In search of my lost voice

I guess it must have happened slowly and over time. I didn’t see it coming, although in hindsight, it should have been clear. At first, perhaps the butt imprint in my desk chair became a little more pronounced. I noticed I wasn’t meeting my daily step goal on my Fitbit. Then a day went by where I made no music. Then two days. Then it became most of the week. In fact, I did little more than what was necessary to keep the day-to-day going at work. It wasn’t until the holidays came that I realized the glaring reality—I was burning out. Continue reading In search of my lost voice

Do clients really die to meet our needs?

Narratives

During the height of the primaries earlier this year, Meghan and I participated in a (rather heated) community discussion about the role misogyny and sexism played in shaping how the presidential candidates were perceived. In a private follow up with Meghan, I noted that my entrance into a feminist perspective began with my daughter four years ago, that before my daughter was born being white and male afforded me a position of privilege buffering me from the troubling hegemonies that affected others. But after my daughter’s birth, I argued, I vicariously lived my daughter’s interactions with the social cues – e.g., a cascade of pink clothing, affirmations of being “cute”, questions about her favorite princesses, etc. – that dictated how she “should” be, affording me new insights and expanded awareness.

Meghan offered a pointed reflection, noting that while my entry point into the feminist narrative that resisted such gender roles began four years ago, a woman’s entry point (as it has been for my daughter) was from birth. Consequently, my awareness of sexism was not experienced so much as observed, limiting my perspective due to my context of privilege. It was a clarifying comment that resonated beyond gender issues into end-of-life care, and led me to the question of what is our role as hospice music therapists when we enter clients’ life narratives at the very end.

A calling or a privilege?

 It is common to hear hospice music therapists refer to their work as a “calling”, suggesting that they are “born into” or “created for” hospice work. It is a perspective that says “I was made to be a hospice music therapist and be here to provide you this service” thereby positioning the client as an object utilized to achieve fulfillment. In essence, by designating hospice work as a “calling”, we are assigning our practice an existential function that places our needs for actualization before the needs of our clients.

This is a perversion of our intentions and obligations as healthcare professionals. Clients do not die from cancer to meet our need; they die from cancer because they have cancer and they are dying from it. Death does not come to an individual so as to address another’s need to feel validated or fulfilled. It is a natural function of life, and the eventual demise of our physical body is an objective fact unmoved by any subjective value placed on it. Being a hospice worker does not assign us the right to attribute personal meaning to the death of a client.

To be sure, there is great value to be mined from the work, but that is secondary to working with clients towards achieving good deaths. And it is that good death – that opportunity to die with the resolution necessary for peaceful transitions into postlife – at risk when we assign ourselves undue agency in a client’s life narrative. We are invited – not called to – the final hours, days or weeks of a narrative that began multiple decades ago. We are afforded the privilege by our clients to participate in the final chapter of that narrative, and perhaps even the epilogue if we are so honored to participate in a memorial or funeral.

What do we have to offer?

So what does it mean to enter into another’s narrative? How do we partner with our clients so that we can align with their experiences without appropriating them? One potential avenue has been paved by Martin Buber’s I and Thou (Note: Rudy Garred explores to a much greater extent the intersection of Buber and music therapy in Dialogical Music Therapy). In this seminal work, two types of relating are described: I-It, which is a subject-to-object interaction, and I-Thou, which is a subject-to-subject relationship.

When we engage with clients through an I-It interaction, we are acting on our clients as objects. For instance, the music therapist plays music at a client to lower anxiety or the music therapist responds to a client’s increased respiratory rate. Within this dynamic the therapist assumes the brunt of agency in the session: they make the assessment, they develop the intervention, they determine the goal, and they evaluate the outcome. If clinical practice is perceived as a calling, then the music therapist has pre-determined what the meaning from the session shall be (e.g., “This is what I have been born to do so my actions with my client will be in service to realizing that meaning for myself”).

Conversely, when we engage with clients in an I-Thou relationship, we are finding points of unity through which a shared resonance manifests within the therapeutic relationship. Such relating fosters authentic interactions defined by a mutuality wherein each individual shares with and receives from the other.

