Tuesday, November 27, 2012

Slowing Down, and Not By Choice

Recently, I posted thoughts on mental health days. Today, I am on my second consecutive sick day away from my clients - right after Thanksgiving break - and am starting to have some cabin fever! (If you are unfamiliar with that phrase, it epitomizes the restlessness that you have when you must stay in one particular place - often used when settlers spent lots of time snowed in during long, cold winters.) So, today's post is regarding sick days - keeping our germs to ourselves!

We have a responsibility to our clients and to ourselves to be a bit selfish when it comes to germs. Some of my kids are medically fragile and do not need to have me sharing my coughs all over the music room. While I do not like being sick, I have come to the conclusion that it is better for me to take some time away from therapy than it is to push through the germs to offer inadequate experiences.

I still feel guilty about it though.

I have bronchitis. I am running a temperature, so have been told not to return to work until the fever has broken. I have taken my second dose of medication, so anticipate that I will be back in my music therapy room tomorrow. I will still be coughing, wheezing, and tired, but the fever should be done. We will spend some time engaged in quiet things, therapeutic experiences that will require little active singing on my part to decrease the coughing, wheezing, and exhaustion.

My body is telling me, the only way it can, that I need to take some time to sleep, force fluids, and keep coughing in isolation. If I do not listen to what my body is trying to tell me, it will just plain old shut down.

When I get back tomorrow, I will be greeted by kids who will have noticed my absence and who will interrogate me about where I have been the past two days. There will be some looks from my co-workers wondering if this was just a sneaky way to extend my holiday (oh, how I wish I had been able to return to work instead of having to be on the holiday at all!! It was not something that I wanted to extend AT ALL!). Then, they will hear my cough. They will scatter as far away from me as possible and allow me to hack and wheeze without further comment!

It is important for therapists to be aware of the situations that affect our therapeutic relationships. If I am sitting in a session, feeling poorly, interrupting every song by long coughing spells, I am not offering my client the best of my therapeutic self. I am not able to use music the way my client deserves from me. It is better to not offer the session than wasting the session by offering less than the best of me. When clients are paying for their sessions, I think they would much rather pay for quality rather than quantity.

So, I am going to get some breakfast and go back to bed with my cough and my tissues. I am going to listen to my body and slow down. I'll be back tomorrow ready to get back into the swing of things (I hope! I REALLY hope!!!) and to make good music with my clients. The germs will NOT win!

Friday, November 23, 2012

Rude Awakenings

I was part of a domestic disturbance yesterday morning. I did not start the disturbance, nor was I a big part of the situation, but I called the police and got things going. The girls next door started screaming. Apparently their mother was under the influence of something and attacked her boyfriend. When I saw them, he was trying to throw her out of the apartment, she was scratching him, and the girls were screaming! I called 9-1-1 and reported the disturbance.

In the end, the mother was taken away in the back of a cruiser. When the police arrived, she didn't show any emotional affect and simply asked for a chance to smoke a cigarette. The kids were picked up by their dad, and the police informed the man that the woman was not allowed back at the apartment without a police escort.


As I was sitting in my apartment somewhere between panic and hysteria, I started thinking about my clients.

I work with kids with psychiatric diagnoses in addition to developmental and intellectual diagnoses. The situation that I witnessed this morning was just a small taste of the lives that my clients have lived already. They often come to my facility with histories that include police involvement, assault and battery, post-traumatic stress, and experiences that no child should ever have to live through - EVER!

As a therapist, I have become more and more interested in Trauma-Sensitive Care. I cannot fully understand what is going on in the lives of my clients since I have not experienced the type of trauma that they have, but I am becoming more conscious of how I need to approach my students when they are in the grasp of their memories and experiences. I heard a good article on NPR about veterans with PTSD working with other veterans through meditation and relaxation scripts. The most important part for me was a statement by a Vietnam vet who was able to understand what a vet from Afghanistan was going through and who talked the vet in the middle of reliving his personal crisis back into his present situation. There was something so powerful about hearing their connection - similar events and experiences - that resonated with me on a very deep level.

There will always be a part of me that cannot connect with my clients. For this fact I am truly grateful and truly sorry at the same time.

