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Monday matters: Consistency in practice

I have been receiving clinical supervision for one year now. Around this time last year, I was beginning this slow transition into working a process-oriented approach. My supervisor has let me repeat myself while I struggle through the same issues over and over again with different clients. What do I do with this person? Am I using the right language? Am I using too much language and not enough music? Am I using the right music? What am I doing? Am I doing what I’m doing the right way? and so forth.

I’ve learned I don’t have to do things. I have to observe, listen, and support. I don’t have to be right in terms of correctness, but I have to be genuine. I have to uphold my role in the therapeutic relationship.

My role is to practice being consistent. I need to be the most genuine version of myself every time I show up to see a client. This means, to me, that I acknowledge where I am in my emotional spectrum and use it to best observe, listen, and support my client where he or she is. To be consistent also means to enforce the same boundaries that I always have, especially when I’m working with my younger clients.

Recently I saw a client with whom I work very hard not to direct. This client uses minimal language, and I believe the client, as an adult, has lived her whole life in an environment that decides her behavior. I think she expects to be told. I try very hard not to tell. Slowly, each week in therapy, we’re getting to the point where I hope she expects to have autonomy with me, where she can guide the session. I usually have a sense of unease about these sessions, but I continue to show up and to try to be consistent. I imagine I’m getting the unease from her as much as I’m feeling it myself, but the hope and the goal here are to find a way to consistently let her lead.

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Preparedness

As a therapist, I feel stretched and challenged and delighted several times a day. Every day I approach sessions with questions, many of which can be really difficult, and leave me wondering how prepared I am. When I consider preparedness, I sometimes let myself think that I can never be fully prepared, that I am never going to facilitate and support as well as I should. Lately, I’ve repeated to myself, “Don’t let the perfect be the enemy of the good.”

At times I let my definition of perfection cripple me. I sabotage myself; I will never know my standard of perfection. I don’t have enough repertoire. I need to learn to play more instruments. I should study mental health more in depth. I need to read a certain number of journal articles each month. If I can’t accomplish all of these things, I shouldn’t bother with anything at all.

Being prepared means knowing, predicting the future, right? To be prepared means to assume that I have the answers before I know the questions.

I’ve been thinking about this post in the blog, “What a Shrink Thinks,” by Martha Crawford. I love the last lines, “No answers please. Deeper questions.”

Now, to work on defining “preparedness.”

 

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Not an expert

Two and a half weeks ago, when I started back to work full time, I was trying to be cognizant of all of the changes that being a new mom would bring. I have to say that I am frustrated with myself for not being expert at this new life yet.

I love working for myself. However, I have a long list of tasks to accomplish in any given day that weighs on me. I thought I was being clever in my scheduling, setting aside the morning hours to be with the baby, and then going off to work in the afternoon. I forgot, though, that I need a certain amount of time– so much time, really– to be uninterrupted while working at the computer or organizing or sending out invoices or doing any other administrative task. I forgot about the amount of work there is to do that isn’t done with the client.

I am surprised at how scattered and messy my days seem. And yet, my days come and go, just as they always have. As much as I’d like to fit every piece of the day into a special little compartment, I can’t. I have a new appreciation for flexibility, since the baby doesn’t care what my timeline is.

I have a new awareness of relationship, as I’m finding that therapy lies within the relationship. This is a concept I’ve been considering since I’ve been back to work, and one I hope to elaborate on in future posts here. I hope to do so soon!

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Monday matters: Accept!

I am back to work. I am done with my maternity leave. I saw one group of kids two times this month, but aside from them, I hadn’t seen any clients until today. I was beginning to get used to having time at home with my baby. Now I have to adjust to working with a baby at home.

My theme this week is to accept, already. I have to accept that this transition is difficult and that I won’t find a routine for weeks to come, probably. Clinically speaking, I think of how my clients feel about transitioning back to working with me. Many of my clients worked with another music therapist while I was with my newborn, and the rest decided to take a break from therapy for that time period. In a session today, I worked with two clients who don’t use speech often. I had to guess and assess how they felt about my being back with them. So many of my clients have decisions made for them. I hope they are able to accept this transition easily.

I leave with a shot of my baby, already moving, moving, moving.

