefully you're all wondering what the heck is going on, and asking yourselves, "where in Pete has that girl been!?"


So, here's the scoop: this has been the summer of ailments (and, evidently, I forgot to mark it on my calendar). No, really. It's been a little bit ridiculous. 


Since April, I've caught two colds (I hardly ever get sick), one monster case of allergies that led to never-ending coughing and ended up requiring two asthma inhalers (I don't have asthma), and, just because life wasn't going to be complete without it, I've been limping (very painfully) around for four solid weeks with my backside, hip, thigh, and knee out of whack. 


Honestly! Is this truly necessary? 


I say all this to you, not just to whine and kvetch about it (because, I mean, who would I be without my whining and kvetching?), but because getting around with extreme pain (it's finally starting to settle down somewhat, thank goodness) has forced me into an awareness I've never had before.


I'm ashamed to admit to you how completely ignorant I've been of this fact: There are a lot of people walking around in constant and terrible pain. They're not complaining and carrying on (like I am). They just go about their business and do what they've got to do. In pain. 


It's one thing to get this on an intellectual level (and, of course, I've always understood this on an intellectual level), but that doesn't mean anything. 


Sure, I've seen my dear friend get to a point where she's had to walk around with a cane (and only for very short distances) because she has extremely painful knees. I always known that she's in pain most of the time, but until recently I'd only understood it on a peripheral level. 


Until I experienced what it's like to be absolutely unable to get from point A to point B (forget the fact that moving made me want to scream and/or cry)...I had no clue. 


Do I have a point I'm trying to make here? Well, yes, I think so.


I'm realizing (yet again) how important it is for me to question some of the things (maybe many of the things) I think I "know". Because a lot of the time...I really don't. Often, all I have is some vague idea in my mind about what someone's experience is- whether the person's in pain, has a serious illness, comes from a culture or ideology different from mine, has some sort of a label (whether s/he wants that label or not), is socially ostracized...The list goes on indefinitely, as you can imagine.


I am struck by how limited I am in my understanding of what any of these things actually mean in terms of a person's life and how it affects who the person is and how they relate to other people and to the world.


In short, I am, yet again, astonished by how much I just don't know. And, more to the point, how much I'm not even aware I don't know. And I have to ask myself: as a music therapist, what are the things I think I know? And how willing am I to find out my assumption(s) may be incorrect? 

Journal Prompt #4- Uncertainty

Image by cowbite via FlickrOne of the hardest aspects of being a music therapist, at least for me, has been working to come to terms with the experience of uncertainty as I work with clients. I'm sure this won't come as a surprise to you, because I've written about it a number of times (here, here, and here- to name a few).


I think part of what makes it difficult to sit with the sense of "um, I'm not sure what's going on here" is this mythology we tend to buy into as music therapists (I guess as any kind of therapists, really) that tells us "you must always know what's going on with your clients and have the perfect intervention and/or response to address it."   


Even after doing this for 24 years, there's still a nagging sense of "I should know" in the back of my mind- even though I know (intellectually anyway) that I don't have to know, and even though I'm well aware my clients aren't always ready for me to know (or aren't ready to know for themselves), and even though I realize it's just a matter of sitting with the feeling and trusting the process.  


I understand that some of my uncertainty comes from the fact that I work with people who don't use the usual means of communication or ways of relating to people. Using a process-oriented approach (and not a product-oriented one) also increases the likelihood that I won't always know what's going on in my sessions. 


And, really, I'm okay with all of that. I'm just...very aware (shall we say) of a feeling of "hmm" when I'm faced with a situation and I'm not sure how to proceed. 


So, lovely readers, I invite you to join me in looking at this part of our work as you journal.


-Do you allow for a bit of uncertainty as a part of your music therapy practice? If you do, in what ways? If you don't, why not? 


-How do you approach uncertainty when it comes up in your work as a music therapist? Do you power through it on your own? Do you seek supervision or consultation? What kinds of questions do you ask yourself?


-How do your beliefs about what it means to be a "good music therapist" affect the way you deal with uncertainty? What does it mean about you, about your abilities as a music therapist, about how people might view the field of music therapy to "not know" what to do or how to approach a therapy situation? 


-What if the "perfect" song or intervention isn't coming to you and you're in the middle of a session? 


-What are some of the things you're doing in your music therapy practice that help you avoid the experience of uncertainty? How does that affect the therapy relationship? What might you be communicating to your clients?


I'd love to hear your thoughts about uncertainty (written out, sung, played as a piece of music, acted out as a play, whatever works for you), so please share them freely. 

Video journal #1 (So THAT's what Countertransference Sounds Like)

Seriously. What is with me and all this numbering? 

Anyway...

With all this conversation about trying different forms of journaling (okay, maybe there wasn't any actual conversation, but it's definitely something that's been on my mind), I decided I wanted to try a video journal. So I did an improvisation after a session. Here's what that looked/sounded like: 

After I listened to it, it occurred to me that it sounded sad and sort of poignant. I was struck by how extremely consonant it was as well. I didn't think it would be. I guess the point is that maybe on some level I did know what might have been going on in the session, but it just hadn't become conscious yet. 

Who's in charge here?

I realize this is going to sound like I'm ranting. And not only that, I'm fairly certain I'm going to sound judgmental. And you know what? Maybe I am. This issue is so profoundly important that I think it deserves a bit of a rant, so I'm going to ask you to bear with me today, because this is serious.


