Learning to Fly: Part Deux

January 3, 2013

In September, I started a new chapter in my professional life.  With the help of a few wonderful colleagues and advocates, I was able to create an internship program based around the hospital system I work in, and let me tell you – it has been a whirlwind.

My two interns have just completed the third month of the six month program.  Yikes! How did the time go by so fast?

I’ll tell you how.

Pre-Internship

Before the internship was able to start, the universities and the hospital had to come to a contractual agreement.  This took a while. The issue was: the hospital I am working with has recently decided that it does not provide criminal record checks (CORIs) to interns.  The schools my interns are from also don’t provide criminal record checks.  Luckily, the memo didn’t get passed along to HR at the hospital, and the person in that department ran checks for us before I knew that CORIs were the main hold up. We eventually got everything straightened out, but the person in the legal department in charge of the contracts had not known that I had a relationship with the hospital prior to this, (or that project supervisor, S – a unit manager, was on my team) and had let the contract sit on their desk for over a month before it was sent to the administrators for signing.  The interns started a week later than expected, because in order for me to even set up hospital and behavioral health orientation for the interns, the contracts had to be signed.  In order for the interns to even start observing on the medical units and psych units, they had to go through said orientation and turn in their proof of immunizations, behavioral health and student rotation forms (this is something nursing students fill out so that the powers that be know where they’ll be, how often, and for how long), and get ID badges (which was a trial in and of itself).  It was painfully frustrating.

In the time that I was waiting with bated breath to hear about the contracts, I had to create a schedule for the interns, a list of assignments and readings, make a contract, sit down for IIPs (Individual Internship Plans), talk with liasons from both schools about the contracts and liability insurance, check with every single facility I work at to make sure it was okay to bring the interns with me (there are 12 facilities), send memos to the medical units explaining the brand new music therapy program to staff, and do some sessions to acquaint myself with the medical units and staff.  It was a lot of work, but I have to admit, getting my ducks in a row felt good, and with any luck, my experience this time around will make everything easier next time.

Then there was the actual internship.

Month 1 – First, we had two weeks of orientation.  This consisted of the interns coming with me to every place I go, observing and participating, engaging in discussion before, between, and after sessions, and doing various assignments. After they completed behavioral health and medical orientation, as well as the required immunizations and hospital forms, they were able to observe me facilitating bedside MT in the hospital.  After learning how to document, lead sessions in the hospital, and after a hefty amount of observing me in group sessions, they began to lead on their own.  This happened just in time for me to get violently ill and lose my voice (which I wrote about in THIS post).

Month 2 – The interns got their feet very wet leading sessions as a duo (without my direct supervision) in the hospital, and leading my groups while I quietly observed their progress.  There were a couple of misunderstandings and some personal issues that came up, but it was all productive, and all a great lesson in how to work and communicate effectively with others.  Both interns chose topics for research study – one created a survey to find out how staff is benefiting from the music therapy program (indirectly and directly), and the other is conducting research to find out what the most popular interventions are, depending on demographic information.

Month 3 – Both of the interns solidified their final projects – One intern will be starting a music therapy program at two facilities with emotionally disturbed children and adolescents, and will be meeting with the coordinator to nail down details sometime in the next two weeks.  The other intern is starting a pilot program on the hospital’s pediatric unit.  We met with the unit manager to discuss logistics, my intern sent out emails and memos to the unit managers about the program so that staff is informed, and after a relatively easy process, it will begin this coming week!  We found out about a month ago, however, that in order to conduct research having anything to do with the hospital, the interns must propose the research to the Institutional Research Board which requires six additional steps/forms/written work!  Eek!  The Board doesn’t meet until mid-February, so there is time, but it was an unforeseen obstacle.  I guess this is all a learning experience!  At least I have my trusty project supervisor, S, to guide me through the maze.  Another fun and exciting thing that happened during the third month, is that my wonderful boyfriend (a professional photographer) did a photo shoot for me!  One photo of all of us in transit is pictured above (courtesy of Chris Conti Photography).

The interns have been home for the holidays for two/three weeks, and while it has been nice to have a little break between groups, there is still a lot to do, so I’m looking forward to getting back into the swing of things on Monday.  It’s amazing how productive I have let myself be, and how well this has all worked out.

Now, onto the National Roster application…

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If you have any questions about the process, please don’t hesitate to ask!  “Like” Bostonmusiclady on facebook to get more updates.

