Friday, March 28, 2008

Therapy and me

I love being a therapist. I enjoy the act of making music with my clients. I like the challenge of finding the music that will best fit a client and a situation and making that music assist the client in completing a specific goal and objective. I like the flexibility within structure that is required when working with human beings, each with a different perspective on the world. The combination of successes and failures are what keeps me interested in the field after 16 years of clinical practice.

I am somewhat of an anacronism at my school. I am a Ph.D. student with no aspirations for a University appointment. I have tried to be interested in the University system, but I still feel really linked to the client-therapist relationship rather than the student-teacher relationship. Because of this link to the clinic, I want to do what I am doing right now - clinical music therapist as well as internship director and small business owner (the business part is developing slowly!). Most of the folks I know wonder why I am bothering with a Ph.D. I sometimes wonder as well, but will continue along that path. I think the field of music therapy needs more Ph.D.-clinicians to assist in public awareness, mentoring, and practical research.

These feelings have come about because I have increased the amount of therapy that I am doing in the clinic at work right now. This increase is due to a recent intern graduation, so I get to reestablish therapeutic relationships with my students. My co-workers are concerned about how much therapy I have to do now that I only have one intern - I laugh in their faces and remind them that it is more unusual to have an intern than not. I miss the act of therapy when I am relegated to the position of observer. (Another indication to me that "Professor" is not one of my future titles!) I enjoy being the one of the only staff members that my clients associate with positive experiences and the opportunity to play. I like the uncertainty that arises when a client comes to music therapy and I have to shape their suggestions and ideas into a session that allows them to work on their goals. It is a challenge that I relish and want to continue.

Monday, March 24, 2008

The Things I Dream About...

This morning, I woke up with my thoughts on a discussion that has been going around the music therapy listserv regarding observers in music therapy sessions. I have not posted any of my opinions on the listserv primarily because I am not able to have a policy that excludes observers - my clinic is always open to all folks who enter, as is every other classroom and therapeutic treatment room in the facility. This is for the protection of the clients as well as the staff members. I admit to getting frustrated when 20 people enter my music therapy room, but I ensure that they participate in the therapeutic process rather than just staring at my clients and myself.

I have a strict "NO NOTES" rule in the therapy room. Everyone who comes in is expected to be a part of the group and the activity that is occurring st that time. This has been the hardest rule for others to accept. When I explain the therapeutic process, the relationships involved, and the need for participation, most observers go right along with my policies. If they do not, we ignore their presence, but do not stop clients from interacting with them. I figure, if they are not willing to accept my needs in the therapy arena, I am not responsible for "rescuing" them from the awkward questions that my clients will and do ask.

The other staff at my facility know that I am generally fine with observers, but they have learned to knock and look for permission before barging into the therapy room. This has been an uphill battle with some social workers, but I model the behavior that I want from them for them when I go to their rooms. My clients are learning this prerequisite well - it is amazing that the direct staff members have the greatest difficulty with common courtesy and actually attempt to make clients enter the room before I have prepared for them.

I like having observers in my room. I am not a psychodynamic therapist, so my goals are not generally concerned with disclosure or confidential topics. I am generally concerned with more concrete goals and objectives due to my clients. Group treatment is designed to increase socialization and impulse control with my clientele - adding new group members actually assists me in assessing growth in these areas. I am more reluctant to share my individual sessions with others since that is the time when a client directs the session, and I shape the session to accommodate the goals and objectives of each client. These sessions are the ones where I tend to be more probing, in addition to working on impulse control and socialization.

I was a student who entered school with the desire to be a music therapist without any actual opportunity to observe one. Apparently, my parents knew a music therapist, but did not realize that I wanted to be one as well. They tell me they would have ensured that I had observed him, had they known! I know of several non-music therapy students who have continued as music therapists because they had the opportunity to come and observe. I feel this is a crucial part of the professional development of our field. I know that many of the students that started the music therapy courses with me dropped out once they saw what a music therapist had to do in sessions. I am glad and proud of being an example of professional behavior in my area.

