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?
-musiceri-
Living Music Therapy Blog 
I feel both if these terms are inappropriate as they have associated negative connotations. As a teacher I was always intuitively and directly assessing individuals as to the support or freedom they needed with a task, or, ‘match and mismatch’. The use of an extreme term like abandonment suggests that one would give up assessing a situation, while interference insinuates a thoughtless act. Both polemical terms are alien to the therapy and teaching situation, but perhaps that is the point behind this reflective post!
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Yes I see the potential for confusion and these probably wouldn’t be appropriate for use in reports for example…
However, as therapists we are dealing with emotions- so perhaps ‘match and mismatch’ wouldn’t really be polemic enough in thinking about how we feel?
It is about feeling that I am interfering with the patient if I say/do/play too much or abandoning them if I say/do/play too little rather than actually doing so. And that’s usually to do with how the patient feels. I am sure this happens in an every day context too- we may feel that friends/family are ‘interfering’ if we try to do something independently but they keep butting in, or we may feel ‘abandoned’ if they are not there to help us in a time of need. In reality the friend/family member may be trying their best to give us support/space.
Some patients may have been physically abandoned by their parents or excluded from school etc. so those could be very real feelings about that coming through in therapy- perhaps anticipating that they will be abandoned again.
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I see…so the use of those words are related to the feelings of the patient and not the action of the therapist, although obviously, such feelings have a direct consequence on any intervention. In such circumstances it is the absence of fear and the need for a positive and safe atmosphere which is paramount along with the observation skills you mention and transactional analysis.
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Spot on pemean- I try to use predictable behaviour, and clear boundaries (same room, same time, no interruptions) to try and create a safe feeling environment. Aim is to create a secure base to explore both positive and negative feelings.
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