Tough decision

Posted: April 26, 2011 in Music Therapy

I picked up a new client a few weeks ago.  Young man, autism, let’s call him D.  I went for his intake, got a chance to meet him, asked some questions, was all ready to go.  Two weeks ago, I went in for his initial assessment.

I have never had someone react so negatively to a hello song.  He began biting his hand, screaming, and banging the side of his head with his palm.  Usually, people give me a little bit of time before they start acting out.  The reaction I typically get is either one of being excited, pleasantly surprised, or at the very least, vaguely interested.  I don’t always get a huge reaction, but I’ve never had someone act like I was actively trying to cause him harm before.  Not in the hello song – I’ve gotten that plenty of times at other points in the session.

D’s staff had to come help try to calm him down.  Eventually, we moved D down to the other end of the table from me, and he calmed.  He listened as I played.  But when I tried to engage him in playing instruments, he was not having it.  In fact, the only instrument he didn’t shove away was the egg shakers, and that’s because he thought they were Easter eggs and was trying to open them.

I didn’t see him last week because I needed a copy of D’s behavioral support plan to find out what I needed to do in this situation.  I would have been more prepared, but I got nothing about these behavior problems from the intake interview.  Today, however, I went again, and the agitation started before I began playing.  This time, I didn’t let him get away with it.  I remained close by the entire session, and while his staff had to help him calm, he still refused to participate in anything.  The only instrument he took this time was a maraca so he could toss it away.

So now I’m faced with a dilemma I’ve never been faced with in my professional music therapy career – is music therapy really going to be appropriate for D?  He will sit and listen as long as I’m not asking him to do anything – I actually got a smile out of him while playing Take Me Home Country Roads.  But is that really therapeutic?  I mean, teaching coping skills is one thing, but if my presence causes more stress, shouldn’t we be looking at other options?

I’m not ready to give up – not yet.  The smile represents a glimmer of hope.  However, I have to be ready.  I’ve never turned down anyone for music therapy services.  I’ve had people decide that they didn’t want to continue with music, but I’ve never been the one to say “no” at the beginning.  It’s not a precedent I really want to set, but it’s an option that I have to consider.  Especially in this case.

Thanks for reading!


  1. Caylyn says:

    Jesse, I don’t think you should ever be concerned or feel bad about not recommending music therapy for a client. So, don’t think of it as setting a precedent of not providing services, but as setting a precedent of recommending services based on data of what they best respond to, which is ultimately best for the client. Anything else would be a disservice to the client and a disservice to our profession! Now, all that aside, this is a difficult situation you have with your client, because I don’t know the client and I don’t know the type of facility you work in. So, I’m not saying you should or shouldn’t provide MT, because there’s so much I don’t know. I know for me, I work for a school district, and if a student is to receive music therapy on his/her IEP, there needs to be supporting data showing educational need, which includes data showing an increased response in a music setting as opposed to a nonmusic setting. So, there are many students that may, of course, benefit from music therapy, but not qualify for services. And I don’t have a problem sitting in an IEP meeting explaining this to parents, that their child will not have MT on their IEP (because I have strong data (and administration) to support me). This is specific to special ed and my school district. Anyway, I know you didn’t ask for my unsolicited advice. I just happen to follow your blog on my google reader, and figured I’d put in my 2 cents. Feel free to email me. I’m fascinated with individuals with autism, and would be happy to problem solve more if you need.

    • themtguy says:

      Thanks! Advice is a good thing…that’s part of why I do this, just to talk through things and maybe get some other ideas. What I should have said is that it’s a precedent I don’t want to set, but will if I need to. I want to take my time in deciding what is best for the client, I’m just not looking forward to the prospect of having to say no. I also don’t want to make it a habit…I don’t want to start giving up too early.

      I appreciate the comment…feel free to weigh in at any time!

  2. Roia says:

    While it is possible that this young man may not be appropriate for music therapy, it’s also possible that he needs a completely different approach. If he’s okay with you singing to him, then start there. Start by singing about what’s he’s doing. Sing about the fact that you’re trying to learn about him and you aren’t sure what’s upsetting him and why, but you’d like to work on figuring it out with him. He doesn’t seem to use speech, and he clearly hasn’t figured out a more effective way of communicating with you. It may not be that he’s “trying to get away with” acting out. Work at listening to him (rather than expecting him to listen to you), and let him know that that is what you’re trying to do. Often we assume that just because we’re music therapists our clients are going to like us and want to have a relationship with us. Sometimes it takes a while to build a therapy relationship and even longer to create trust. Don’t give up yet.

    • themtguy says:

      Thanks…that’s a thought. That’s a different approach than I’ve taken before, and I’m not exactly sure how it would go. I’m willing to give it a try. And thanks for the encouragement!

  3. Dad says:

    Whoa! That’s a tough one, seems worthy of thought. I can appreciate how unpredictable your world can be – even as experience indicates almost everyone progresses, they don’t stay where they began. His baseline (?), what he brings in, seems to be in a hard to reach place. Thankfully, “his” staff is available to monitor somewhat. I’m guessing you’ll be tracking him for another session or two … it sounds like you’re probing the right places. Any clues from family or staff about what his “acting out” is about? These immediate reactions?

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