It's not exactly news to anyone that I work with people who have intellectual and developmental disabilities (many of whom also happen to have autism and many of whom do not use speech). When I'm talking about clients (below), I mean it to apply not only to doing music therapy with folks who have a whole bunch of labels, but I'm talking about working as a music therapist in general.


So, why am I carrying on? Let us commence with the rant now, shall we?


I have an important question I want us to consider: Is it our clients' jobs to listen to us? Or is it our job to listen to our clients?


I ask this, because I've been noticing what seems to be a tendency in music therapists to go in to a new session and expect their clients who have severe disabilities to just do what they ask them to do. As in, "here are the planned activities/events, and here's what I think you ought to do. Your job, client of mine, is to perform these tasks/activities. And my job is to get you to do that. Period."


Well. Okay...but...


Let's pause a second and think: whose need are we here to meet?


If we want to teach our clients to be better listeners, are we modeling that by listening to them? If we want to help our clients to be be better at paying attention, how willing are we to pay attention to them? If we want people with significant disabilities to engage with us, what steps are we going to take in order to engage on their terms? 


If we can't understand the language someone is speaking (particularly if their language does not contain words), are we truly serving that person when we expect him/her to do what we ask before we even make the effort to try to learn about who they are?


Again I ask the question that my college music therapy professor asked us all the time: whose need are we here to meet? And is that need best met by our coming to our clients in a music therapy session and expecting that they will do what we'd like them to do? 


Or is that need best met by asking that person to help us learn about who they are (even if they don't use speech to say it) and then creating the musical space within which our client can find a way to communicate and then making a point of hearing it?


We are music therapists. Let us honor that fact and work hard to develop skill in the art of listening. 


Let me end by saying this: when we work with folks who confuse us (and even if we think we know what's going on), the first place to start- always, always, always!- is by paying close attention and listening as hard as we can! 

The Act(ion) of Thinking

Image via WikipediaI've been thinking about RD of late (well, particularly today, because we had a session this morning). 


RD is a very sweet young man on the autism spectrum (he does not use speech to communicate), and he is very particular about things. And by this I mean that he seems to believe that all things should have a place (I think I can thank one of his family members for his excellent manners and his tidy nature.)


It so happens, that we work in a terrifically messy room in his cottage (oddly enough, it's the, um, "sensory room") (yes) (well). 


Anyway. 


No matter how much I try to clean up all the clutter in the place before I go and pick him up for his session, he still finds things to, er, tidy. 


He also likes checking out all kinds of objects. He has a collection of action figures with giant feet (I don't want to know!), and his staff people find him books and various things that have moving parts to them. He keeps them all in a big box with his picture on the front. Great! 


So. Back to the aforementioned "sensory room"...


Because this is, apparently, a full service sensory room, there are almost always broken battery-operated sorts of things lying around in varying states of function and dysfunction. This means that the batteries are lying around (lovely), and the little parts that keep the batteries quietly tucked inside the gadgets are also roaming about freely.


RD, being the tidying kind of guy he is, and being the kind of person who likes to bond with objects, has been picking up these little plastic parts that were supposed to hold in batteries. He just turns them over and over in his fingers and holds them close to his face so he can examine them.


While he's doing that, he sings. He hums little melodies (I've come to learn that he repeats specific melodies with small variations here and there). I either sing them back to him or play them on the guitar (with my own variations and chords). And while he's scurrying about the room arranging things, we sing and play back and forth with each other. 


The other thing you need to know is that, when he borrows an instrument from me (to check out as described) he often puts it back in the closet that's in the sensory room. As such, I have to go and retrieve the instrument quickly because otherwise it'll be there for all eternity (I have reached the official limit on my brain's memory card, and, let's face it: some things are just going to have to go!). 


Now, not only does he take my stuff and put it in the cottage closet, but he puts stuff he picks up in the cottage on my music cart or in my instrument bag. I am forever pulling things out of my bags (after his session) and putting them back in the room (back in circulation, as it were).


Okay.


So, as I mentioned above, I was thinking about RD, and I was wondering: why does he keep putting cottage things in my bags? And why does he keep putting my stuff in the sensory room closet? What's that about? Is there something he might want me to know? Or that I should be noticing about this?


And I thought, hm. So I mentioned to him during his session that maybe he needs to have me hold on to a small piece of him when I go (i.e., don't forget me, please). And maybe putting my stuff in the cottage closet is a way for him to keep a piece of me as well. 


When I gave it some more consideration, it occurred to me, again, that here's a guy who likes everything to have its own place- whether it's the "right" place or the "wrong" place. And I remembered that he himself grew up in a few different places, being sent around to various family members, because his mother died when he was an infant. 


And now here he is with us, in an institution.  


And it made me think about objects. And about having a place to be. And I wondered (out loud to him) if maybe it was important to him that he have a specific place to be. And what his thoughts are about being in the "right" place or the "wrong" place. And which one he feels the institution might be.


RD's response was to increase his singing. He and I sang back and forth for ten more minutes than usual today (we usually make it for 20 minutes, but today it was 30!) before he hopped up and began pulling the guitar off of me to indicate that we were finished.


So, I'm thinking this is veeeery cool. 


Definitely warrants some more thinking...