General, Multidisciplinary, Self-Care

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”

Countertransference, General, Grief

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”

Best practice, General

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”


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”

Best practice, General

Supervision Demystified III

This is our third of four posts this month on the topic of clinical supervision, borne of our collective enthusiasm for supervision processes and their value in each of our own journeys of clinical and professional development.  You may want to go back and read part I and part II before you continue reading below!  This week we will each talk a little bit more specifically about how and why we have found professional supervision to be an indispensable component to competent and satisfying clinical practice. Continue reading “Supervision Demystified III”

Best practice, General

Supervision Demystified II

This is our second of four posts this month on the topic of clinical supervision (read Part I here).  We’ve observed that lots of music therapists aren’t familiar with supervision, what it’s for, and what it’s like to receive it. This series was thus borne of our collective enthusiasm for supervision processes and their value in each of our own journeys of clinical and professional development.

In this particular post, we want to address how supervision for a professional differs from the supervision that all music therapists are required to receive during internship.  Below you will read each of our answers to this question, which we all tried to address from dual perspectives — our personal experience as music therapists who have received supervision as both interns and professionals, and our professional experience as supervisors observing those that we have supervised. Continue reading “Supervision Demystified II”

Best practice, General

Supervision Demystified I

For our last series of 2015, please join us in a conversation about supervision.  “Supervision” for professional music therapists refers to a specific process in which the music therapist pursues ongoing clinical guidance from another professional in the field (or a related field). The music therapist wanting supervision will seek out a clinician that they feel they can learn from, and pay them for regular meetings (usually 45 minutes to an hour in length, on phone/Skype or in the supervisor’s office) where the two discuss the music therapist’s cases, and sometimes other professional issues as well.  Sometimes music is used as part of this. Supervision is an opportunity to explore the dynamics of therapeutic relationship with various patients, as well as to develop greater understanding of one’s clinical identity.

Another valuable iteration of supervision is the peer supervision group, in which group members take turns sharing case material and providing feedback to each other. In private supervision, one gets the whole time to oneself to receive guidance and feedback, while in group/peer supervision, the time is shared and in addition to receiving one also reflects on others’ cases and shares impressions or suggestions.

This series of posts on supervision came about because of our collective observation that “supervision” is a foreign concept to a lot of music therapists. In my own personal experience, supervision was something that sort of appeared in my daily schedule as an intern, without any real explanation of what it was for or what I was supposed to do with it. Different schools and different internship sites seem to handle the concept of supervision differently: Some don’t mention it at all. Some consider it a time to go over practical matters, whereas others encourage deeper consideration of clinical issues. Some bill it as a part of internship only, whereas others encourage their students and interns to make supervision an ongoing aspect of their future careers.

We four are, of course, part of that last camp. We’ve all found supervision to be exceedingly helpful, and we all can hardly imagine our work without it. So we’re each going to share our thoughts on supervision this month, with another post on each of the next three Tuesdays.  Each week we will address a different question about supervision.

Introduction: What’s Your Supervision Story?

Jillian: I’m currently involved in a peer supervision group that includes music therapists working in hospice as well as other settings. As for our training and our theoretical orientations, while we are by no means clones, there are a lot of overlaps and similarities.  At times, that is a strength, and at times that may be a weakness. Regardless, the group is a professional lifeline.  We meet monthly, and have been doing so for a few years now.

I am not presently engaged in individual supervision, and I miss it.

At work, I supervise interns with whom I work individually.

Noah: I currently receive individual supervision from a music therapist in addition to peer supervision with a cadre of colleagues that, as Jill aptly described it, are a much needed lifeline. Each supervision I receive roughly once a month.

I find individual supervision to be at once one and all of the following: confounding, angering, relieving, and clarifying. Confounding because of the barriers that our explorations frequently uncover, angering because of my tussles with those barriers, relieving when those barriers are either dismantled or reconfigured into an access point, and clarifying because of the insights that emerge and evolve when granted more fluid access to my intrapersonal world. There are times when one characteristic will dominate over the others, but the most meaningful sessions are when all four balance each other out in what Joseph Zinker coined a multilarity.

A multilarity is when there are multiple outcomes, as opposed to “just” two outcomes in a polarity. As this diagram of a supervision multilarity shows, the balancing of these four experiences creates a dialectical tension. When I have been able to successfully use individual supervision to resolve this tension, it has given birth to deeper, more nuanced insights.

