When we are injured by our clients

One of the scarier things about being a music therapist is that sometimes we get hurt on the job by our clients.

This is something I've been meaning to write about for some time now, but I've been procrastinating. I mention it now, because, recently Todd Henry, a man identified as a music therapist, was actually killed by one of his students.

It's a real issue when we provide services to people who are not always able to control their behavior. Or those who have gotten used to using violence as a means of communication. Or who have serious mental illnesses and aren't able to distinguish between what is reality and what is generated in the mind.

I've been hurt at times by my clients. I've been smacked, bitten, scratched, had my hair yanked, my fingers squashed, I've been head butted, grabbed, in a headlock, pushed, kicked, and pinched. Depending on the day, the situation, the context, and how violent the situation was, I've felt varying levels of distressed.

In general when I get hurt, my immediate reaction is that I feel uncomfortable, angry, frightened, ashamed, uncertain, violated, powerless, and with a general sense of not being sure how to proceed after it has happened (other than to say, "we need to stop the session for today.").

Because I work the way I do (using an object relations approach), I absolutely believe that the feelings I experience in reaction to getting hurt are more than likely the feelings my clients either are, or have, experienced in their lives (hello, projective identification).

As such, part of moving forward with my clients after violent behavior is addressing what happened in the following session(s), talking about how it impacted me and what I think my client may have been trying to communicate to me (i.e., that s/he was feeling powerless, ashamed, angry, frightened, etc.).

I work with people who live in an institution. By that very fact alone, they have experienced trauma. Never mind the many other forms of physical, sexual, emotional trauma they've likely endured over the years. When a person doesn't use speech, and doesn't feel as if s/he's being listened to, and s/he is fresh out of coping skills, violence is sometimes the result.

This issue isn't talked about much, if ever, when we're in school and learning to become music therapists. It's also not a topic that I see coming up in music therapy conferences either.

One of the reasons I don't usually bring it up is that it scares people. Another reason is that I don't like the idea that people see my clients' violent behavior as being a factor of their disability. I don't think most of my clients are violent (and not all of them are) because they have autism or some other intellectual or developmental disability. I believe it's usually a result of their life and not having learned better ways to cope with extremely challenging situations.

So I'm bringing it up today. And I'm wondering what your experiences (whether you're a music, creative arts, or other sort of therapist or supporter/caregiver) have been with this issue.

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.