On this day after Thanksgiving, I am truly thankful for being loved and part of a strong family. I am thankful that my situations have been free of trauma, and I mourn for the people in the world who have not been as free from pain, abuse, and trauma as I have been in my life.

This morning, I woke to bronchitis and quiet in the hallways. I am not sure what will happen from yesterday's events, but I hope that the kids will be safe with their father and the woman will get some treatment for her own issues. I anticipate that they will be leaving the complex soon...

Tuesday, November 20, 2012

Mental Health Days

We've discussed lots of things over the years, but one of the things that I feel is most important (and an issue often glossed over in education and clinical training) is the mental health of the therapist. Now, we talk about mental health in terms of transference and countertransferance, we talk about burn-out, and we talk about making sure that we keep our clients' goals in mind always, but we rarely talk about those times when we are not able to give the type of attention to our clients that they need and deserve. In those cases, it is time for the therapist to take a mental health day!

Now, I am a person with a strong work ethic for which I thank my parents every day. I enjoy most things about my job, and I love being a music therapist for and with my clients. I drag myself to work on days where the weather is nasty. I am constantly looking for new ideas and experiences to share with my kids, and I try very hard to make my work environment a pleasant place for all who enter.

I am human. There are times when I am happy, there are times when I am unhappy. These past few days have been some unhappy days for me. There is lots going on in my life that are not very positive, and I am having to deal with the ramifications of my life choices and an uncertain future. In this case, being at work, even with all the crap going on, has been helpful for my mental health. I was feeling pretty sorry for myself this weekend. There are times, though, when being at work is not healthy. At those times, I take a mental health day and simply stay home.

I allow myself to have mental health days when I need them. I think of them as just as important as sick days for when I am transmitting contagion. I attempt to use all of my days off sparingly, but there are times when I just have to be away in order to provide my clients with a safe situation - a distracted therapist may not be the best person to guide a client's therapeutic process.

My friend, Lillieth Grand, posted this comment on a post in the Music Therapists Unite! group offering the ethical and professional requirements for us to consider. Thanks, Lillie, for all of this!!

From the AMTA code of ethics: 1.5 The MT is aware of personal limitations, problems, and values that might interfere with his/her professional work and, at an early stage, will take whatever action is necessary (i.e., seeking professional help, limiting or discontinuing work with clients, etc.) to ensure that services to clients are not affected by these limitations and problems. From AMTA Professional Competencies: 22.8 Demonstrate critical self-awareness of strengths and weaknesses. and 14.1 Recognize the impact of one's own feelings, attitudes, and actions on the client and the therapy process. 14.2 Establish and maintain interpersonal relationships with clients that are conducive to therapy. 14.3 Use oneself effectively in the therapist role in both individual and group therapy, e.g. appropriate self-disclosure, authenticity, empathy, etc. toward affecting desired behavioral outcomes. So, the point is, take the day off if you need to!!!

I concur heartily!

There are some things that you need to be aware of that may be signals of bigger issues.

  • If you are consistently dreading a particular day or a particular session, there may be something wrong with the relationship between you and the people that you interact with during those times.
  • If you keep feeling the need for mental health days, it is probably time to change something - your job, your profession, your surroundings. It is fine to take the occasional mental health day, but multiple health days are signals that you need to change. 
  • Sometimes a lack of interest in what you need to do is not just a mental health issue. There are times when physical illness first manifests in feelings of malaise, depression, restlessness, difficulty concentrating, and other symptoms that we may initially identify as mental health rather than as physiological. Check out your physical being as well as your mental being.
As a therapist, I am constantly striving to be more self-aware, and my mental health is a large part of my self. When I wake up in the morning feeling like I absolutely CANNOT be a therapeutic guide during the day, I have to make a decision. Do I go to work? Do I stay home? Why do I feel this way? Is is a symptom of something else? Can I fix this alone? Do I need help from someone else? All of these questions are important to consider.

At this time, right now, at this very moment, my life and mental health are starting to be more positive in nature. I am now being more and more proactive about my own life situations - work and outside of work!

Just a couple of concluding thoughts.