Peer supervision is like the good kind of high school reunion (I’m assuming they exist somewhere…) where you connect with friends that you feel like you haven’t seen for a while, and pick up where you last left off. Sometimes the explorations are as intense as in individual supervision, but what I have found to be the most invaluable aspect of peer supervision is the deeply embodied compassion and empathy for my process through work and school that I do not get anywhere else. These are truly a collection of my peers who have lived similar experiences as my own, and can extend supportive understanding through as simple a gesture as a head nod.

I currently provide individual supervision via phone and Skype to music therapists out of state. With some the focus is on clinical issues, while with others it is more focused on professional development.

Kristen: My current supervision situation could be described as “complicated”! Previously, I had participated in and greatly benefited from weekly clinical supervision from a music therapist that I highly regarded. When that relationship ended, I had a transitional period, consisting of a “grief” of sorts for a relationship that I highly valued. I felt myself wandering and trying to determine what to do next. I think it’s also important here to mention that my needs had shifted. I had taken on a management/administrative role, causing the main focus of my work to be on staff and program development and management. Currently, I receive weekly administrative supervision, monthly clinical supervision from a psychologist, and participate in a monthly creative arts therapy peer supervision group. This has been my supervision arrangement for the past year and a half. I am currently looking for a music therapist who has experience in providing supervision to supervisors and managers. Through my role as program director, I provide weekly or biweekly clinical supervision to a team of 7 creative arts therapists (music and art) and child life specialists in the workplace setting. I also provide clinical supervision to music therapy and dance therapy interns as a component of their clinical training.

Meghan: I have had a lot of different supervision situations over the years: private supervision with a senior music therapist (in my case Diane Austin); private supervision with a drama therapist in my workplace and concurrently with my boss at the time, a clinical nurse specialist; several iterations of peer supervision with other music therapists; and two iterations of peer supervision with a group of various creative arts therapists in private practice. Currently, I do peer supervision once a week with an art therapist and a peer consultation group once a month with a group of clinicians of various backgrounds who work with people with foster care histories (which is part of my private practice work). For the past three years I have also paid for weekly private supervision with a psychologist/Jungian analyst.

On the provider side, I have supervised practicum students, interns, and new professionals in on-site workplace supervision sessions for a number of years. Currently and for the last few years, I’ve provided private supervision to music therapists in my office or via phone or Skype. I’ve worked with MT’s who work in hospices, psychiatric hospitals, and private practice situations.

Thanks for reading this first post in our series.  We’re interested in your reactions as we continue on this topic!   What do you want to know more about?  What of our supervision stories surprises or intrigues you?  What would you like to share about your own supervision story?  Please share.

Countertransference, General

There’s No Flirting in Hospice

Actually, yes, there is.  Let’s talk, for a bit, about the presence of sexuality between us, the end-of-life music therapists, and the people to whom we provide care — meaning our patients and whoever else is included when we come for our sessions.  Our music therapy literature barely acknowledges that sexuality exists — almost as if music therapists don’t have sex, or sexual thoughts, and neither do our patients.  But we know otherwise. Continue reading “There’s No Flirting in Hospice”


The Balance of Mental Health and Medical Health at the End-of-Life

How do we “know” mental illness?

Recently, a client I had been working with since January disappeared for a month with neither warning nor explanation. When he re-appeared, it was discovered he had been in a psychiatric hospital to treat chronic depression recently exacerbated by a month-long medical hospitalization. Upon returning home from that medical hospitalization, he had been unable to regain a sense of self or stability, and ultimately his mental health decompensated.

It was a stark reminder that mental illness is neither cowed nor tamed by advanced medical illness, and that a decline in physical resources and health may provide opportunity for parallel declines in mental/psychic resources and health. Our cultural penchant for infantilizing the elderly or ill with statements of “Oh, he’s so cute!” or “She is such a sweetheart!” perpetuate a belief in an inherent docility to death and dying. This narrative threatens to minimize any continued manifestations of mental illness, placing the already vulnerable at risk of significant decompensation that can rupture any present balance in their daily functioning.

Continue reading “The Balance of Mental Health and Medical Health at the End-of-Life”


The allure of fantasy


Lately I’ve been thinking a lot about fantasy and its role in the therapeutic process. Fantasy, among its other benefits as a force in therapy, is uniquely situated to challenge entrenched cognitive structures, bound emotional energy, and divisive power structures. Comprised of fundamental human features (e.g., imagination, creativity, etc.) essential to personal foundations of wellness, fantasy is a necessary ingredient in a person-centered practice. Fantasy plays a significant component in my current work, exploring such questions as “Who would I be without this illness?” and “How can I be a health, integrated person in the future even if this illness persists?” in order to foster an imaginative process that creates possibilities and activates potentialities. Continue reading “The allure of fantasy”