Our Lips are Sealed

December 31, 2011

Part of the fun of meeting famous people is that you can tell everyone that you met them, right? Well, not if you work at a health care facility where they are admitted and you are under strict ethical and legal restrictions prohibiting you from mentioning anything at all.

I met someone famous recently at one of my many contracted facilites. I know all of you reading this want me to tell you who it is, and believe me I want to. I just can’t. I can’t even tell you if it’s a male or female, what their age is or why this person is famous. Bummer. But… rules are rules, and if we didn’t keep these secrets, you know that pretty soon everyone would know not only the physical whereabouts of the person, but also private medical information about the person.

I certainly don’t want that to happen.

This doesn’t just happen with the rich and famous, however. I work at a psych unit near where I grew up, so occasionally someone I know will be admitted to the unit. The first time it happened, I was very freaked out, but I kept my cool and only said hello to the person. I didn’t look at the person’s chart (I was curious about the dx but didn’t give in to temptation) and I decided I would only have a conversation with that person if they approached me. Another person was a family friend, and I had to approach the person to let them know that I wasn’t going to look at his/her chart, let alone tell my family about it (I “found out” later from the fam that this person had been there).

In past posts, I have been very careful to keep people’s information a secret. I use clients’ first initials, but sometimes I change the initial depending on the setting. I may mention diagnoses at times, but because I don’t mention the person’s name or the names of the facilities I work, it is almost impossible for anyone, anywhere, to ever know who I’m talking about. The world of HIPAA regulations and patient confidentiality makes it illegal for me to talk about patients in a casual sense, but I’m wondering where the line is.

I was recently at the annual AMTA (music therapy, not massage) conference and attended several sessions where other professionals mentioned names (first names), diagnoses, facilities and generally private information about individuals. These were anecdotes about our work, and while I’m not offended or bothered by the way in which some of my colleagues mentioned their clients by name, I have to assume that the clients may not have appreciated it had they known. Was it okay because it was at a professional conference? Was it okay because most of the people in the audience were music therapists? Had the presenters gotten permission to use the names of their clients at the conference? All good questions, some of which I wil never know the answers to. I am only concerned because of my own boundaries and personal ethics.

Something else came up recently, also at the conference, that is currently haunting my blog and may be one of the reasons that I haven’t been posting as much recently (sorry, faithful readers!). My (very cautious) internship director of old is publishing a book of some past interns’ weekly anecdotes about clients who taught us something. I was notified that one of my “patient highlights” was in the running to be used in the book, and is it okay if they use it (?). Of course it is. Would I have ever known that it was mine if I read the book without being asked? Probably not. Would I have cared? Probably not. Is my name on it? No. Was my patient’s name on it? No, but his diagnosis was and the unit he was admitted to in mid 2006. Even though this patient has long since been discharged from the hospital, and no real identifying information was given in my paper, the people working on this project had to ask permission from the hospital to use the information that was there.

Question: If that project is following ethical and legal guidelines, then how ethical is the information I put in my blog?

I hadn’t thought about this until the conference, but I haven’t been able to get it out of my head. Because of this, there are three or four posts “on deck” that I haven’t posted because I’m worried about being unethical. I did go to a “privacy in social media” session at the conference hoping to get some validation or at least some clear guidelines, but it was just about facebook’s ever-changing privacy settings, and professionalism on the web, not ethical boundaries in social media. New regulations and ethics considerations have arisen because of the world’s use of the internet and social media to talk about formerly unknown or uncommon topics. Is the information I’m giving too telling? Is a client going to find my blog and know I’m talking about them? What is the line between presenters at conferences talking about their clients using first names, ages, where the client resides and diagnoses and me writing about my clients in a profession-based blog? I haven’t decided yet. Any thoughts?

Let’s go back to my famous person from the first paragraph. Something that has made this all more difficult is the fact that other people, other clients at this place, know who this person is and have told their family members of my client’s whereabouts. The family members come in for a visit and seek my famous client out to chat. These family members don’t have as great a responsibility to my clients as I do, so who’s to say that they’re not going home to their spouses, friends and coworkers and letting them know who they met earlier that day? In this case, does it make the boundaries more relaxed? Does this mean that eventually it will be okay for me to talk about it with my friends, boyfriend, family and coworkers? If it ended up in the news, would it be okay then? What about if I was finding out about this from random people I meet? There are such gray areas surrounding the topic of client confidentiality, and it seems like no matter how hard I try, I can’t understand where certain lines are – not only in blogging – though if I have a nagging question about whether something is ethical, I generally put that post on a shelf and wait for an answer from somewhere.

