Thoughtful Thursday: The Responsibilities of Being a Gate-Keeper

There is a power differential that happens in an internship program. This power differential is not unique to music therapy, in fact, this happens in every single profession. There are always power differentials. Someone always has more power than me. Even as a small business owner, there are people and entities out there that have more power than I do. Power differentials ALWAYS exist.

I am in a position of power as an internship director. I am acutely aware of this fact and strive to ensure that there is always this imbalance that occurs between myself and my interns. I do my best to make sure that I do not abuse this imbalance. I try to encourage my interns to understand that there are things that I will not do because they are my students and because I am required to be their supervisor. There are also things that I have to do, for the exact same reason.

I find it extremely funny when my interns ask me not to judge them. (It happens with each intern at least once.) That is literally the only reason that our relationship exists at the moment! It is my job to judge. As that is my primary role, I am a gatekeeper, standing in front of each intern and blocking their entry into the profession through my evaluation and response to what they do in my music therapy program.

This is a tough place to be. I, technically, have the power to recommend or not recommend that a music therapy intern move out of the educational part of their career into the profession. I have always felt a bit uncomfortable with that role, but I find that it is becoming more important as we are changing requirements and opportunities so rapidly.

A gatekeeper has to be mindful of the power differential and has to understand the inequities of being in charge. This is not a position to be taken lightly, and this fact has to inform all of the decisions made about assignments, about clinical duties, about supervision style and format. There are special ethical considerations that have to be acknowledged when you are moving into any supervisory relationship.

When I first started my internship (in the last century), my principal at the time wrote two versions of the letter of recommendation and support for me as a supervisor. One was submitted to the review committee, and the other one was preserved in my records. The purpose of the second was to be humorous, but it was also a great reminder of what a supervisor should NEVER do.  In the letter meant for me only, my supervisor basically outlined all sorts of unethical advantages that anyone in power could require from their supervisees. There were things like picking up dry cleaning, washing my car, cooking all my meals. It was signed by the Goddess of Light, and I read it every once in a while to remind me of what I can never do - I can never put an intern in a position where they are doing something that does not benefit their education and professional development.

This particular tenet - that of ensuring that all tasks have a direct link to the educational and professional development of my interns - has been my guiding light for the entire time I have trained interns. I have learned as I have supervised different people, and I have found my educational philosophy and preferred way of teaching. I believe in competency-based education and, as an extension, in competency-based clinical training.

What does this mean?

The basic idea of competency-based education is that students are aware of the desired outcomes of their education from the moment they start the process. The other requirement for a program to be a competency-based program is that students do not get letter grades. The emphasis is on education and training until a student is able to demonstrate the competency as defined at the start of their process.

The American Music Therapy Association has two sets of competencies - the Professional Competencies and the Advanced Competencies. You can find both of these on the AMTA website - I usually search "competencies" and they show up. Since my internship is the culmination of entry-level education in the US, I use the Professional Competencies for my evaluation of my interns.

Now, I am a fan of competency-based education, but I am wish that the AMTA Professional and Advanced Competencies were just...more. Our competencies are not always the most "easy to define" of competency systems I have experienced before. There is huge room for interpretation in most of the AMTA competencies. In addition, many of the competencies include more than one skill within the competence which can lead to some difficulties when attempting to use the document as an evaluation. So, I have spent the better part of two decades working on these problems.

When my interns enter my program, they get a copy of my competency-based internship evaluation. That is part of their first-day orientation paperwork. On that evaluation, I break down each of the AMTA Professional Competencies into specific areas - operational definitions (the specific, observable skills I believe are part of the competence); area where skill is demonstrated (assignments, clinical duties, meetings, etc.); and an evaluation portion where I judge where each intern is based on observation. I strive to make every task and assignment that I include as part of my program directly linked to these competencies. There is one assignment that is not part of the Professional Competencies, but it is part of AMTA requirements, and that is the site evaluation that all interns fill out at the conclusion of their National Roster Internship. Interns are evaluated on a three part structure - A-area of focus; E-emerging skill; and P-proficient at skill. This allows for the recognition that we are all on a continuum of professional development. It also identifies areas that need to be demonstrated and mastered before the intern will leave the program. Remember, competency-based clinical training is a pass/fail system. It is the job of the gatekeeper to set those expectations and remain firm with those expectations.

I think I will copy the AMTA Professional Competencies and the Advanced Competencies at work today. It is past time that I remind myself of what our professional organization thinks we do at our jobs. I look at the Professional Competencies quite often, but I do not often look at the Advanced Competencies - those are the ones that are most relevant to me as a "seasoned" professional. I might use them to do some operational definitions for myself and my professional development for this year. I might. I might not.

If you are interested in seeing my competency-based clinical training evaluation, let me know. I am always happy to share with other music therapists.