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?" 

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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. 

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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.

"What's your story?" 2013 Social Media Advocacy Month

It's Social Media Advocacy Month again, and this year we're talking about connections and the stories we share about music therapy. Or, put another way, we might say we're looking at how our stories define us and then help us to connect with each other. 

Whether or not we're aware of it, we're always telling stories. Stories help us describe (among other things) what we do, who we are, what we believe, how we've come to be, who we've come to be. And stories connect (and sometimes disconnect) us to/from ourselves, to/from our history, our families, our friends, our clients, our communities, our cultures. 

For this moment, let's focus on the stories we tell ourselves. Let's consider the stories we choose and use to help us form a professional identity.

The way I understand it, our identity as music therapists is a compilation of the many stories we have about ourselves: as musicians, as people, as therapists, as family members, as community members, as service users, as learners.

In the process we consider our beliefs about music, about therapy, how we define music therapy, what we understand about health/illness, how music fits into health/illness, about our clients, our biases, what it means to help someone else, what is/isn't helpful, what is meaningful, what we embrace, what we avoid. 

And our stories evolve even further as we give thought to how we choose to present our professional selves/stories to our clients, to our places of employment, to supervisors, to potential users of our services, to curious people, to lawmakers, to our larger communities. 

All of these elements start with the stories we tell ourselves. 

To that end, I'd like to share a list of questions I put together a few years ago for a presentation I did for a self-care series at the Kardon Institute for the Arts.  My hope is the questions will help you become more aware of your own stories, how you decide which stories you'd like to share, how you choose to share them, and with whom. 

What does it mean to be a music therapist? 

• Who am I, or who do I think I need to be as a music therapist? How have I constructed my music therapy identity?
• Do I think there's a "right" way or a "wrong" way to tell my stories as a music therapist?
• What does it mean about me if I present myself in the "wrong" way?
• How much does my history/personality/temperament influence who I am as a music therapist?
• How comfortable am I when I feel I have to defend my role as a music therapist? In sessions? At work? In team meetings? What if someone doesn't like my story?
• How comfortable am I with regard to my skills as a musician, my skills as a therapist? And does that level of comfort (of lack thereof) have an impact on my identity as a music therapist? In what way(s), if at all, does this change my story?
• In what ways do my clients’ needs and expectations of me shape who I am as a music therapist? How do we weave our stories together?
• What do I believe makes someone a “good” music therapist? 
• How do my race, culture, gender, sexuality, abilities/disabilities inform who I am as a music therapist?
• How do my beliefs and/or prejudices with regard to race, culture, gender, sexuality, abilities/disabilities impact my work?
• How do I feel/respond when someone outside of my field defines my profession or makes assumptions about music therapy? What happens when someone else tells my story? What if our stories conflict?
• How has my identity as a music therapist changed and evolved as I’ve moved through my 20, 30s, 40s, 50s, etc.? What are the ways in which my story has changed as I've grown through significant life changes (marriage, birth, loss, death, serious illness, natural/human made disasters, etc.)? 
• If I am a music therapist practicing in a culture that is not my culture of origin, how has this affected my identity as a professional?
• How committed am I to a specific identity or role (or story) I play as a music therapist? Am I comfortable expanding my identity/role? Is it okay to change the story? Under what circumstances? 
• How much of and which aspects of our clients' stories are okay for me to hear? And which aspects frighten me or make me uncomfortable? 
• What roles do I unconsciously assign to my clients?
• How do my beliefs about what constitutes music therapy affect the stories I tell about being a music therapist?

 (Copyright 2010 Roia Rafieyan)

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Introduction: 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 over 35 active state task forces, 2 licensure bills passed in 2011, 1 licensure bill passed in 2012, and an estimated 7 bills being filed in 2013 that seek to create either title protection or a licensure for music therapy. This month, our focus is on YOU and on getting you excited about advocacy.

Wow! It was an honor just to be nominated!

A few weeks ago, a kind woman by the name of Rebecca from the Masters in Counseling website, sent me a note to tell me my blog had been nominated as one of 100 Best Resources for Counselors. Who knew?

And then, a short while later, she sent me a congratulatory note. How neat! And I'm in such fine company to boot. Thanks, Rebecca, and thanks to the kind folks who nominated me, and, mostly, thanks to you, you lovely readers you! I very much appreciate (and am humbled by) your willingness to slog through my commentary and carryings on about my music therapy experiences.

As it happens, a few other favorite bloggers are also on this list, so check them all out at some point.