Really hard.

Being a therapist is difficult work. It’s not only emotionally draining most days, but occasionally physically demanding. Especially in Psych.

Today I had the honor of being ‘blooded’ in my first fight. Thankfully, I was not [...]]]> I’m going to try really hard to keep this from being a post about how seriously bad ass I am.

Really hard.

Being a therapist is difficult work. It’s not only emotionally draining most days, but occasionally physically demanding. Especially in Psych.

Today I had the honor of being ‘blooded’ in my first fight. Thankfully, I was not actually blooded.

For those of us who work at institutions, we all receive defense training. We’re all educated about the steps of escalation and de-escalation. For a lot of the line staff who are not a part of nursing, it’s not too frequently we’re involved in altercations.

A lot of the time, it’s Patient on Patient (who’s peers don’t occasionally piss them off?), Patient on nursing staff (they are always there), or Patient on Case Manager or Doctor (source of frustration).

Today, we had patient on patient, but while I was closing group. I was playing a game that I do once a week with my kids, and all enjoy it. Minus this one patient who has refused to do anything whatsoever, has very inappropriate affect, and is a really scary kind of version of conduct disorder, with perhaps some psychosis (he may just be laughing because he’s twisted, I’m really not sure).

We also have a morbidly obese patient on our unit who has already attacked one staff member with (supposedly) absolutely no provocation. This patient is, to put it unpleasantly, a beast.  She goes into rages, is over 350 lbs, and just wow. Don’t want to tussle with that.

In my situation today, psycho-boy was walking up and down the halls during group flipping the girls a bird and cursing out of no where. He was redirected by staff to sit in the day area (oh nice, where I am having group), and he complied. He then continued to sit and curse at me, the males, and the females.

I told him in my most awesomest of therapy voices, that while I am very glad he is participating, his cursing at his peers is not tolerable. He then went down this lane of weird questions to me as to why it’s not tolerable, and who says it’s not tolerable, but I did not engage him. He then turned to Amazon, and called her… guess what?

A Bitch

She told him, showing remarkable restraint, “You don’t call me a bitch”

His response?

Biotch.

To channel my sisters and brothers of another color, that girl got up so fast and went and choked that boy it was just cuhrazy.

Now, to make a story short, I intervened, assisted in pulling them apart, and was really proud of myself for the actions I performed without hesitation.

To stop talking about myself now, I want to bring back attention to how this can be part of the therapists repertoire.

We occasionally have to be intermediaries in conflict. Even as Music Therapists (although there was nothing musical about this conflict). I really believe that this is an important skill that we posses, and often times, don’t even know that we possess it. It’s a gut reaction to protect those that we care for.

I ironically, had my update to my defense training yesterday. As I mentioned, there was a woman there who refused to give mouth to mouth to a patient without adequate protection (i.e. mouth guard). That to me, is appalling. Not only is there the litigiousness of the situation, there’s also the fact that this person is working multiple hours a day in a position where she is supposed to care for these individuals– yet she wouldn’t touch one with her mouth if it would save their life.

We, as therapists, are first responders. We are those that care about the people in need. We are those that shake after an incident, think of what we could have done better, and actively work to make changes so that the next time can be better.

I did the best I could today in the situation I was presented with. No staff was hurt (unfortunately, most of us focused on pulling Amazon off of Psycho, so he was able to get some good hits in). There was no major injury to patients.

I was, however, almost pinned against a wall and I actively worked during the situation to extract myself. I had another staff person tell me later that I was “pulling out of the fight”.

I was very offended. I removed myself from the dangerous spot I was in, then went right back to restraining the patients as much as I could. This person apparently expected me to hold that position at risk of my own safety.

Really? This is where boundaries enter in. I am here at this job, working to provide care for these patients. If I am injured, my ability to provide care is minimized. I had to get out of that situation asap. This person thought I should have stayed to help protect him.

I’m working myself into a rant. I shouldn’t do that.

The main point is that we, as therapists, even music therapists, have to know ourselves well enough to know what we can handle. If two patients start fighting, will we be okay? If a verbal altercation begins, can you diffuse it? the list goes on.

Safety is so important. I’m really proud to have learned today that I am a reactor, and not a freezer.

I honestly forget just how dumb people can be.  And that’s pretty bad, because I don’t necessarily consider myself the brightest crayon in the box, either.