The other things that I dreamt about last night were getting abandoned at a rest stop, a friend (fortunately, not someone that I actually know) getting sick, and the cat - any interpretations?!?!?!?

Thursday, March 20, 2008

Refreshing Myself...

Today is the fourth day of Spring Break. I enjoy a teaching schedule and all of the breaks - one of the advantages to working in a year-round public/private school, I guess. I receive enough time off during the year that I can get away from the demands of being a therapist and get amped up for new therapeutic interventions. I tend to use this time away from work putting high expectations on myself that I do not accomplish. Rather, I tend to sleep, read, and catch up on all of the things that I do not feel that I have time to do during the year. This is one of those times.

As I am starting to prepare for our regional conference, I am thinking alot about what therapy is and what I do as a therapist. These thoughts have led to some introspection about the therapeutic relationship and use of self within therapy. I do not pretend to be a psychoanalytical therapist - my training is firmly on the behavioral side of things - so cannot necessarily base my rambling thoughts in theory, but I do feel that the way you use yourself in therapy is an important part of how your clients respond to the music that is made during sessions.

I stress to my interns and practicum students that a therapeutic relationship is the second most important element of a music therapy relationship. (The first, of course, is the relationship that the client has to the music being produced in the session.) I firmly believe this as a therapeutic fact. I first interact with new clients musically, getting myself to play a secondary role to the client's interests. Once I can see what types of music clients prefer or are interested in learning, I start to build the relationship by facilitating the client's interest. I seek to understand the client musically before anything else. Once there is a relationship between the client and the music, I can start to act in a therapeutic manner with the music and then build my relationship with the client. I already have a strong relationship with music. This triad allows me to shape the music to the expectations and needs of the client.

This entry is really starting to veer away from the title...let's see if I can get it back on track.

My purpose in rambling on about the therapeutic relationship and use of self within the relationship is to emphasize the importance of "downtime" for every therapist. Vacations, time-off, sick days are all important to maintain the well-being of the therapist. I enjoy the structured time away from therapy that I receive as a school therapist. It provides me with specific times to plan activities other than work. I always end up with new ideas on how to reach clients or how to solve problems. I allow my time off to become time to ramp up my creativity, revamp old songs, and refresh my memory about why I do what I do. This is a necessary period of time for my own health as a therapist.

Did that get back on track? Seems to. Off to a doctor's exam - one of those things that I can only do during a break.

Wednesday, March 05, 2008

Taking Care of Yourself...

I am home today after not sleeping all night. Around midnight, while my mind was racing and my legs were aching, and I was getting increasingly frustrated with my sleep-less situation, I took a shower in an attempt to get sleepy. Did not work. Neither did the breathing medicine or the sleep tapes. This is a situation I only find myself in once or twice a year - I am very lucky that this does not happen often. However, I did not sleep until after I called in to work and left messages for my interns and for my principal. After I arranged the sick day, I of course managed to get about 3 hours of sleep.

I realize that insomnia is a wimpy excuse for a sick day, but for me, it is an important signal that I am not taking care of myself. I tend to be a Type-A personality, busy all the time and constantly feeling that I should be doing more with my life. This leads to overloads and stressful moments. Occasionally, it all comes crashing down on me. This appears to be one of those times.

I don't feel particularly stressed, but my body apparently is aware of some stressors that I am ignoring or unaware of at this time. Interesting, isn't it. With a good night's sleep, I will be refreshed and ready to be a therapist again.

I look forward to returning to work tomorrow. In the meantime, I'm going to nap, work on visual aids for sessions, and relax.

Sunday, March 02, 2008

I have recently been the recipient of iTunes gift cards. I love these cards as they give me the freedom to download legal music that I want to purchase while I am sitting in my home with the cat. The problem that I have is choosing what to purchase.

You wouldn't think that would be such a problem, would you? Well, it is for me. So, the cards sit, fully loaded, on my desk, waiting to be of use.