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Sweet Emotion

October 2, 2012

I am a crier.  I cry all the time.

I recently cried while watching “The Blind Side,” “Crazy, Stupid Love,” a random “Friends” episode and almost cried when listening to a random movie theme.

Truth be told, I have been meaning to write a post about emotion for quite a while, but the interns started a couple of weeks ago, and things have been a little crazy.

Here we go…

To be in this profession, empathy is key.  We all know that.  We need to be able to make the right decisions about how to handle a situation based on our ability to read someone, and putting ourselves in someone else’s shoes is how we do that. Duh.

There are situations when our own emotions come out at unexpected times, and I think we have to be okay with that, at least for the most part.  One of my interns said to me recently something to the effect of…the more we cry at movies and weddings and Hallmark commercials and anytime anyone else is crying, it reflects how empathetic we are as people.

I agree.  But sometimes we miss the boat.

Last week in the psych unit, we had a group singing session.  I have piles of lyric sheet copies which are laid out on a large table for patients to choose from (I know there’s a better way to do this) and a few tissue boxes.  I encourage patients to choose a song that speaks to them or that they enjoy, and to take the entire pile of copies to hold on to.  Each person shares their choice, and I ask them why they chose that particular song.  Sometimes there’s a deep and meaningful story attached and sometimes they “just like it,” but regardless, we sing the song (sometimes using small percussion instruments, if the person wants us to) and when we are finished, I thank the person for choosing that song and we move on to the next patient’s choice.

Last week during our group singing session, a patient began to cry during “Bridge Over Troubled Water,” which was a song chosen by another patient in the group.  I thought to myself (during the song) that I should process with her when we had finished, but I stopped myself.  I didn’t know this person, and since another patient had chosen the song, I didn’t want to make the other patient feel that her choice wasn’t honored.  We finished the song and I moved onto the next patient’s choice.

Following the session, when we were all processing, the intern I mentioned above posed an extremely good question, wondering why the tearful patient was crying during that song.

I forget sometimes…I forget that crying is an individual’s situational outpouring of emotion or pain or joy, and that in a psychiatric unit, it might be something worth asking that person about.  So many people cry when music is present (especially in those forums) that I forget how new it is to my interns, and how much better I should be about making sure I process those feelings with patients.  Not only that, but spending the time at least asking the person if they want to talk about how they’re feeling, which I have done in the past, but didn’t that day.  I forget that not everyone is attention seeking, like a patient who was in the unit several weeks ago.  I forget that crying can be significant, even if it’s an every day occurrence in my life because of sitcoms and pictures of cute animals and human interest stories that turned into movies.

After I responded to my intern’s question, I went out to the milieu and, sitting down next to the crying patient, asked her if she was okay.  She responded with “Yeah, I’m fine – that song always makes me cry – I have it on CD…but I’m okay.”  I thanked her for coming to the session and told her I hoped that she would come to the drumming group on Monday if she was still there (she did).

I thought about my lack of good judgement in that moment all weekend and realized that I got lost in the structure of my session and forgot the important parts.  Having tissues on the table is not enough.  Surely, some people just want to be alone with their tears and are crying for no reason in particular, but what if someone was crying about something very specific?  What if someone was crying for the first time in years?  What if someone was crying for attention? Or out of frustration? Or anger? Or despair?  The significance of any of those may not ever matter.  We don’t have to pry if we think the person may need that solitary safe space to cry in, but we should at least ask.

Everything seems new-ish again with my interns asking simple but poignant questions, and I feel so happy that I’m able to share my knowledge with them, even if I make mistakes sometimes.

I’m so happy, I could cry 🙂

(But I won’t because I met my quota today during an old episode of “How I Met Your Mother”)

Ease on Down the Road

January 18, 2012

In two weeks I’m leaving a job I’ve been at for four and a half years.  It’s at a nursing home in the Boston area and while I love the residents I work with there and have become very attached to some, it’s become a twice-weekly reminder that we do not care for the elders in our country with the right priorities.

There are other reasons why I need a change, but that’s all I’ll say for now, because this post is actually about the transition I am helping to create with the music therapist who is taking over my position.

I gave almost three months notice, and while I’m no Mother Teresa, I admit I feel some responsibility, not only to the residents I work with but also to the person replacing me, to ease everybody into my absence smoothly.

