This is my first post in a while as I have started working with lots of new patients recently and have just about settled into the new routine. Unsurprisingly, lots of new patients means lots of different responses! I can safely say that music therapy is not a profession where you can stop learning.
As a result of all this new work and from supervision, I have been reflecting on the idea of interference and abandonment in therapy.
Especially at the start of therapy, it can be a challenge to get the balance of how much structure I provide, what questions and comments I make (and what I withhold) and how much musical support I provide.
If I give too much too soon the patient may experience me as an intruder. This can leave the patient feeling unsafe and invaded (or alien). Flipping that around, if I don’t give enough the patient may be left feeling unsafe and confused. This is less to do with what I am doing, and more to do with how the patient responds but how I am feeling can give me clues to how the patient is feeling, and their experience of life.
There’s no magic formula that gives me the perfect balance. Everybody has different experiences of relating, and what one person perceives as me abandoning them, could feel overwhelming or interfering to another. Some people come straight into therapy and start improvising with me, whereas others may find the situation intimidating and need support before they start playing any instrument.
Attunement helps- being aware of and responsive to my patient. Listening to the changes of mood in the music; what the patient says and how they say it; and their body language (e.g. tension, eye contact, flushing skin) and responding. This helps me develop an understanding of when I need to draw my patient into interaction and when I need to give them space. Eventually patients can use the therapy as a secure base and start to internalise the healthy relationship- that’s where we start to see therapeutic change.
A helpful book to find out more about these ideas is Margaret Wilkinson’s ‘Changing Minds In Therapy’.
I’d be really interested to hear from other therapists- how do you arrange your sessions so that the patient is both comfortable and challenged? Do you ever experience feelings of interference and abandonment simultaneously?