Music therapy at the boundaries

It happens I'm a part of a group on LinkdIn for psychologists, counselors and coaches. Not that I'm a psychologist, counselor or a coach, mind you... 


But anyway.


We've been enjoying (okay, I've certainly been enjoying) a robust discussion with regard to the question of "how much of our personal selves do we share with our clients?"


To the best of my recollection (which is a bit, er, well, let's just say it's not what it used to be), Rachelle Norman has tackled this question (a couple of times, actually) in her blog, Soundscape Music Therapy. A while ago she wondered how much should she share regarding the birth of her baby (who is awfully darned cute, if you must know), and, in a more recent post, she talked about The Top 10 Rules to Break. A big hooray to you, Rachelle, for addressing this complex and apparently rather heated issue!

So, back to the conversation going on at LinkdIn...


I've been sort of surprised at how many counselors and therapists seem to believe, rather ardently, that the "rule" regarding the "therapist as blank slate" is too stringent. A large majority advocate sharing more of themselves as a way of "being authentic" with their patients. If I'm understanding them correctly, they seem to feel, "that's what our clients are really looking for- for someone to be authentic with them."

Interesting.

Among the questions that came up for me in reading comments along these lines was: are we really being inauthentic with our clients if we don't share on a personal level with them? And does being authentic with someone always mean being transparent? 

When I looked up the word, I learned that being "authentic" is associated with being genuine, or being truthful. Which is not the same as being self-revealing. Hm.

For me, I think the question of what and how much to share of ourselves boils down (as most things in the therapy situation seem to do) to another central question: whose need am I meeting in this situation?

As many music therapists are aware, simply because of the nature of our profession, we actually share quite a bit of ourselves through the music-making we do with our clients during sessions. Just as we learn about our clients through their musical expression, they learn an awful lot about us when we interact with each other musically.

Obviously, we do our best to keep to professional boundaries- for many legitimate reasons. One very large reason is the power inequity. It is (usually) a paid relationship. Therapy isn't meant to be a friendship, and, whether or not we choose a fairly egalitarian approach to our work as music therapists, we can't control (or ignore) our clients' perceptions that we have a certain amount of power, authority and influence in their lives. 

As an example, in my particular line of work (with people who have intellectual and developmental disabilities), I often remind myself of the fact that I have keys to my clients' homes, and they don't.

I wonder if, in the end, it's about coming to terms with the duality (maybe it's a plurality?) we are asked to hold as music therapists (or any kind of psychotherapist, I imagine). Yes, our clients often do come to us in pain and in a tremendous state of need- for, among other things,  friendship and for people to be 'real' with them. Simultaneous to that, we are bound to uphold our code of ethics, to maintain an awareness of our own unmet needs (and our rather human tendency to want to take care of those needs in all of our relationships- including those with our clients), and an awareness of the power dynamic that exists in the therapy space.

It certainly isn't easy to keep track of these various elements. Of course, as my supervisor often reminds me, "that's why they call it work."


What are your thoughts on boundaries and being authentic with clients? Does it depend on the situation? Or on the particular group of people receiving services? Are you likely to have more "flexible" boundaries with certain groups of clients and not as much with others? And what does that fact say in terms of the ideas and beliefs we hold about the particular groups of people we serve? 

Beautiful and thought-provoking quote

From the transcript of the January 15th, 2012 On Being episode in which Krista Tippett interviewed singer/songwriter/author Roseanne Cash.

Ms. Cash: Sure. You know when I first became a performer, I was so anxious about it and it took me a long time to grow into it, because I thought that being a performer was about getting a lot of attention and I didn't want that much attention. I liked the writer's life. I liked the privacy and the solitude and being inside my own little mind cave. And over time I realized that it's not about the attention, it's about the energy exchange. I'm doing something for them, but they're doing something for me too, you know? And there's no hierarchy really. It's — and some nights that exchange is so beautiful, you know, I can feel my own energy stretching out to the far reaches of the room and theirs coming back. And there's something sublime about it, and also the temporal nature of it that at the end of the night it's over.

Ms. Tippett: Right.

Ms. Cash: It's like a monk's sand painting, it's wiped clean. And so you can't grab it, you know, which is part of the — the mystical beauty of it. You can't repeat it. You know, the next night might be just awful, like, your energy might not expand beyond two feet beyond you and they are not giving you anything and it doesn't work, but you know, that's the way life is.

Ms. Tippett: Yeah, it's that spiritual discipline of knowing impermanence.

Ms. Cash: Knowing impermanence and showing up even though you don't know what's going to happen.

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I love that! 

"...showing up even though you don't know what's going to happen." 

Isn't that gorgeous?

Aside from the fact that it was just...overall, a beautiful conversation about creativity and music and spirituality and how it all melds together, this particular snippet just captured my attention instantly. 


Here's what I loved about it:


First, it is so absolutely descriptive of my daily experience as a more or less psychodynamically-oriented, relationally-focused music therapist. I am not (really, I am NOT), by nature, what one would call a "flexible" human being. However, many years of practicing music therapy using this approach (and taking part in my own therapy, of course) has gotten me to a point where "showing up even though you don't know what's going to happen" has become okay. It's a concept I've grown into and have come to embrace with a comfortableness I would never have imagined for myself. 