So…for the past few weeks, my lovely replacement has been attending my groups, meeting my clients, learning their favorite songs and asking priceless questions about technique and interventions, as well as exhibiting a wonderful personality that fits into the group dynamics well (If you’re reading this, L., I really mean it).  What’s interesting about all of this is that she wants feedback, which I am comfortable giving because of my love for supervision and, I feel like I’m training someone, which wasn’t my original plan but seems to be working out quite well for everyone involved.

Today she and a Master’s level expressive therapy student (who has been observing my group for several months) led the entire session and my residents really seemed to enjoy it. They have always loved it when I’ve had students in my groups and I think the fact that a familiar face (ET student) will still be there after I leave, and that my replacement is able to spend so much time with them before I leave, is hugely helpful for them.  Some of them have known me for nearly five years and have voiced their sadness that I’m leaving, but seeing them so enthusiastic and open to the new MT makes me feel like a giant load has been lifted off my shoulders, and makes me feel less like I’m abandoning them.

When it’s time to ease out of a job, thinking about everyone involved may be inconvenient for us, but it’s worth it for them.

My advice is this: When quitting a job, if it’s possible for you to prepare your clients, co-workers or supervisors for your absence with good feelings, peace of mind and a smooth transition, do it.  It makes all the difference in the world.

 

Patience

October 29, 2011

The following post is a sequel to this post about perfection and improvement.

I began my musical education when I was just a bambino, with musicians for parents, and it continued (more officially) throughout grade school, my (6) years of college, my internship, and professionally, to this day.  I’m a singer by practice, but at this point, I’m more of a practical musician than anything else.  I’m a decent rhythm guitar player, a good pianist, I can play various hand drums and auxiliary percussion instruments (woohoo!), and I can play most songs by ear to some extent.  I have relative pitch, so I can stay on key easily, but I don’t have the nails-on-a-chalkboard aggravation when someone changes the key of a song, like people with perfect pitch sometimes have.  I’ve gotten pretty good at some things over the years, and am still improving every day.  I’m not a virtuoso, and that’s okay (hey – that rhymed!).

I’m not trying to impress anyone in this work, right?

Right.  Unless I’m trying to impress myself.  I hold my music-therapist-self to high standards usually, so I try to do my best.  My best, though, is NOT playing everything perfectly, and always making the right choices, clinically.  It IS challenging myself and taking risks as often as possible, which means that I also have to have a lot of patience with myself when it comes to making mistakes.  It’s important for people in any job to take risks and chances, and if we don’t, we’re really not learning.  Patience is a virtue that helps us improve, not one that wants us to be perfect.

I have forgotten the lyrics to a song, and had to instead lead an impromptu improvisation exercise.  I have said the wrong thing to clients, and I learned not to say those things again.  I have asked questions with confusing wording, and have had to change the question numerous times in order to find just the right one for certain clients.  I have started songs in difficult keys for my clients, and had to transpose into a different key for the next time.  Just two days ago, I gave someone an instrument that ended up being very distracting for him, and I had to do a switcheroo.  It happens all the time. Oh well!  No harm done, and I learned something new about that resident.  The list of things I have done that I would do differently the next time goes on and on and on.  And I’m glad.  If I expected everything to go perfectly the first time, I would end up being sorely disappointed.  If I’m not able to make mistakes and learn from them, I’m really not doing my job effectively.

Most importantly, it takes time to learn.  We dont pop out of the womb knowing everything.  We learn new things, little by little, step by step.  When we’re babies, we learn how to turn over, crawl, walk, talk, and socialize (among other things, of course) at different stages of our infancy, and some of those take longer than others for us to achieve.  Some of those things are a constant process, like language (which unfortunately some adults still don’t have a good grasp on :P) and socialization (with every new person we meet, we learn new rules of that game).

With each stage of our lives, we learn different things, and it’s important for us to really experience and marinate in each of those stages in order to be present and self-aware.  It seems counterproductive to place pressure on ourselves in learning situations, especially when there is sometimes a scheduled process that our progress is dictated by.

As is with any process, whether it be playing piano, practicing yoga, learning to cook, re-learning how to use computers with each update and technological advance, or becoming a therapist, there are stages and milestones, but we’re really always improving ourselves and learning new things.  Which takes patience.  What concert pianists do you know who have stopped challenging their dexterity and musical abilities, and have decided that the most difficult piece they can play is “Rhapsody in Blue?”  I could make more comparisons, but you get the point…

You (and I) are NEVER going to be perfect, and we need to have patience with ourselves wherever we’re at in order to progress.

