Tag: supervision revelations

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Monday matters: Losing clients

I have been a recipient of clinical supervision for about two years now. Because I do not work with other music therapists, and because I was starting to burn out working the way I was working, I found a clinical supervisor with whom I have been speaking on a weekly basis. In many of my conversations with her, I ask her for advice, support, sometimes validation, a new direction to take, and often how the quality of the music being shared between my client and me is indicative of progress or resistance (which is not to say that resistance is not progress). Over the past year, I spent most of my time with my supervisor talking and sometimes playing through my work with a particular client. Finally, last week, this client really opened up and I felt an enormous shift in the session. I was both electrified (this is how therapy really feels) and terrified (repeat: this is how therapy really feels) by this change. I believed in our process at that point– that all of the work and supervision and consideration regarding this client mattered. We had moved into another level of work.

The next day, the client was pulled from music therapy because apparently this person’s other therapists reported progress, too, and inexplicably for that reason, music therapy was no longer needed.

I could not believe it. I still cannot.

Here are three steps I’m taking to deal with this blow:

  1. Talk with my supervisor.
  2. Write about it, create about it, play about it. Consider my feelings about this abrupt termination. Recognize that this was a therapeutic relationship in which I was a member, and that I can be upset by the fact that my opinion about this sudden termination didn’t change what happened.
  3. Find peace with it somehow. We’ll see how this turns out.

I wonder what steps I’m missing. This is the hardest termination I have experienced yet.

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Looking for a peer support group? If you’re in the Minneapolis or St. Paul area, and you are a board-certified music therapist, feel free to connect with me and I will let you know about our group.

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The triad

I have had a rough day. I realize we’re all supposed to cherish the holidays and love this time of year. Well, I guess I’m not working hard enough to feel the joy that I’m supposed to feel. (I am looking forward to Santa’s first visit to The Baby, though.)

Regardless of how I’m feeling, I have to dig out and find the space to work with clients as best I can.

I have a client who says “No.” “No” to almost everything I offer. This client is very clear about her disinterest in engaging with the music. What’s hardest for me is that I don’t blame her. When she says “No” to the music, I am left with this vacant feeling that I can only articulate as You’re right. Why use the music? And once I feel that, I am left with nothing, really, to provide her. Well, at least that’s how I feel in the moment. What I am providing her, on the base level, is our relationship.

My supervisor left me with a visual that will possibly possess me when I think about my work these next few days. She talked some about the triad of roles in the music therapy relationship. The triad consists of music, the therapist, and the client, and my job as the therapist in any given situation is to consider what purpose each role is playing in the session.

But what does that mean?! What does the triad tell me in regard to the existence of resistance in a therapeutic relationship? 

What does it tell you?

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Get out of the way

My internship supervisor told me once that I need to get out of my own way. I’ve been done with internship for a while now, but I continue to hear that piece of advice. I still have my struggles with music, yes, and there are years of learning left to be had in regard to counseling skills and therapeutic intervention. However I am happily coming to terms with my abilities and efforts to engage my clients every day.

Earlier this week, I met a new group of clients whose warm, renewing energy was infectious. Only one of the clients used words to speak, but everyone in the group knew how to communicate. One of my pet peeves is that people who don’t know much about music therapy like to say, “Oh, that sounds like so much fun” when they find out what I do. Usually I don’t think of what this kind of therapy is as fun, but during that session I knew how fun felt. (I was especially impressed that one of the clients reliably clapped on 2 and 4.) Those clients came together in the music in a way I imagine they don’t otherwise. Most of the clients acknowledged and related to other group members in singing and in dancing, and even in sharing instruments. This was the very first music therapy session that they’d had. I was so happy to be there with them. I even found myself improvising in a key I hate, using a strumming style I never do in front of other people. I completely got out of my own way. I was thrilled.

I wonder, have you ever held yourself back? What kind of work do you do to keep yourself from becoming your own barrier? Please leave your thoughts in the comments!