What about clients who have passed away? Their obituaries are in a dozen newspapers all over Massachusetts stating where they lived for the last ten years of their lives, who their family members are, sometimes what they had been suffering from, and their age and background. At what point would I be allowed to talk about the person as a person, instead of an initial, if ever?

I don’t need to talk about my clients – any of them. All I want is to talk about instances that may be of interest and provide education to other people in my field or a similar one, but is my desire to share useful information compromising my ethical standards and boundaries? I am very intentional about how and when I share information, but is that good enough?

When and how do the gray areas turn into something clearly defined? What can we ethically say in conversation and/or public forums?

Discuss (for real).

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Georgia on My Mind

November 30, 2011

Foreword: Before I go on to rant and rave, I must apologize to all my faithful readers (some of whom will appreciate this post more than others) for being MIA from blogland for the past two weeks.  There really isn’t an excuse other than, “getting back into the swing of things after being away was harder and more overwhelming than I thought it would be.”  So I’m sorry.  And I’m back.

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Welcome to Atlanta, where the playaz play.

For starters, I thought about using the song “Welcome to Atlanta” by Jermaine Dupris as my blog post title, but upon looking up the lyrics, decided against it.  Good call.

Last weekend I was in a place where no one asked me what music therapy means – where drums, maracas, guitars and everything in between seemed to be everywhere and not looked at by passers-by with questioning eyes – the AMTA annual conference.

Since I became board certified and joined AMTA (the American Music Therapy Association) five years ago, I have gone to four national and four regional conferences.  Conferences are energizing, motivating and often a good time to catch up with MT friends who live far away.  This year, the conference was held in Atlanta, and I must say, even though I wasn’t able to go to the Coca-Cola museum [insert animated sad-face emoticon here], it was a great time.

Here are some things I learned and re-learned:

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Reunions are important.

Not only are reunions enjoyable for many reasons, but they are also great networking opportunities.  My internship from years ago has a reunion every year at the conference, and I always get new ideas, meet new people and make new professional connections.  Regarding the fun of reunions – one particularly enjoyable part of reunions (for me) is seeing all of my past students who are all entering or leaving their internships (a little shout out, past students – great to see you in GA).

Sessions led by non-MTs are a toss-up.

In two presentations I attended, it was suggested that music has an effect on our brains.  (!!!!!insert sarcasm here!!!!!) This is true.  This is also the most obvious fact, ever, to music therapists, and really doesn’t need to be reiterated at a music therapy conference, to people who learned that in the first semester of college. I was also informed that the way to find work in mental health facilities is to volunteer at different places for a half-hour or an hour per week.  (!!!!!insert palpable silence and blank stares here!!!!!) We make music therapy our careers.  This is not only a thing we love to do and are passionate about, but it’s also our job.  We have to make money doing it, or we can’t pay our bills.  Not to say that there’s anything wrong with volunteering in the more general sense of the word, but since half of the country thinks music therapists are uneducated volunteers, it would probably be beneficial to our field if we got paid for what we did.  That all being said, doing a promotional session or in-service at a facility certainly doesn’t hurt, but that’s purely for marketing and not meant to be the final solution. There was also a session where I felt that I was being sold a product,  instead of being taught about real-life applications, and in the hour that I remained in the meeting room I not only didn’t hear or see the product used, but I felt like I was being preached at about music therapy and its significance in health care.   We are music therapists, and we were being told how important music therapy is.  Talk about preaching to the choir…

7:30 AM is too early [for me] to be learning.

If you have been to MT conferences, you know that getting sleep while still going to sessions and enjoying all of the later-night festivities is very difficult.  There is music happening literally until 2 AM some nights, and there are parties, reunions, concerts, performances and open-mic/cabaret events to invest energy in.  7:30 AM is too early, in that regard, but the issue with starting sessions later every morning (there aren’t 7:30 sessions every day), is that the conference is only a few days long, and because it’s expensive to attend, I want to squeeze as much learning in as possible.  Getting enough sleep never happened at conference this year, and I realize that it’s okay because… Note to self: conference isn’t a vacation or a time for rest.  It is fun, but it is not a relaxing or restful time.

Location, location, location (does matter).