  • Life is too short to be miserable in your job. If you don't like what you are doing, the unhappiness is just plain old NOT WORTH IT!
  • If you find yourself lost in your work, you have found your future (Got this from a Ziggy cartoon a very long time ago!)
  • Always have things around that require less from you as a therapist - I keep simple games, music-altered games (like Uno, Bingo, hangman, etc.), and file folder activities that my clients can complete on their own. I also have music videos that explain some form of goal. I have things that I can get started and then sit back and watch.
  • Acknowledge that you are human and accept that fact. We are not meant to be super-heroes when it comes to taking care of others.
Take care of yourself physically, emotionally, mentally, and spiritually! 

Saturday, November 17, 2012

Giving Thanks

It is that time of year, here in the United States, for all of us to stop and think about the things that are in our lives. For several years, I listed something that I was thankful for every day on Facebook, but since that is now the popular thing to do, I refuse to follow a trend! So, here are all of the things that I am thankful for in one fell swoop!!

I am thankful for this sweet face that yells at me, frisks around our home, sleeps on top of me, hogs the covers, bites me when I'm trying to play, and is obsessed with white plastic bags! There are lots of things that pets bring into our lives. Bella definitely enriches my life in many ways.

Her purr (especially the monster purr) makes my bad days a bit more bearable!
This is a mandala that I drew in 2011 for one of my family members. I don't know which one yet. I kind of matches my sister's decor, but it seems more like my mom's type of thing. Anyway, I am thankful for the creativity that my mother and father fostered in all of us. 

We have always been encouraged to think well away from the box, and all three of us are good at that skill. It is just one of the MANY things that I am thankful for about my family. I am also thankful that we are able to remain close, even when we are far away from one another in the geographical sense. I miss seeing them everyday, but am glad that we have Facebook and the telephone!

I am thankful for this tree.

Yep, this particular tree.

A couple of years ago, I saw this tree on my commute home. I really enjoy its bare bones and the way it stands there, in a solitary manner, day after day. It inspired several family tree projects.

A couple of weeks ago, my daily commute moved from the road pictured here to a new highway a bit removed from the road. I do not drive right past the tree, but I now have a new viewpoint of the tree. I have the opportunity to look at something that I love from a different point of view. I am rediscovering what I love about the tree each time I drive past.

I am thankful for my music therapy room. I am glad that I have a space dedicated to making music with my clients and interns.

Thank you, clients and former interns, for teaching me so much about music therapy. Without you, I would just be sitting in my house, making things up! With you, I get to see the joy of making music in your faces every day!
I am thankful for my family and friends - especially the friends who take the time to really get to know me and who love my quirks and foibles as just part of me. In the past year, I have received three of these WONDERFUL M&M dispensers!! Two have been Darth M's and the other was a baseball M (from my St. Louis Cardinals fan intern). I enjoy the absurdity of the M&Ms and am a die-hard Star Wars fan, so the combination of the two really makes for something that I enjoy.

Thank you, friends, for finding things that you know will make me happy, even when you don't understand or share my tastes!

I am thankful for Kansas skies. There is always something interesting to see in the sky. We have a small joke out here...

"You don't like Kansas weather? Just wait 10 minutes and it'll be different!" I love that this joke is pretty much true. The weather keeps me engaged in what is happening outside of my habitat. 

I am thankful for our community of music therapists. Even though we, at times, tend to squabble amongst ourselves about petty little things (and who doesn't??), there is no better group of people to advocate for each other. When you ask a question, people answer!

I found this button a bit ago. I have no idea where or when I obtained it, but I have really felt the power of the music therapy community this year. Thank you, therapists, for your support and interest! See you at a webinar??

I am thankful for music. I am thankful for the person who said, "Oh, there is another music program here, but the professor couldn't be here. She asked me to hand out these brochures. It's called Music Therapy." Without that person, I would not be doing a job that I love! I may never have heard about music therapy and would not have found a profession that challenges me, motivates me, makes me frustrated, makes me cry, and makes me laugh on a daily basis. Thank you, anonymous person from the University of Evansville, for giving me the gift of my calling and profession.

I am thankful. 