I had the pleasure of brushing up on these skills in the presence of Dr. White, and I’ll have [...]]]> So here recently, I had to update my CPR and defense skills.

I honestly forget just how dumb people can be.  And that’s pretty bad, because I don’t necessarily consider myself the brightest crayon in the box, either.

I had the pleasure of brushing up on these skills in the presence of Dr. White, and I’ll have to ask him to supplement my memory some, but here are some of the highlights I remember:

“I’m not giving no breathing to any patient without mouth protection”

In discussion of severe choking:

“I had that happen once.. I jumped over a gate, fell down the steps, landed on the couch and couldn’t breathe.. I opened all the doors and called 911″

Talking about defensive moves:

“I haven’t had to use it once, except when I strained my back lifting suitcases”

I need Dr. Black to help me out with the rest of this.. my mind is blocking it all out. Needless to say, there was a lot of under the table text messaging.

I wrestled with presenting this story for two reasons:

1) I have not yet written the blog post I mentioned I would be posting.

and..

2) it’s all about boundaries AGAIN!

But then I had a growth moment and realized that if you’re working child and adolescent psych and there are no boundary issues with a patient, that child [...]]]>

I wrestled with presenting this story for two reasons:

1) I have not yet written the blog post I mentioned I would be posting.

and..

2) it’s all about boundaries AGAIN!

But then I had a growth moment and realized that if you’re working child and adolescent psych and there are no boundary issues with a patient, that child might not need to be there, or you should be very, very worried. In the wonderful course of bureaucratic events that I so love to complain about, Dr. Black and I have been, for the most part, unable to work together. This makes me sad, because I am unable to find out if she has refined her Coke Zero Bong Skills. Maybe next time we’re out to lunch, I’ll ask for an updated demonstration..

I digress.

In the wonderful world of sports here in CrazyTown, USA (I named it after myself )patients occasionally have to move from unit to unit based on psychiatric need. Dr. Black is now on what is supposed to be a relatively stable unit. Dr. Black had a patient, whom we will name Britney Shears, cut herself, and threaten suicide. I don’t think this was an isolated incident, so she was transferred to a more acute unit to stabilize her.

I do happen to serve this unit.

Now, in my massive amount of  years of experience (shout out to Michelle Erfurt), I’ve developed the skill to identify potential problems on sight. When I walked on the unit the first time that Britney Shears was present, I knew that a firm boundary maintaining approach would be needed.

Man, I am SO SMART. People are like, CrazyMusicLady, how do you know these things? and I’m like, it’s like ESP man, you just know, and then they’re like Whoaaah and I’m like Whooah.

I digress again.

Britney Shears started by monopolizing activities by asking questions that she already knew the answer to. I played along until she interrupted a conversation I was having with the Charge Nurse. Then it was time to politely redirect.

Oh man. Tears welled up in Britney’s eyes and she left the group before it even started. She spoke to Dr. Aerobics (the psychiatrist on this unit), and told him that she has the same feelings for me as she does for Dr. Black (target number 7, I’m number 8), and that she thought I was mean to her and that she wants to kill herself.

After group, she asked to talk to me, and told me that she thought I was mean. I explained to her that it is my job as a therapist, to not only provide activities, but to also redirect behaviors. I wasn’t trying to be mean to her, I was just letting her know that interrupting conversations isn’t a good way to get my attention, which I knew was what she was trying to do.

Fast forward 5 days later.

Ms. CrazyMusicLady, can I talk to you? I give her 20 minutes.

She then tells me that she’s obsessed with me, not in a sexual way, but in an if she doesn’t have my attention she wants to hurt herself way. I told her that I knew, and you know what? Awesome therapy ensued.

Tomorrow is back to work. More work doing too many groups each day, doing individuals, doing major boundary work, doing wanting to pull my hair out.

I can’t wait for private practice. Then I might be able to write a song or two.

Now before [...]]]> So one of the things I’m really excited about in starting my own business is how I won’t be forced (I know I will to some extent) to work with people for whom I have no respect. I could choose not to work with those people within private practice; I’d just be out money.

Now before you make judgments, on my character, etc know that I give everyone a chance. I reserve judgment on people’s characters for a good while if nothing is remarkable, and only make judgment after a pattern has been established.

No, I am actually not talking about Lord Emperor or Brand New Boss. I’m talking about RON- the Ridiculously Obnoxious Nurse.