In the past six years, four out of the six national conferences were held in the mid-west. They were all in great cities, don’t get me wrong, and I still learned a ton and managed to have a great time with my friends I never see in two of those mid-western hubs.  I know that the mid-west is in the middle of the country, and that conference location bids are a factor, but it just doesn’t seem right that the scale has been tipped in that region’s favor, even considering the prices of certain locations. And…next year, the conference is an hour west of Chicago.  Mmmkay.  On a happier note, last night I had the pleasure of experiencing Pittypat’s Porch (a great southern restaurant based on a character in Gone With the Wind) which was an appropriate way to end a nice weekend in a fun city.

Keynote speeches are usually worthwhile.

Kenneth Bruscia – a guiding presence in the field of music therapy and the author of books that we all read in college, was our keynote speaker this year (that introduction was just for you non-MTs).  Not only was he funny at all the right times, but the content of what he was saying was valuable and also easy to grasp.  What I learned from Kenneth Bruscia, is that thinking of music therapy sessions in only one way is dangerous and counter-productive.  We all have to be more flexible in our expectations of how sessions are supposed to go, or our clients won’t benefit.  There was more to his speech, but that’s a little teaser for ya.

Lifetime Achievement takes a while.

I am blessed and fortunate enough to have been mentored and taught by two amazing women who have also won lifetime achievement awards from AMTA (one of whom won the distinction at this conference!).  When I think of all both of them have accomplished, I am humbled, and I realize that that kind of recognition only happens after years of really hard work, motivation and passion.  Regardless of a Lifetime Achievement Award,  I hope that in 30 years, I am able to look back with no regrets and be proud of myself for all that I’ve accomplished.  Someday…

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This conference also taught me several different clinical methods and interventions regarding the populations I work with, and brought me some insight about the end of life and it’s profundity (as I realize some of my more recent posts have been somewhat dreary) as well as some new ideas and a much needed kick in the tuchas regarding my contracting business and a project I’m working on (If I told you, I’d have to kill you).  Even if I don’t go every year, conference is always exactly what I need when I do go, and it usually happens during a time that I need it the most.
Thanks, Hotlanta AMTA conference, for being exactly what I needed.  I learned a lot.
Oh, and P.S.  Ben Folds was at the conference.  Yup – we’re just that cool.

Shelter From the Storm

October 4, 2011

I love drumming.  I particularly love participating in a drum circle with lots of people in it, but drum circles can’t always happen.  The benefits I experience from drumming end up happening exclusively in my percussion-based groups, and then it’s not for me, but I still love it.

There’s a particularly wonderful drumming exercise I use occasionally (usually on rainy days) in percussion groups, and it has a name.  It’s called “The Storm.”  I have been told that this exercise was created by an influential music therapist named Deforia Lane, though I can’t be sure.  If it was ethical (or legal) to videotape one of my sessions, I would post a video of this exercise.  Unfortunately, you’ll have to use your imagination.  Maybe I can kidnap some friends to recreate it at some point…

This exercise doesn’t need quite as much explanation in some settings as the amount I give in my groups, but I find it’s helpful to give the clients as much information as possible so they dont get confused.

A small set up of my drums before a percussion group on the psych unit

Sometimes, before or after the session, I begin a discussion about “the storm” as a metaphor for difficulties in our lives, and invite clients to speak about their own personal storms for as long as they want.

I start by turning off/down the lights in the group room and I ask participants to chose a percussion instrument.  We talk about the different aspects of a storm, and try to recreate those sounds with our instruments.  I explain that there aren’t any real guidelines, but I almost always have to remind clients that this isn’t a rhythm exercise, and that talking isn’t allowed until we’re finished.

After our initial exploration, I invite the group members to close their eyes and take a deep breath, followed by a loud sigh.  I tell the clients that we’re going to start with wind (as storms tend to do) and we’re going to end with wind, but that anything that happens in between is up to them.  I also explain that if a person wants to stick with one aspect of the storm for the whole exercise, that’s okay, or if they want to try different sounds, that’s fine as well.  With everyone’s eyes closed (except for mine – I peek to make sure nothing goes awry) we create a unique storm of our own.  Sometimes there’s more rain than anything else, sometimes there’s more thunder, and sometimes, it takes a while for people to allow the storm to taper off.  It’s always different, but people always report that they feel relaxed following this exercise.

I learned this activity at a conference a couple of years ago, and I liked it so much I have used it in the psych unit, in a dementia-specific assisted living facility, and with well elders in independent living complexes.

Something to remember: Even if storms are frequent or long, they always eventually end.