Second, I was drawn in by Roseanne Cash's sharing of her struggle, as a musician and as a writer (basically, as an artist), to come to terms with her art- playing, performing, being musically present, which artistic voice to choose, and what all of that means to her. 


Periodically, people will ask me, "Does one have to be a good musician to be a music therapist?" And, until very recently, I've always responded with what my clinical supervisor has said to me, which is: "Well, the more accomplished you are as a musician, the more you have to offer your clients." And that still makes sense to me. 


But, in a recent email conversation with my colleague, Brian Abrams (who just had a terrific article published in the Arts in Psychotherapy journal), I realized that not only do we, as music therapists, benefit greatly from this type of engagement with our experience as artists and musical beings, but, on some level, maybe because of our chosen professions, we actually need to go through that kind of a struggle. 


Put another way, I think a willingness to come to terms with our own sense of what it means to be a musical self and building an identity as musicians and artists enables us to be present to our clients in a more profound, authentic, and meaningful way. 


You might even say it prepares us to  "...show up even though [we] don't know what's going to happen."

Music Therapy Advocacy Month- Our Most Powerful Advocates

Advocacy --> Recognition --> Access

Since 2005, the American Music Therapy Association and the Certification Board for Music Therapists have collaborated on a State Recognition Operational Plan. The primary purpose of this Plan is to get music therapy and our MT-BC credential recognized by individual states so that citizens can more easily access our services. The AMTA Government Relations staff and CBMT Regulatory Affairs staff provide guidance and technical support to state task forces throughout the country as they work towards state recognition. To date, their work has resulted in thirty-five active state task forces, two licensure bills passed in 2011, and an estimated ten bills being filed in 2012 that seek to create either a music therapy registry or license for music therapy. This month, our focus is on YOU and on getting you excited about advocacy.

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A story Paul Nolan (my teacher when I was in graduate school at Drexel University) loves to share is about how he used to constantly drill us in class to answer the question he insisted our clients would inevitably ask us: What am I going to get out of this? How is music therapy going to help me?

I, who had already been a music therapist for thirteen years with people who didn’t use speech to communicate, was convinced this was never going to happen.

Ahem.

Well, I was doing my internship at Hahnemann Hospital when I was referred by one of the psychiatrists to work with a man who was struggling with depression related to the spread of his cancer. Would you believe, the first words out of his mouth after my brief introduction and explanation of who I was and what I was there to do, were: What am I going to get out of this? How is music therapy going to help me?

Seriously!

I think I probably scared him a bit when I laughed out loud, and I asked him if my teacher had put him up to this.  And then, after explaining Paul’s perpetual insistence on our being able to answer this question, I answered him.

He agreed to let me sit with him and play music. But he was absolutely clear in his refusal to take part in any way other than to suggest a few songs and to listen. So that’s what we did.

We had a couple of sessions, and he’d gone home and that was the last I’d heard.

A few weeks later, I happened to be walking to the nurse’s station in the different unit of the hospital, and, as I walked by one of the rooms, I heard someone call out: Hey! Music Lady! Would you mind coming in? I have something to show you.

As it turned out, he was back in the hospital- sicker this time. And, although his participation during sessions had been rather minimal, he had remembered his experience in music therapy when he went home. He said he’d told his family all about it. And when he had to be re-admitted he had decided to bring along some of his own music (that he wanted to tell me about), and he also brought a record album (yes, a vinyl record album) of a band made up of a bunch of guys he knew back in the late 1970s. During one of his previous music therapy sessions he mentioned that he had taken a photograph of them, and they liked it so much they made it their album cover. And he had been hoping I’d come by, so he could show this to me.

Now, many years later, as I’m sitting here contemplating this idea of advocacy, I’m realizing that one of the ways we start to know how important music therapy is to our clients is when they begin to become their own advocates- when they want more music therapy, and they do what it takes to get services.

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A question that often comes up when I tell people I’m a music therapist and I work with folks who have a variety of intellectual and developmental disabilities (just after the usual “How interesting! What is music therapy?” question) is: How do you know it’s making a difference? If your clients are severely disabled and can’t tell you, how can you know whether or not your clients are benefiting from music therapy?

And I tell them sometimes it takes the form of my realizing that, after years of my client sitting and waiting for me to invite him or her to music therapy, he is now standing up when I come in the room to greet me and pull me to the door so we can go to his session. 

Or it's deciding that snack time (which can be considered one of the holiest times of day for some of my clients) is less important than going to music therapy and rushing through snacks so we can get to a session. 

At other times, it’s someone picking up an instrument for the first time to play it and not throwing it across the room.

I always think it’s cool when my clients (again, this is after many years of waiting for me to approach them and ask if they want to come to music therapy), see me go into the room where we have our group session, get up on their own and start to come in while I’m preparing the space.


An even more important way that I know what we're doing matters and is "working" is when my clients tell me (usually through their actions) "no" they'd rather not have music therapy on a given day. Because, ultimately, isn't being one's own advocate what we're working to support?

So, in this month of music therapy advocacy, I want to propose the following:

There is no more powerful music therapy advocate than a person who has been receiving our services and has gotten to a point where s/he wants to make sure those services continue.

And what a wonderful testament to the importance of the work we do when our clients can become their own advocates!

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For lots more blog posts about music therapy advocacy, 

please visit:

http://www.musictherapymaven.com/social-media-advocacy-month/