Tuesday, November 13, 2012

Thankful Things

Over the past two weeks, I have enjoyed working with my kids around giving thanks for what we have in our lives. I have started a piggyback song to the tune of Soon It's Gonna Rain (from the musical The Fantasticks, Music by Harvey Schmidt, and lyrics by Tom Jones) which allows my kids to fill in their own thankful things.

Here is my current version...

I am thankful for my patient family.
I am thankful for Bella-cat as well.
I am thankful for the end of each workday too.

I am thankful for each student in my class.
I am thankful for making music.
I am thankful for the time we spend together too.

My students have made some very interesting statements about what they give thanks for this season. One person stated, "Barbies." Another stated, "Shelter." Yet another said, "God." Their written products are more involved and more positive about their current situation. 

As you probably know, my students attend a school contained within a center for persons with developmental and intellectual disabilities. The children's program is approximately 50% day students and 50% residents in a psychiatric residential treatment facility. The residents live at the facility full-time, away from their families. This is especially upsetting for them around the holidays. We have been able to address some of these concerns in our song this week.

I am thankful for many things in my life. For those things that I am currently finding challenging, I simply remember my clients - the things that they have already survived and the situations that they experience every day. I am reminded that there are many good things that happen on a regular basis - you just have to look for them sometimes.

I am thankful for the opportunity to indulge in a stream of consciousness on this blog. Thanks for reading!

Sunday, November 11, 2012

Enough is Enough!!

Have you noticed a trend in my posts lately?? Here is a conscious effort to change all that!

Typically, my Novembers are fast - there is AMTA conference followed by two days of work and then the Thanksgiving holiday. I do not often have time to engage in Thankful themed TMEs with my clients. This year is very different.

With the AMTA conference already over, this year I have the entire month of November to work with my kids. We are starting to focus on being thankful for what we have - whatever that is.

Last Monday I placed the words, "Thankful Things" on my large bank of cabinets. I made two half sheets - one for narratives and one for drawing - and got out the markers and pencils. Kids came in, we did our opening TME, and I then asked them to write or draw about the things for which they were thankful. The response was wonderful!!

This week we will be singing or rapping about our thankful things.

I am enjoying the opportunity to spend some time thinking about being thankful. I am thankful for my clients - the people in my life who seem to value what I do with every interaction and encounter. I am thankful for my education and the people who have taught me everything I know. I am thankful for my friends. It is amazing who cares about me, and I enjoy being around each and every one of them. Their support and expressions of interest astound and amaze me! I am thankful for my family - for the four people who have shared many of my experiences with me and for the additional one who came into our lives ten years and 6 days ago.

My song this week will include many of these themes as I share my thanks with my clients this week. I know that many of their songs will also include similar things. We will have an opportunity to celebrate the good things that are in our lives.

Saturday, November 10, 2012

Going on a Squeegee Hunt

One of the songs that I sang over and over and over again as a song leader in Girl Scouts was "Going on a Squeegee Hunt." Now, you may be wondering what a "squeegee" is - good question! It is an imaginary creature that was probably invented by some obscure girl scout in Southern California many, MANY years ago!

Anyway, similar to the traditional children's song of "Going on a Lion/Bear/Tiger Hunt," the song takes you through a sequential process over, under, around, and through various obstacles towards a goal.

Today, as I am sitting here writing, I am thinking about the poor squeegee being hunted. It is just in its cave, trying to do its squeegee things without interruption, when suddenly, BOOM! Some Girl Scout arrives to poke it! The poor squeegee does what it can - it jumps up and chases the Girl Scout all the way home!!

This has not been a good work week. It is amazing how people will make mountains out of molehills. Here is the deal. I sent out an email to the global distribution list asking people to think about the detrimental effect of scents in the workplace. I have asthma and have had several attacks which coincide with the increase of use of Scentsy pots and aerosal air fresheners in the past two months in my work area. I requested that folks at work consider the people who react strongly to such scents when they start their scent stuff. It was received well by people who share my scent difficulties, and it was received negatively by the Director of Human Resources of the facility. She stated that I had no right to send out an email on the global distribution list without having that email checked by my supervisor first.