 

Getting to Know You

September 22, 2011

To my 5 faithful readers out there, sorry it’s been so long since I posted.  Here goes…

Ehehem…There are five major aspects of clients’ lives that I always try to learn first.

Names

One of the most challenging things about starting new jobs is learning all the new names.  I now work at 10 facilities a week.  That’s roughly 150 names to remember, and given the constant turnover in the hospitals I work in, and the turnover in AL and SNF facilities, it becomes…how do I put it…overwhelming.

Last week I started a new contract!  The group was pretty large – 15 people – and I was actually impressed with myself that I remembered everyone’s names ten minutes into the session.

I’m good at it.  Throw me into a social setting, and I’ll forget your name three seconds into meeting you (not something I’m proud of), but at work, I’m a champ.  People are often amazed at how quickly I learn names, and I always say “It’s part of my job.”  It’s incredibly important for the residents and patients I work with, that I never question their names.  If they remember me, I should remember them, and because I do, they might feel better about themselves because someone remembered something about them.  I try to repeat everyone’s name back to them while making eye contact.  That usually works, but when it doesn’t, I go to the nurses’ station and check the names on the white board, or ask one of the aides so I don’t have to let the client know I forgot his name.  If I’m mid-session and blank on a name, I say, “Remind me of your name?” but I try to avoid that.

So…getting to know people is important.

Songs

Usually, upon meeting a new client, there are many things to learn, but there is one thing other than his or her name that is somewhat important as a music therapist, and that’s their favorite song.  Or their favorite singer.  Or their favorite genre. Or their ethnic heritage at the very least.  Sometimes, it’s really hard for clients, particularly those with memory loss to think of just one song, so I play these guessing games until we come up with an answer and sometimes it takes quite a while.  When a person can’t give me an answer to an open-ended question, I give them a multiple choice (between two songs).  Song choices are a big part of my sessions – any former student of mine who’s reading this is probably nodding and smiling – and more often than not, that’s how I find out what someone’s favorite song is.

When MT’s are in training, something we learn is that age often determines what music someone likes.  This is not always the case, which is why we give song choices and begin conversations, etc., but it usually plays a large part in determining what music speaks to people.  It’s a familiar notion that the music from someone’s late teens – late twenties is usually the music the person is most familiar with.  Also, songs from musicals and movies are often exceptions to the “age” rule, as those were meant to entertain a variety of ages at their conception.  People who are 85-93 years old sometimes suggest songs from “The Sound of Music,” or “Cabaret,” even though those musicals came about when the folks were well into their forties or fifties.

Occasionally, someone will have a favorite popular song that makes no sense based on their age, but we figure it out, and play it with the person regularly.  It seems to make a client so happy, so validated, when someone knows their favorite song or singer and remembers time and time again.

Cultural Background

Sometimes the clients in my groups are from different countries, which can be a challenge, communication-wise.  I can certainly ask them in Spanglish or Frenglish or Portuglish what their favorite song is, but often even when a person is from the U.S. I have a hard time understanding his or her response because of a neurological condition, stroke, or missing teeth.  When you throw in a language barrier to those issues, it becomes almost impossible to understand the words a client is saying.  Even if I knew the language it would be hard.  SO… I find out what country they’re from.  I find out what songs were popular in that country when the person was a teenager or child, and I learn them.  I can more effectively give a song choice and find out what a person likes if I have a base to work with.

Sometimes a person’s culture is based on their ancestry or race.  Playing songs that you know a person would like doesn’t just stop with the song, however.  It’s how you play it.  If I have five African-American residents in a group and all of them came from the south, chances are when one of them suggests “Amazing Grace” or When the Saints Go Marching In,” I’m not going to play it straight.  It may seem like I’m sterotyping, but the truth of the matter is that culturally, the blues and gospel are really important to most of those southern folks, and they appreciate when I play the songs with a little soul.  On the other hand, I would switch up the style if a Bing Crosby-lover suggested Pennies From Heaven – in that case, I would probably not play Billie Holiday’s version of the song (http://www.youtube.com/watch?v=JxVXNWdHDq8) but instead, a moderate hybrid of different versions to make everyone happy.

