Take It Easy, Termination Won't Hurt a Bit

I am tired of my Thoughtful Thursday topic, so I am going to vacate it for a while. I haven't remembered to write on different quotations, so it should be easy to let this topic go the way of Sing A Song Sundays and Song Synthesis Sundays. I will be Thoughtful NO MORE!!

So, that leaves me with another dilemma - what should I write about right now? This dilemma always starts after the opening paragraphs. The questions start - "Is this interesting enough to me to continue writing?" "Does this have anything to do with Music, Therapy, or Me?" "Should I just skip today completely?" Then, I usually settle into a topic or an idea and start to write.

As I wrote a couple of weeks ago, I am in the termination process as a client (for, really, the first time in my life). I am down to the last session next week, and I am experiencing separation pangs and simultaneous excitement. I am both very proud of my progress and scared to death that I am going to do something to mess up the work I've put in the last 10 months. I am cycling between being ready to get my Monday and Wednesday afternoons back and wondering what I am going to do on those same afternoons. I am proud that I have improved so much in the past 5 months, but I am wanting more. I want to know what is going to happen after termination.

My therapist is following the pattern well. He has started to just check in with me during my workouts rather than hovering during every exercise. I've been overseen by interns, by athletic trainers, and by anyone passing by. He checks in with me at the beginning of the session and at the end of the session. He offers reminders of how far I've come. He's encouraging and answers my questions but keeps talking about the end of this routine. He is confident that I will be able to pass the skill tests I have to pass in order to get off of light duty. He also thinks that I will be using my brace at work until my annual post-surgery check up in December.

I have been going through the ACL replacement physical therapy protocol. There are benefits to protocols including that of having objectives to accomplish in order to determine completion of treatment. This is handy as I think I've made it to those objectives. (I am not privy to the particulars of the protocol, so I am not sure what those objectives actually are, but my PT is clear - I've reached them.)

I think that, in this way, PT is a bit easier than Music Therapy. It is rare that I treat a client who has a specific goal that can be accomplished through a set pattern of tasks and objectives. My goal for physical therapy? Return of physical function to my knee at the highest level possible for me. My goal in music therapy? It might be more complex.

When I start treatment with a client, I do an assessment. This gives me an idea of how to proceed with the client's treatment plan and possible goal areas. If a client is referred for a specific reason, it is easier to determine the treatment path. If a client just shows up in your clinic (like in my job situation), the treatment path has to be determined. There are so many things that music can help with that there are an unlimited number of pathways to termination.

I have always been a fan of the "fade to function" school of thought. There should always be a therapy ending point to therapeutic interaction. This ending point should also be known at the start of therapy to make the interaction time-framed. In my work situation, termination from services is not determined by me. It is often determined by outside agencies such as insurance companies. As a result, I often see progress but not completion of objectives. It is my job to help my clients find the tools and strategies that will get them to their objectives. I would love to be able to use an entire treatment plan for all of my clients, from assessment to goal completion to termination of services, but that process is often interrupted by people who are not immersed in therapeutic intervention.

As I am preparing to move from client to PT graduate, I am thinking about my interactions as a therapist with my clients. I do not have the luxury of tested protocols (and I really don't want any as I feel that music therapy should always be an individualized process) that outline specific completion benchmarks, but I can work on the establishment of tools and strategies with my clients. Knowing that their length of treatment is unknown, I will be changing how I approach individual music therapy treatment towards coping skill development and strategy building for each person who comes to my music therapy room.

This experience of being a therapy client has been extremely good for me as a therapist. I hope to keep the perspective that I have gained over the past 5 months to continue to inform my music therapy practice to help me be a better therapist in the future.

I'm not ready.

I'm ready.

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