I am now the target of a hunt where I feel that people are making up things in a way to reprimand me for violating nonexistent policies. There are no policies that outline appropriate and inappropriate use of the email global distribution list. I was called into my principal's office at the end of the day and was handed a "Memo of Understanding." She stated it was not a written reprimand, but it was. She required my signature before she would talk about the scents present in the environment. I requested a copy of the policy that I had violated. She did not have it. I refused to sign, and she terminated the discussion without addressing the other issue. I went about my duties without saying anything else.

There will be times in your professional life where you will be the hunter and other times when you will be the huntee. I am currently feeling like the prey - hunted rather than being able to move freely. I feel confident that this fight will not be easy, but that I have specific rights as an employee that are being violated that are covered by personnel policies. The lesson here - KNOW YOUR FACILITY POLICIES AND PROCEDURES VERY WELL!

Read your policies and procedures. Review those policies on a regular basis. Use them to your advantage, and stick to the right path!

Thanks for letting me vent. Things will be better.


The Squeegee

Tuesday, November 06, 2012

Small Things Lead to Bigger Things

Today I am taking a brand new, 3-ring binder into work.

There. How is that for thrilling news?? I am going to use the 3-ring binder to organize my internship stuff. All the stuff that I give to interns will be freshly organized into a new folder. The old folder is worn out and cracking at the seams. It needs some updating, so out with the old, in with the new. Sometimes, it's the little stuff that really makes a difference in someone's life.

I have a young man who has finally started to realize the importance of communicating what he wants and needs. He has experienced the "A-ha" moment when he realizes that what he signs is meaningful to others. If he doesn't know the sign for harmonica, he is able to mimic what he needs to do in order to play the harmonica. COMMUNICATION! He is a signing sponge right now - pulling out pictures and looking to me to give him words (which I can do with my 20-year old ASL vocabulary and a signing dictionary!). He seems thrilled when learning the sign for "eagle." Little things that are really big things!

Small things always lead to bigger things. My new internship binder will probably make me feel that the rest of my desk is not up to the standard, so it will lead me to want more and more organization. My young man's dip into the pool of communication will probably lead to more and more signing, including making demands and refusing to do what I want to do during sessions. Instead of feeling upset about him exercising his right to be defiant, I hope I will celebrate it in the spirit of the growth that he has shown.

What small things are happening around you on a regular basis? Sometimes it is difficult to see the small things when we are overfocused on the large things going on around us all the time.

One day, I called my dad in excitement. "Dad, P didn't kick me today!!" My dad, the engineer/computer guy/plant manager that he is, asked, "MJ, why do you work in a place where kids kick you??" I answered, "Because, today he didn't kick me!" It was a small thing, but a large step for my relationship with P. Great things.

Look for the small things - the accomplishments, the new folders, and revel in them.

Monday, November 05, 2012

Those Challenging Groups

There are times when every group of people becomes a challenge for the person tasked to be the leader. In my opinion, the mark of a great leader is the ability to find a way to bring the group of distinct personalities into cohesion - by any means possible. You cannot just shrug your shoulders and state, "That's the way this group is always going to be."

I currently have one EXTREMELY challenging group (fortunately, the other 10 groups that I work with are currently pretty cohesive for the moment). Here is the situation:
  • Four students - three males, one femaie
  • Diagnoses - Pervasive Developmental Disabilities; Classic Autism; severe emotional disorders; severe behavioral disorders
  • Lots of staff support - this sounds good, but sometimes it's more of a hindrance than a help!
  • Group session - the attitude is that kids MUST have group treatment in order to give teachers planning time.
  • 50 minutes - always broken into short therapeutic music experiences (TMEs)
  • Group members accustomed to short, repetitive work tasks. Attempts to provide structured learning experiences including picture schedules, but not much recognition or independence with the schedules
  • Early afternoon session
  • Students transition from a different building to the music therapy room
So, lots of things happening.

Right now, I am trying something radical. We are going to incorporate movement throughout the session, staying on our feet until we are tired. We are going to make music throughout the session, but the movement will be the requirement for most TMEs until kids start to show that they are tiring. Then, we will sit down for our familiar TMEs that require more stationary involvement. I am going to function with simple tasks led by one staff member for each child.

