Online Conference for Music Therapy 2012 Resources- Part 2

Recognizing and Responding Musically to the Emotional Pain of 

People Who Don't Use Speech

As many of you already know, working at becoming a better listener, a more mindful clinician, and a curious practitioner is one of my passions. And this struggle to make sense of my experiences as a music therapist is something I try to share in my writing. 

To that end, I offer you links to a number of blog posts I've written over the past five years that are (mostly) directly related to the ideas I shared in my presentation for the 2012 Online Conference for Music Therapy. 

Some folks asked about working with groups, and I made note of posts addressing that subject. I also included a post about writing a process paper, which I still think is one of the best ways to start thinking about your sessions ( or should I say re-thinking your sessions?). 

I hope you find them to be useful.

Roia Rafieyan, MA, MT-BC

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

9/9/09 blog post

Paying Attention in Music Therapy Series- Part 1: How to Process a Music Therapy Session

11/26/08 blog post (Writing a process paper)

Sick and tired

5/1/09 blog post (Group music therapy countertransference example)

Listening

4/7/09 blog post

Who knows?

2/6/10 blog post (on not being understood)

Quote: Developing a relationship through music with someone who doesn’t use speech

1/26/10 blog post (quote from Mercedes Pavlicevic’s book “Music Therapy: Intimate Notes”)

Violence in the lives of people with disabilities

10/25/09 blog post

Getting there is half the battle

9/29/07 blog post (addresses respecting “no")

People in pain

2/10/10 blog post

Music and countertransference

6/7/11 blog post (countertransference songs)

And how was your day, dear?

12/27/10 blog post (working with groups)

Back off lady! I’ve got this.

11/21/10 blog post (countertransference songs)

Reflecting on feelings of powerlessness (A video blog)

12/6/11 blog post (using music to process countertransference)

A musical portrait

11/29/11 blog post (using music to try and understand clients who don’t use speech)

Holding on to our clients’ stuff

6/24/11 blog post (communication)

The eyes have it

7/14/11 blog post (countertransference and communication)

Online Conference for Music Therapy 2012 Resources- Part 1

Recognizing and Responding to the Emotional Pain of People Who Don't Use Speech

Thanks so much to those of you who were able to join me at the 2012 Online Music Therapy Conference! And to those of you watching the recordings, a hearty welcome as well. For anyone else who may find this to be of use, feel free to make use of the information but please give me credit for having made the effort to put this together. Thanks! 

Roia Rafieyan, MA-MT-BC

Elements to Pay Attention to as You Work to Listen to People Who Don't Use Speech

Pay attention to what’s going on for your clients

The physical

·       Sensory/movement issues?

·       Medical issues?

·       Environmental issues?

The historical

·       What has gone on in this person’s life- including trauma history (biography)?

·       Patterns of behavior and contexts within which they occur?

·       Relationships with family, peers, staff (and any changes in these)?

The musical

·       How does the person use music?

·       Which instruments/sounds does s/he gravitate toward (vocal or instrumental)?

·       Meaningful music?

The right now experience

·       What’s going on in the relationship and how is my client responding to the experience?

·       How is the person using music/sound/behavior to connect/disconnect?

·       What questions are coming up for you as therapist?

Pay attention to what’s going on for you

The physical

·       What are my somatic reactions during the session?

·       Do I have a pattern of responding in a particular way?

·       How am I feeling physically on a given day?

The historical

·       Have I done my own therapy work (aware of my own issues)?

·       How much support do I need to do this work?

·       What beliefs and ideas do I carry with me?

The musical

·       Have I taken care of myself musically?

·       What are my musical blocks (fears) and needs?

·       What role does music play in my life?

The right now experience

·       What’s going on in the relationship and how am I responding to the experience?

·       What patterns are emerging (for my client and for me)?

·       What thoughts, fantasies, songs etcetera, are running through my head while we’re working together?

Pay attention to what’s going on in the music

The physical

·       What instruments are we using (vocal/instrumental? quality of sounds produced?)?

·       Are you/your client mainly using your voice or playing instruments?

·       Use of silence?

The historical

·       Which music has been important to this person and to you as therapist as you’ve worked together?

·       Do any particular songs trigger any particular reactions for your clients?

·       Musical themes which you/your client keep coming back to?

The musical

·       How musical are we being (aesthetics)?

·       Is the music being neglected entirely?

·       What role is the music taking on within the context of psychodynamics?

The right now experience

·       Why am I playing right now (what am I hoping to find out?  What am I looking for?)

·       What is going on in the music right now?

·       Who is playing/singing what right now?

Pay attention by:

• Reflecting and interpreting
• Learning more from reading, asking a lot of questions, taking classes, other disciplines
• Listening more (especially to people who have autism)
• Do your own work (get therapy, get supervision, join a peer supervision group)
• Be aware/mindful
• Ask yourself questions and be willing to find out the answers
• Consider “whose need am I meeting here?”
• Learn to tolerate ambivalence, ambiguity, not knowing, uncertainty

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?