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Monday matters: Finding space to listen

While I am working through this long transition into process-oriented music therapy, I’ve come up upon some obstacles and struggles along the way. Luckily, I have a clinical supervisor with whom I can voice my frustrations with the fact that I think I’m not doing it right at times. In the times I feel this, I can remind myself to come back to the client and come back to what is happening in our therapeutic relationship in that session and to come back to being truly client-centered by listening.

In the past two weeks I’ve had two sessions with one client that have been both difficult for me as a therapist as well as enlightening. This client and I have known each other for months now, but only very recently have I felt that progress is being made. My focus with this client is to provide ways in which she can communicate her needs to me through the use of music and musical instruments. This client does not use speech, but has solid receptive language skills. Oddly enough, these past two sessions have had a fair share of silence and space. I can sense resistance on my client’s part. I can sense that the client is contemplating how to respond to my questions of her. I can sense more now because I’m allowing for that time to elapse. I am hoping that I listening in a more effective manner. Perhaps this is why these sessions have been so challenging for us both.

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Working with change

This summer seems to be all about working up to slowing down. Because I am now seven months pregnant, I am focusing on scheduling clients and determining whether or not they’ll have a substitute music therapist in my absence. Some of my clients prefer to continue therapy with the substitute, and some do not. I leave this decision up to the parents and caregivers of my clients.

I am surprised that with my upcoming schedule change and lifestyle shift, I am nevertheless generating all kinds of ideas for the business and my work in music therapy. I wonder if this is because I am having trouble recognizing that I simply cannot, and should not, take on anything new at this point. I have a fear that my professional identity will be lost somehow. So, I was relieved that another music therapist in a similar situation addressed this “down time,” as she put it. You can find Michelle Erfurt’s posts about this subject here and here. I was happy to come across this relevant (to me, at least) writing.

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Monday matters: Termination and transition

I was under the impression that my summer scheduling would be much easier, but I am wrong. The logistics of configuring schedules is really difficult, especially when I’m also integrating maternity leave at the end of the summer.

Because of my pregnancy, I am shifting around a few roles I have as a music therapist, and transitioning a few clients and groups to other therapists. I haven’t had too many instances in which I’ve terminated therapeutic relationships. I told one of my groups today that I would be leaving and that another therapist would be taking over for me, and the reaction was surprising.

Clinical termination and transition

“I don’t like change. I like you,” was one of the comments today that came from a client in a group that I will be transitioning. I held her hand and agreed with her that change is difficult. I assured her I would see her one more time. I felt guilty. I didn’t anticipate the group’s reaction correctly. A few of them seemed genuinely disappointed. I’m not sure why I thought the transition would be simple, but apparently I thought it would be less emotional. This being one of the first groups that I’ve transitioned or terminated, I clearly have a lot to learn, considering there are so many people in the mix.

Professional termination and transition

I have also decided to step away from being a guest blogger on Child Development Club as I have too little energy to adequately contribute any kind of quality writing. 

I’m hoping that I will find space in the upcoming months to fill in more projects, but at this point, my biggest challenge in my professional life looks like it’s going to be dealing with termination and transition.

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Into the summer

I’ve been away over the Memorial Day weekend. I hope all has been well in your worlds.

I am scheduling for the summer. I have a somewhat looser schedule, starting in June, than I’ve had for a few months. Though I am preparing for my maternity leave in August, I am also taking on new clients and work projects now.

Please contact me if you are interested in knowing more about music therapy services.

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Process proves process

On Thursdays, I meet with my clinical supervisor via Skype. I always marvel at how much more clearly I can see my struggles while simply talking through them with my supervisor.

One of the bigger revelations I had during tonight’s session had to do with structure in the context of process-oriented work. I have had a lot of trouble articulating this challenge to myself, really, but I’ve known for weeks that this was a big question I needed to ask. Finding a structure in this new approach I’m adopting is daunting, and it is in and of itself a process. But, I have some clients who are children and some who have a history of trauma who quite simply need more structure than some of my other clients.

I don’t know where, but at one point I heard this story that relates to this question about structure. In the story, there are two playgrounds with children playing on them. One playground is surrounded by a fence. The children in this playground are playing all throughout the space, even all the way up to the fence. The other playground has no fence. The children in it are all huddled together in the middle of the playground, because, supposedly, they do not know where their boundaries lie, and they do not know how they can reach them.

I wonder how you build structure in your session. Of course I do maintain a structure, it’s just a little different than it has been in the past. Does the fence story resonate with you at all?