We will see if this works - if not, then back to the drawing board, as we say... 

Sunday, November 04, 2012

The Importance of Music Theory

Many years ago, I sent out an informal survey to interns asking them to identify the advice they wish they had been told before they started their internship. Almost every single one (there were only 9, but still...) stated, "Don't sell your theory books back! You will need them!!" I laughed when I saw that comment on survey after survey!

It amazes me how many music therapy students do not realize why they have to take music theory as part of their music therapy education. Music theory is the foundation of all of the things I do in my sessions - ALL OF IT!

I spend most of the time that I am in music therapy sessions actively engaged in making music. Sometimes I engage in musicking with my clients, other times I am the only person making music. All of my songs, chants, raps, and improvisations are rooted in the things I learned in my two and a half years of theory as well as my additional theory study over the past 22 years. Playing by ear? Helps if you can narrow down the options based on typical chord progressions. Wanting something new? Try a different mode - place something in the Lydian mode instead of the Ionian. Rhythm experience? Heading to the basics of meter, subdivision, and tempo...

I write songs all the time - THEORY!

Without a sound base in music theory, we cannot make quality music with our clients. Know those chord progressions, know your secondary dominants in all major and minor keys, know how to transpose from one key to another without thinking about it.

This is all coming from the fact that I need to transpose a song for my accompanist for this morning. I am very glad that I am able to do this task without difficulty, as I had amazing theory teachers and professors!! Thank you for giving me the foundation that I needed to do my job each and every day!

For all of you music therapists out there, crack open your theory books every once in a while. If you sold it back to the bookstore, buy an advanced theory book and challenge yourself to write music that addresses each of the lessons in the book. Your musical offerings will be much richer for the practice, and you will feel a sense of accomplishment when you can improvise within the Aeolian mode! Enjoy!! 

Saturday, November 03, 2012

The Wee Small Hours of the Morning

This has been a strange week filled with anxiety dreams, headaches, and full-time therapy! I am really hoping that all of these things are not related since I love doing full-time therapy and, well, you know...

Anyway, I fall into bed exhausted every night and then dream all night long. 
This is not typical for me - I rarely remember my dreams. These dreams are directly tied into my work - I am dreaming about being switched from one place to another, about secret meetings, and about needing to be in 14 places at once to get the job finished. It interests me that none of my anxiety dreams have anything to do with my clients or music therapy, but that just indicates to me that music therapy sessions are the things that are right in my life right now.

Now, you may be wondering why I'm writing about this.

Me, too.

This is one of the phenomena that happens when I am not sleeping the way I want - seven straight hours and under lots of covers - I start to obsess about non-issues and they start to take over my consciousness. It is currently early morning, and I awoke at 3am for some reason. So, take your chances...

Here are the things that tend to take over my brain at 3am...
  • Thoughts about my education
  • Songs that flit through my head - wonderful compositions that are there for a second and then gone again, never to be heard or remembered EVER again!! (These are ALWAYS songs that I feel would be the magic song for a particular client. I try to make an effort to remember them, but never do! Probably in the light of day, these songs would not be the panacea that I believe them to be at 3am, but I will never know...) [Self-pity here - can you feel it??? Snark!]
  • Thoughts about finances
  • Wishing for more sleep - this is especially bad when the cat is sleeping peacefully...
  • Minor frustrations that appear to be more major in the still of the night
What does this have to do with music therapy? I think lots - because the health of the therapist has lots to do with the quality of the therapy. The concept of health includes being well-rested, being able to handle any and all situations placed in front of you, and being able to problem-solve. Rest has lots to do with this concept of health.

Tonight, most of the folks in the US will "fall-back" by changing our clocks. I am never sure why we do this as it does not make much sense to me, but I have to do it in order to be time compliant with the rest of the world. Most of us seem to think that this means that we get to sleep an extra hour. For me, it means that I'll be getting up at 2am instead of 3am. I think I'll put some staff paper on the desk, and just embrace the dreams as messages and try to capture the songs as they arrive in my brain...

Sweet dreams, everyone!