On the inside

On the inside I am jumping up and down shrieking with excitement because my client is watching me. Intently.

On the outside my unwavering voice continues singing, my fingers steady on the guitar, my eyes have met and held their interested gaze, their warm smile has re-ignited mine. My music therapist hat is on, and things evolve.

Side bar: Who do you imagine as the client? If you read on, comment below or let me know.

On the inside I am unnerved, because my natural somewhat-introvert doesn't like being in the spotlight. But at the same time I am ignited because here is someone whose condition-related isolation, lack of interaction and disconnect means that them watching me is a shriek-worthy, music-has-captured-their-attention moment.

On the inside I am gushing, in ways that normally the other staff or family get to, because this person hasn't shown any signs of withdrawing or declining, and has instead reached out to accept one of the instruments I'm either holding out or have placed in offering. Ah ha! They’ve claimed a piece of control!

On the inside I am gushing, because the staff member sitting alongside supporting them is beaming at me – they’ve seen it too! And they’re smiling the significance of it right at me!

On the inside I am beaming, because the staff member has read the assisting guidelines I sent and listened when I explained my approach and ways they could support their person. I'm beaming because instead of enthusiastically selecting an instrument for them or shaking it for them or shaking their hand with it for them or saying, "Come on, play it!", they've discreetly put their arm under theirs to support the weight so it's one less thing for them to do or think about and so as to enable them to self-initiate their movement and their choice and their play. They've also picked up and started playing the same instrument as their person, encouraging through modelling.

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On the inside I quickly analyse their choice of instrument - funny how much it can tell you about a person, what they like, the mood they're in, what they might be ready to explore and more.

On the inside I'm frantically trying to keep the lyrics of my welcoming-hello song going while I recall what I'd noted on the referral form from my discussions with them and their family about what music they like - did they have a favourite musician? Or band? Or song? Or style? Or genre? Or even just a clue into if they tend to like fast, lively music? I see my notes in my mind's eye, I see the way they're holding their head during this song, I notice small movements in their toes, I wonder about their unfurling fist, and it sparks the ideal song to suggest or try out next. Or, something else about this person has told me - start with a gentle, quiet instrument. Work towards using voice and song later.

On the inside I am making note of the time, how long they’ve sustained holding my gaze, and my observations that are leading me to consider that they’re holding it with intention.

On the inside I am celebrating, because they've started singing with me! I didn’t think they would today, given what the staff or family told me earlier about how their condition has deteriorated recently. I pace the song slowly, in a key that should suit their voice as I know it, and when they stumble, or switch words or verse or song, I adapt and go with their flow.

On the inside I notice the way they’re holding and playing their instrument, apply knowledge gained through training, reading and experience about their condition(s) and make a mental note to offer a thicker handle, a more accessible angle, a lighter instrument in our next session.

On the inside I am a mess of emotions as I experience this person so engaged, so connected, so responsive, so interactive. I feel my training and experience and skills and intuition have led to this worthwhile point where music therapy has successfully enabled this person to actively listen, respond and contribute.

On the inside I am also a mess of emotions because when I walked into this music therapy space I left several of my own metaphorical bags at the door, and my client just burst a couple of them wide open. It's happened before, and I have strategies for managing it when it happens.

On the inside I feel thankful that my Masters training* and praciticing requirements** has and continues to equip and re-upskill me to work safely with vulnerable people with hard stuff to tackle - so that I'm safe, and they're safe. If I bring my own stuff into this moment, if I relate my own stuff within this moment, if I cry in this moment, I will instantly change this significant, meaningful moment for this person. If I take the focus away from my client's moment - well, that says it, because it's their moment, not mine, and I'm here to facilitate theirs, and hold my stuff until I'm in my own safe space. Sometimes facilitating means a carefully considered element of self-disclosure. Always with a therapeutic purpose, with them in mind.

On the inside today I allow the rising ball of emotional response in my chest, identify it as mine and not theirs or both of ours – because transference doesn’t just exist in textbooks -, and let it ease into the background as I refocus on my breathing.

On the inside I smile, because by facilitating their moment, they're starting to express their inside on the outside.

On the inside I remind myself that later I will reflect and redirect my experiences by putting what was on the inside here. I have a reflective journal, as do many therapists alongside their clinical notes, it’s an important part of the process. I also make a note in my clinical supervision notebook to make sure I talk about what came up with my clinical supervisor. Lots of notes, lots of notebooks – I find that keeping organised is endlessly helpful, and as my colleagues will tell you, I like details :)

On the inside I notice their breathing starting to grow heavy and wonder if they’re tiring and need an instrumental verse as reprieve, or if I initiate the song ending and move to hand-focused musical play.

On the outside my unwavering voice has continued singing one of their favourite songs, my steady fingers have kept strumming the guitar, my eyes have met and held their interested gaze, their warm smile has re-ignited mine. I have instantly changed key to match their voice as they joined in. I’ve relaxed my shoulders and back as I stand grounded but at a somewhat awkward angle so that they can better see the guitar and my hands playing it should they wish to. I have changed my strumming pattern to fit with their rhythmic style, and started tapping my foot along with them. We have both stayed here, in this room, in this space, together. My music therapist hat has stayed on, our music and being together evolves from there, and my excitement comes with us.
 
Side bar:
Who did you imagine as being the person, my client, in this account of a part of a music therapy session?

Was it a young child, a teenager, an adult or older adult?

Are they living with developmental needs? Physical challenges related to for example Cerebral Palsy or stroke? Communication goals related to Down Syndrome or Parkinson’s Disease? Psycho-social-emotional needs related to mental health needs triggered by trauma, grief or loss? Nearing end of life?

I purposefully wrote the above account holding in mind a plethora of clients I have worked with over the years. One reason being so that no-one was identifiable. Another being to show just how versatile the work of a registered music therapist is.

Someone who I have the utmost respect and admiration for recently shared with me the term ‘Versatilist’. Because to describe a registered music therapist as a ‘Generalist’ doesn’t accurately account for the fact that we are specialists capable of working as specialists across the board. We provide evidence-based therapeutic services in a diverse range of settings, with a multitude of clients living with various needs with whom we individualise and adapt to facilitate client-centred (in my case, some music therapists take for example a music-centred approach). I like it. It especially suits my practice because I continue to work across the lifespan in various settings, rather than focusing on working with people of one age-group with certain need(s).

​Next time someone asks me to explain what a music therapist is – I’m a versatilist.
 


* Master of Music Therapy, Te Kohi, New Zealand School of Music at Victoria University of Wellington
** As part of my registration with the New Zealand Music Therapy Registration Board, I apply annually for my practicing certificate, which reflects that I meet the criteria including meeting the MThNZ Standards of Practice, MThNZ Code of Ethics, and undergo clinical supervision and continuing professional development.

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