For instance, the music therapist engages with clients in co-constructed music experiences that assign both as stakeholders in the aesthetic experience. Here, the client is provided space to be expert on their experiences and the music therapist allies with them to facilitate client-directed experiences. These interactions support a resource-oriented perspective founded on the assumption that clients have intrinsic resources and attributes for complete personhood. I have nothing to give another that they do not already contain within themselves, and that surely includes music. If we truly ascribe to the notion that music is an intrinsic function of humanness, then “my” music has no place in another’s journey towards self-actualization and resolution. And, if we respect the autonomy of another, then my existential needs have no place in that journey either.

Subtle shifts

What I hope to see moving forward is a substantive shift in how we conceptualize end-of-life care work by

  1. Moving away from focusing on how we are impacted by the work and how we experience fulfillment when musicking with a client, and re-situating ourselves from the client perspective of what impact and fulfillment means for them.
  2. Acknowledging that placing our needs before that of our clients represents countertransferences that are not to be shamed but worked through so that they can inform rather than obstruct the clinical process.
  3. Changing our language so that our articulation and framing of that clinical process speaks to the client experience instead of our own.

I believe in both the validity and value of our practice and in our ability to ensure our clients’ narratives are honored and empowered.

The Art of Coping with End-of-Life Care

What do we do when we leave a visit feeling as though we have journeyed a thousand miles since the visit began?  When we arrived, all we knew were facts–name, age, diagnosis, recent medical history, comorbidities, referral reason, primary caregiver’s name and relationship to patient. Now, as we walk out the door, we can not comprehend all that has transpired–interpersonally, intrapersonally, emotionally, physiologically, spiritually. Time has been interrupted, then suspended, then reversed, then expanded, and music lingers in the air as something shared comes to a close and we have to leave the room to go… document. Continue reading The Art of Coping with End-of-Life Care

On Sadness

I recently went through an exercise of connecting deeply with sadness and how wonderful it can be.  In May, I closed my psychotherapy practice in New York City, and I had to say goodbye to all of my patients, most of whom I had been working with for over three years.  I was bereft.  I absolutely adored all of these individuals, and I hated the idea of not seeing them every week anymore.  We processed termination for four months, and in that time we talked quite a bit about sadness — their sadness, and mine as well.  I felt the sadness deep in my heart, like a longing.  And, as I shared with my patients when they asked me about my own feeling experience, I treasured that sadness just as deeply.  While I had always found deep meaning in my relationships with my patients, feeling the depth of my sadness at having to leave them brought me to a whole new understanding of how much those relationships meant.  It was like a gift, and one that I could never have allowed myself to open if I hadn’t embraced my own sadness, and felt its preciousness. Continue reading On Sadness

Supervision Demystified IV

This is our last of four posts about clinical supervision.  Thanks for joining in the conversation so far!  If you haven’t read our previous posts on this topic, you might want to go back and catch up!  In today’s post, we’re each going to describe our respective approach in providing supervision, whether as peer or individual supervisor. Continue reading Supervision Demystified IV

Cat Hospice

“We’re running a cat hospice”

I hadn’t really connected the dots in that way until my wife said it out loud to friends. While I had been aware of it on an intellectual level, it was jarring to hear it framed in that way. Suddenly, we weren’t curing our 18-year-old feline’s failing kidneys or reversing her ailing liver functioning. Rather, we were making her comfortable, bearing witness, and waiting.

Continue reading Cat Hospice

Mothering our Patients

We are excited to share with you this guest post from Miriam Sherk, a hospice music therapist at Mercy Hospice Trinity Health Care in Ann Arbor, Michigan. Here, Miriam reflects on the parallels and intersections of motherhood and music therapy in hospice, and considers how the roles of “mother” and “music therapist” inform one another. Please feel free to any thoughts, questions, or general comments for Miriam or about the post to help further this important discussion.

I walked into Ed’s room last winter, knowing that he would not greet me with recognition. Ed had a diagnosis of vascular dementia and his cognition had been slowly declining in his recent months in hospice. His nurse had shared with me that Ed had been crying throughout the morning “for no particular reason.” As I walked towards Ed’s bed he reached out his arms towards my 8 month pregnant belly, looked up at me and spoke the word “mother.” At this moment I felt a sense of vulnerability. Something so personal and cherished to me was being brought into the therapeutic space without warning. Feeling disarmed I hesitated briefly.

Continue reading Mothering our Patients

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A collaborative exploration of creativity, aesthetics, and meaning-making at the end of life