Religious Background

I am not a religious person.  Over the years, I have become more comfortable with my own spirituality and am, for the most part, able to give people the support they need in that regard, but I am severely lacking in the hymn/gospel/praise music category.  If I know that someone belongs to a specific religion or sect, I generally will look up praise music for that branch and give the person choices based on my findings.

Difficulties arise when there is a spectrum of different religions and cultures in one group.  Devout Chrisitians love hymns and Christian praise music.  Jewish residents typically enjoy one or two Jewish hymns, but more often than not choose Yiddish folk songs instead.  Jehovah’s Witnesses do not participate in singing religious music or patriotic songs.  Sometimes there’s age-old discrimination and judgment made by certain residents about another’s culture.  This means that with the religious diversity in a group sometimes comes negativity and prejudice, so unless someone specifically suggests a hymn, we stick with secular music that everyone can relate to.  It’s a hard job, but those group dynamics are always there, and aren’t always conducive to progress.

Physical Abilities/Disabilities

Because I work with elderly clients mostly, I run into a lot of obstacles when finding the most appropriate instrument for someone to play.  If I know they’re strong and have the use of both arms and hands, I give them a drum.  If they can only use one hand, I have flat drums that sit on clients’ laps and the remaining hand can grasp a mallet.  Sometimes a person is severely overweight and doesn’t have much of a lap, so there are maracas for that.  What if a person can’t hear though?  Tambourine.  If a person has pain in their hand and can’t hold onto anything without becoming sore, I have wrist bells.  If I know a person has musical abilities, a flat lap, and the use of both hands and arms, I have a pentatonic marimba for them.  For residents who have dementia and constantly put down anything they’re holding, I have Djembes which stay on the floor and the person can tap with their hands or a mallet.  The list goes on, and over the past several years, I have accrued a myriad different instruments for different abilities, but sometimes the trial and error lasts much longer than I would like, and it’s easy to get discouraged.  When a person (especially a cognitively “well” elder) finds “their” instrument, it’s important for me to remember which one is their favorite in future sessions.

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With each person, there are hundreds of things to learn, and it takes a long time.

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I begin the supervision semester next week.  In my busiest semester, I had 11 students.  This semester I have five.  This means that there are five new people to meet.  Five more people to learn about: their personalities, learning styles, musical skills, sensitivities, emotional health, confidence levels, etc.  I love this part of my year, and it gives me an energy boost knowing that all the things I’ve learned about all the residents I work with, I can teach someone else.  All that knowledge about the little things doesn’t just get lost in the depths of my mind, and the awareness the students gain [hopefully] sticks with them about just how important it is to get to know someone you are working with.

I tend to have multi-dimensional ideas about my posts, and like everyone probably experiences, sometimes things that happen in my everyday, non-work life, remind me of issues in my work life.

One of my hobbies I enjoy the most is cooking.  I’ve been taking risks in the kitchen since I got my first saute pan ten years ago, and rarely use recipes.  The first meal I ever cooked was for my family during winter break my freshman year of college, and it got mixed reviews. I think it was chicken stir-fried with red potatoes, oil, garlic and peanut butter with yellow mustard and a squirt of chocolate syrup.  Hmm.  I remember enjoying it, but certainly not everybody did, (though they were nice about it) and that was fine with me.  The next time I tried cooking that dish, I eliminated the PB and added crushed red pepper.  I made that dish over and over again, changing things and finagling seasoning combinations until it didn’t get any real criticism anymore (except one time when the top of the red pepper container came off in the pan along with about two tablespoons of flakes – eek). I actually don’t make this dish anymore, because I make more advanced meals nowadays, but it was close to the best it was going to be at it’s “last supper,” without me completely changing the ingredients.

Colorful Dinner ingredients in bostonmusiclady's kitchen

When I make dinner now, which is almost every night, I ask my boyfriend how everything is, and I expect an honest response.  Lucky for me, he usually loves what I make, but sometimes the chicken is dry, sometimes the sauce has seized and becomes like hard candy (I often use honey in sauces), and sometimes the salad dressing doesn’t “go” with the veggies and fruit in the salad.  Oh well.  I use this information and use different techniques for the next time I make something, in order to improve at something I love to do, and do almost every day.