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This week in clarity

My focus this week, to some extent, was clarity. I had such a good string of sessions going mid-week. Even though my clients are very different from one another, I still felt like I had a better grasp on how to be supportive. Then Thursday came, and I felt like I lost all of that grip. Today wasn’t so great, either.

In supervision last week, we talked a little bit about how clients might appreciate imperfection on the therapist’s part. Well, my clients definitely got that the past couple of days. As much as I tried to calm down and listen, I found myself feeling frantic and nervous in a few sessions. I wonder how those particular clients were feeling.

Do you ever notice the same sorts of feelings with a client, week in a week out? How does that impact your treatment? Leave a comment below.

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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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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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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?

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In process

Over the past few months I have been shifting the way I think of music therapy and my philosophy of my practice from outcome-oriented to process-oriented. These months have brought such an interesting struggle. I am really fortunate to have found a clinical supervisor who is supporting me in this transition. This change has introduced a number of obstacles, none of which I would be able to navigate successfully without support. All sorts of questions have arisen for me as I’m working through the change, and I am led to believe that the questions aren’t ever going to come to an end. They just may be of a different nature. I think the questions are what is so appealing as well as what is so scary about process-oriented therapy.

This week I’ve come to decide that I need to find my connection in regard to the way I’m practicing, and to recognize that it is itself a process. I have experienced a share of challenges to this orientation, and though I believe in the validity of music therapy as a whole, I cannot switch off the way I provide the best care so that I may sidestep an obstacle. Sometimes connecting to a philosophy such as I am doing now is difficult. But, I already feel more genuine as a therapist, which will in turn benefit my clients.

Here’s hoping that the path keeps winding, but at least smoothes out a little! 

I wonder if anyone else has ever had a transition like this.

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In honor of National Autism Awareness Month: What music expresses

Several of the clients I see have autism. Some use speech to communicate, others do not. Some find the ability to express their needs through various gestures, some sign language, and other physical indications; others do not. Some of them have a combination of verbal and physical communication. Most of my clients with autism, however, find ways to express themselves within and through a musical medium.

By providing a client with a variety of instruments, both melodic and rhythmic, I find that I can notice a trend in the way he or she plays an instrument. Choosing melodic over rhythmic might give me some insight into a client’s emotional state; perhaps this client is feeling a need to explore different sounds within this timbre. Maybe he has more expressive tendencies at this time that only a melodic instrument can allow. If the client is playing in a very high register, I might believe that he is expressing happiness; in a low register, maybe the client feels sluggish or down. I may interpret the choice of a rhythmic instrument in a variety of other ways. When the client plays with staccato strikes, I might believe he is angry or frustrated. If the client’s tempo is quick, with light strikes, I may think he is feeling anxious or scared.

The information that is relayed through music will usually facilitate a better understanding on my part of a client’s emotional state. Musical conversations can at times ensue, but other times a client might need to simply vent to me. My job is to absorb all of this information and find the best way to validate and support this musical expression, and continue to do so throughout all of the transitions and various challenges my clients might face.

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A thought on Thursday

I had another enlightening supervision session tonight. Thursdays are my really busy days, and I’m always a messy pool of goo when I finally make it to 6:45 and talk with my supervisor, but regardless, I took away a great thought:

“The therapist’s job is to say the unsayable.”

I’ve been noticing one of my clients offer resistance in regard to potentially uncomfortable emotions she seems to be experiencing. I say “potentially” and “seems to be” because alas, we haven’t gotten too far into some of these issues. (Which is not to say that we must; just to say that I’m aware of her blocking certain subjects.) Anyway, the above quote is valuable to me because I could actually speak the words “I’m noticing you don’t seem to want to talk about this anymore” (or anything else along those lines), as opposed to drifting over the silence or the displacement or however else that discomfort and unease is manifesting itself without acknowledgement.

That’s my very brief thought on this very big idea. Happy Thursday.