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.

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

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

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

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

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

What I suggested was the usual:

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

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

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

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

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

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

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

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

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

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

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

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

And our presence matters to them. Somehow.

And so it goes.

Supervision: Part II: Peer Supervision

(This is the second part of the article I wrote for NJAMT News on professional clinical supervision for music therapists. The first part is here.)

Supervision: Part II: Peer Supervision

Roia Rafieyan, MA, MT-BC

The previous article looked at professional clinical supervision, addressing common misunderstandings about the role of the supervisor and describing what one might expect when one seeks the services of a clinical supervisor.

Another avenue for growth as a professional music therapist is peer supervision. This article will discuss the benefits of this way of learning and offer the author's experiences with her peer supervision group as one example.

What is peer supervision? How is it similar to/different from supervision with a clinical supervisor?

In contrast to professional clinical supervision, where a therapist with more experience acts as a mentor to another music therapist or a group of music therapists generally for a fee, peer supervision refers to both formal as well as informal connections between therapists who draw on each other's strengths and abilities as a means of developing their competence and effectiveness as music therapists.

Peer consultation/supervision can be as simple as posting a request for information on a music therapy email list or having a conversation with a trusted fellow clinician about a particularly difficult case. Some music therapists choose a more formal option. This involves working with a consistent group of people setting aside a specific time and place, agreeing on areas of focus and having a mutual commitment to ongoing professional growth. This piece will focus on my experience as a participant in a formal peer supervision group.

Where does it happen?

Our group chose to alternate meeting at the work sites of two of our members. Having enough physical space and access to a variety of instruments was important to us because we all felt a strong desire to use music-making as a part of our process. Just as significant was the need to find a central location since the group was spread out over a large geographic area.

How often? How long?

While meeting once a week or twice a month would be ideal, peer supervision groups can meet as often as is practical. The best our group was able to accomplish was to meet once a month. Meeting for about an hour and a half seemed to be a reasonable timeframe for our group which ranged in size from three to five people. This allowed each person to present case material and look at issues and gave us an opportunity to use the music to explore various aspects of our selves which affected the way we work with our clients.

What happens in a peer supervision group?

The group will develop its own rhythm. Ours gathered, checked in with each member, trying to find a common theme and come to a group consensus regarding the issues we wanted to focus on for that particular meeting. If no theme emerged, we did some musical exploring and improvising, starting with where we were and how we were feeling about our work. The music helped to initiate discussions through the act of listening to each other, analyzing our own musical experiences and observing the group process. Sometimes this would lead to more music-making with a more specific focus.

Different groups, because they are made up of different music therapists, will choose different approaches. While it could be a simple as a sharing of ideas and resources for music therapy experiences, it can also be a deep as supporting members to cope with profound feelings of helplessness or secondary traumatic stress and burnout.

How does this process help us increase our effectiveness as music therapists?

Music therapists have a unique opportunity to develop the skill of self-observation and to experience first-hand the dynamics and processes involved in group work when they engage musically and verbally in a self-examining peer supervision group with other music therapists.

By exploring our own feelings about and reactions to the work we do with our clients and our work situation(s) using music, we learn how to better engage our clients in a similar process. This enables us to become more effective in our work.

Helpful tips (based on our group's experience):

§ Let one or two people take responsibility for initiating, organizing and maintaining the group.

§ Meet in music therapy rooms in group members' workplaces (with permission) because it gives access to a variety of instruments (melodic and non-melodic) as well as freedom from distractions. It also provides the space needed to work.

§ Establish a date for the next supervision group before the end of each meeting (or set out a long-term schedule). This helps to create a commitment to the group and to the process. It is also helpful to send out email reminders.

§ Do not allow the group time to become a gripe session about how awful workplaces can be. Use music to explore and identify areas in which your own resistance may make it difficult to understand and support your clients.

§ Look for common themes in the stories that you share, or begin by improvising music based on what is currently being experienced by group members.

§ Watch out for the tendency to avoid using the music and to steer clear of difficult topics.

In summary a peer supervision group is one in which a group of professional music therapists come together on a consistent basis, and they use the skills they have to help each other grow as music therapists. By engaging in this process they are able to learn to be self-examining and may then, by extension, be able to take their work with clients to a deeper level.

Resources

Music Therapy Supervision (2001, Barcelona Publishers; M. Forinash, Editor) has three chapters describing peer supervision as well as experiential music therapy groups.

Chapter 12: Peer Supervision in the Development of the New Music and Expressive Therapist (E. Baratta, M. Bertolami, A. Hubbard, M. MacDonald, and D. Spragg) Chapter 14: Experiential Music Therapy Group as a Method of Professional Supervision (G. Langdon)

Chapter 15: Peer Supervision in Music Therapy (D. Austin and J. Dvorkin).

Additionally, of course, there are the many remaining chapters which focus on supervision of students during practicum experiences and internships, professional supervision, and institute training/supervision.

The Dynamics of Music Psychotherapy (1998, Barcelona Publishers; K. Bruscia, Editor) is a helpful read. While the chapters don’t specifically address clinical or peer supervision, there is a clear focus on the dynamic processes of therapy, and there are a number of chapters which focus on uncovering unconscious countertransference reactions to clients and working with elements of resistance within the therapist.

Online resources

“Models of Clinical Supervision” by George R. Leddick: http://www.ericdigests.org/1995-1/models.htm

“Peer Consultation as a Form of Supervision” by James N. Benshoff: http://www.cyc-net.org/cyc-online/cycol-0801-supervision.html

“Peer Group Supervision”- presents a model of peer supervision for those in the business world as well as in social services. It lists six phases of peer group supervision. Some of the ideas may be useful in getting your own peer supervision group started: http://www.peer-supervision.com/index.html

Specific to a particular approach to psychotherapy, but it could be very useful: http://www.contextualpsychology.org/running_a_peer_supervision_group