I also watch quite a lot of the Food Network.  I watch Giada at Home, The Barefoot Contessa, Iron Chef America, Paula Dean, and my favorite, Chopped, on a regular basis, and I’m always learning new things.  I also see a lot of different personalities, especially on Chopped (if you’ve never seen it, it’s of course dramatic, and contestants get judged on three meals they make out of bizarre ingredients – right up my alley).  Today, while watching an episode of Chopped I had DVRed, I was reminded of an issue in my professional life that I’d like to talk about: Constructive Criticism.

A man on the show was overly confident, and had no shame when it came to his opinion of himself (a little Narcissistic Personality Disorder?) When the judges gave him constructive criticism, he was super defensive, and basically told them they were wrong. It was embarrassing to watch, and the other contestants stood uncomfortably as the man was “Chopped” before explaining to the judges (a panel of experienced chefs and restaurant owners) that they can think whatever they want, because he’s a good chef.  When they explained to him (very sensitively) that having humility is important in getting better at something and overall success, he told them (and the cameraman) that he knows he’s good and that he sorry, he doesn’t have any modesty.  He wasn’t able to hear them in the way they were approaching the subject.  He seemed like he thought he was being attacked, even though they were very professional and diplomatic about everything.

Okay, okay…I’ll start talking about my experience now.

I love constructive criticism now, and it occurs in many areas of my life, but I didn’t always.  I wasn’t ever very defensive, but I used to make excuses when I made a mistake or didn’t do the best I could, and only in the past several years have I been able to become more aware of that “flaw,” and catch it before it comes out of my mouth.  When I was in high school, my band director would correct people every now and then, and we’d all hear the “but, I…” and the director (who is still loved and respected by students at the same high school) would say to the person, “Just say okay.”  The student would say, “but, I…” and he would say, “No. Just say okay.”  We weren’t allowed to make excuses.  If the 30-year band director told us we were playing something incorrectly, we were playing something incorrectly.  This may seem harsh to you, not knowing this person, but it wasn’t.  It was true, he knew it, and he wasn’t interested in our games, or his and our time being wasted by our 16 year-old nonsense.

When a man imagines...that he has attained perfection, his decline begins. - Theodore Martin

This issue is particularly familiar to me now, as I supervise students in their clinical training for the Music Therapy degree (Bachelor’s).  As I said in this post, I love this part of my job.  After each session a student has led part of, we talk for 30-45 minutes about the session.  First and foremost, I ask them (regarding their facilitation) what they felt comfortable with in the session (not what they did well), and then what they would like to improve for next time.  When they are finished talking, I validate what I thought they did well or seemed comfortable with, and then we discuss what improvements can be made.  I encourage students to take risks, and I assure each one that we only really learn when we make mistakes.  I expect students to lead an entire session with functional guitar playing by the end of the semester, but I try to leave out pressure by not ever talking about incorrect chords during feedback time (this was something I was scared to death of in my clinical training, which hindered progress and increased anxiety for me).

I love having students, and some are very attuned to their own strengths and shortcomings, which makes for a rewarding and wonderful learning experience.  Some are not so attuned, and while personality differences are unavoidable, the supervisory relationship is sometimes strained when students feel they don’t need feedback, or that they know better.  They may not choose to do things exactly like I do in their professional lives, but I do expect students to respond to my feedback while they are with me at my sites.  Questions are welcomed, and if a student wonders about my reasoning behind something, I’m more than happy to answer the question.

I am not always right.  I wish I was, but I’m not perfect.  Damn.  What I do know, however, is that I know how to do my job.  I know that the choices I make in sessions are based on trial and error of sessions past, I know the clients and I know what works and what doesn’t with those clients.  I also know that since I went to college for this career and did my required 1040-hour internship six years ago, followed by board certification, five years of professional conferences and doing presentations, experience as a music therapist with seven different companies in over a dozen different facilities, and four years of clinical supervision with students – I have come to the conclusion that I probably know more about my job than someone who has never done it before.  I am constantly improving and developing in new ways, and it’s that change that makes me better than before, all the time.

Once upon a time, in a final evaluation at the school (my grade for students is 40% of their overall grade for the class), a colleague (a professor at the college) and I were told by an 19 year-old, second year student, that we were both wrong in our semester-long feedback.  A long conversation ensued, needless to say, and by the end, this student seemed to understand my perspective, and was able to identify the fact that I was trying to help him to get better at something I’m an expert in, and that he couldn’t let himself hear me say what I was actually saying.  It was pretty intense, so I hope something shifted for him after that.

Constructive criticism is necessary.  Not only does it help us get better at something we love and/or do every day – whether it’s cooking, gardening, skateboarding, dragonboat racing, working, going to school, performing or cleaning toilets – but it helps us become more well-rounded people as well.

When we have nothing left to improve, are we perfect, lazy, or just unaware of ourselves?

Discuss.

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This is the very perfection of a man, to find out his own imperfections.” – Saint Augustine

Perfection is achieved, not when there is nothing more to add, but when there is nothing left to take away.” – Antoine de Saint-Exupery

The search for perfection begins with detecting imperfection” – Anonymous

I have such respect for the elderly. I work with well elders (elders without significant health problems), elders in nursing homes, elders in traditional assisted living facilities, elders in geri-psych units, elders with various forms of dementia…the list goes on. It’s safe to say that in the five years that I have been a Board Certified Music Therapist, I have become somewhat of an expert regarding the aging population. Their diseases, their musical tastes, and their general distaste at being treated as if they were children, are almost second nature to me.

Part of my job is to supervise undergraduate music therapy students during their school year in hands-on, required clinical training. I love the supervisor “hat” and it may be the highlight of my career. I help students learn, improve, and get to really use MT techniques. They come to my sites for 11-13 weeks, and for the last several weeks, they usually are leading entire sessions on their own with my elderly clients, and grow quite attached. They’re not the only ones. Particularly at the nursing homes, the clients (most of whom aren’t suffering from severe dementia) look forward to each student’s visit and when the semester is over, they find it difficult to let go. Those students are literally the high point in my clients’ days.

In my experience, elders like to be around young people because it makes them feel younger, and healthier, and more full of life. They often say things in sessions that would turn their children’s faces bright red, and during discussions, they surprise me by how well they have adapted to today’s societal norms. When we (the young people) aren’t there anymore though, reality often sinks way in.

When one is lucid, can have coherent conversations, and is aware of their declining health, it can be very depressing for them to realize that after our session is over, they must sit with themselves again, often alone, and either dwell on the past, on current aches and pains, or even negative prognoses, and play the waiting game. When a client is emotionally ready to “go,” but their body isn’t finished yet, what can we do, as therapists, to make their time easier AFTER sessions are over, and BEFORE they are able to travel to the great beyond…

I find the Patch Adams school of thought to be very helpful in cases like these. I validate their aggravation, pain, suffering and displeasure at being “old,” and we talk about those things, but then we sometimes go in a different direction. I begin discussions with my elders about the circle of life, about the Earth’s (and our own) natural and perpetual changes, the thousands of generations who experienced the same things, and then we explore the humor in certain unavoidable shared experiences. Ten elderly clients in my groups discuss their various ailments and are always amused and calmed by the fact that everyone is in the same boat. I use a songwriting exercise based on the song “The Old Grey Mare” (she ain’t what she used to be) and encourage the clients to think of things that have changed for them over the years. Through their sometimes hilarious suggestions, they often find companionship and understanding from others, which they might have forgotten existed. They get a reminder that they aren’t alone, and that it’s okay to laugh about a bladder that “aint what it used to be,” or the fact that hair is growing in places it never did before, or even that computers seem to be taking over our brains. It’s a time when humor can be a valuable coping mechanism for folks who have very little in that department, but it’s not always appropriate.

Today, at the end of a session at an SNF, a client’s daughter, who often joins the group with her 96 year-old mother, began talking about how her mother, A., is the “only one left” of all of her friends and family. This is where humor, and my “Old Grey Mare” won’t work, but it was amazing what happened. Every person (who could hear) added a thought or theory about how they deal with loss and loneliness, and we had a meaningful conversation about living “in the now,” as client, L. shared, and not dwelling on things we can’t change. L. is a client who admits to being much nicer and more patient now than she was as a younger person, and presently, she lights up a room with her good attitude (despite hardship and a stroke which left the left side of her body paralyzed) and I believe she copes with her current condition by creating community and friendship whenever she can. Being in the moment is an umbrella that humor is safe underneath, I realize.

We finished the group very differently than how we began it. I’m not a religious person, and “God” isn’t necessarily a part of my life, but here’s what my clients needed at the time:

God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

Que Sera, Sera.