I freaking love nurses. Let me throw that out there too. Nurses are what make the hospital tick. They pretty much run everything and being on their good side is imperative as an activities person. They have the power to control when you get off the unit, if you get off the unit, who is in your groups, who your staff is, etc. They’re also just so funny  and sweet sometimes (depends on the brand).

But then, there’s always the rotten apple. RON is a new nurse in our hospital, and I gave her the benefit of the doubt for a long time. Her voice is really high and sing songy and I knew that wasn’t really something she could help. So I’d talk with her and help her if she needed it, and so on just watching and observing like any good therapist would. At first she seemed okay, but then last week hit. I cannot stand this woman.

Respect is a big deal to me. I show you yours, you show me mine (Hey, kinda like Mr. 20 Questions!  Ba da BING!). I don’t mind if people have problems with others so long as they pursue it in a respectful manner. Passive aggression, yelling in public, and insults are not something I tolerate very well. I deal with enough of that from the patients, so let’s leave it at home, ok? Anyway. Back to the story.

There is another nurse, whom we will call SAM for sweet awesome mama because she is sweet and awesome and is one of my work mommy’s. Now, SAM does her job and does it well. She runs a pretty efficient unit, follows the rules, and is polite, yet firm to everyone she meets. She’s a lot like me (I hope ). I think I have some years to go before I can handle my temper like she does. SAM is normally charge because well, she’s awesome. She came in late due to an appointment and RON is going on in her sing songiness about how oh she can be charge, she hasn’t had a chance to do it and how if SAM is going to be late, she should “Practice what she preaches” and let someone responsible be charge.

All in the middle of the nurses station. Loud as she can be. Over and Over.

But it gets better. That went on and on for a bit, but as I was running a group on the unit, I only caught the really loud parts (how disrespectful, right?).

I make CDs for my patients who have difficulty with anxiety and anger and stress as a way for them to de-escalate. It’s a mix of their preferred music as well as some instrumental soothing music, and one track of music and muscle relaxation. One of my patients asked RON for their CD, so she was looking for it. She was asked another question by someone else and her response was “Hold on one minute, I’m looking for this supposedly therapeutic CD.”

Stop. The. Train.

Supposedly? Supposedly? Supposedly?

I haven’t had to explain what I do here, how it benefits, or why it’s beneficial since I started. I suppose that is one good thing about this job. I had one person question me, I answered them, and it’s been pretty good since then on the recognition front.

But, supposedly?

I really wanted to say something. I wanted to talk about her supposedly therapeutic demeanor when she yells at kids, I wanted to talk about her supposed professionalism when she berates her colleagues in the middle of the unit, I wanted to talk about the patient that snatched the supposed wig off of her supposed head because they just got so frustrated with her.

But I didn’t. I didn’t even say anything. I know I should have, but just wow. To say that with me sitting right there.

Now this isn’t all this woman has done, don’t get me wrong. RON is also a big fan of discussing other patient’s downfalls in a loud voice, discussing other staff in a loud voice, asking about people’s salaries, their positions, why she isn’t getting that much, how she’s super awesome and knows everything, and is a big fan of PRNs.

And I just realized this might be the longest post I’ve ever written. I think I’m going to stop now.

How to you deal with your RON’s? or RO?’s?

If you haven’t checked out their podcast, or these awesome ladies, be sure to. They are all included in my blogroll, but in case that is challenging, here are their links!

Michelle Erfurt

Rachel Rambach

Kimberly Sena Moore

Thanks again ladies!

The kids that tend to hang out with us the longest, however, have [...]]]> A common issue in psychiatry is boundaries. Most of our patients either have none, or over do it. Each patient is different, so there isn’t really a set of diagnoses who adhere to one extreme or the other, although there are some trends.

The kids that tend to hang out with us the longest, however, have no boundaries. These are frequently your personality disorders (and as a caveat, me, Dr. White, and Dr. Black all fear for our own personalities on a daily basis).

I know the majority of my readers are music therapists, so they understand the concept of boundaries, but just in case, here’s a definition:

The emotional and physical space that we place between ourselves and others. Setting proper boundaries is important to our mental health. When appropriate boundaries are not set, we run the risk of becoming either too detached from or too dependent upon others.

So like said, my kids often times have no boundaries. I have one patient who loves to get within three inches of my face (and frequently says it’s against their religion to perform their Activities of Daily Living (ADL’s)). I have a patient who, no matter how many times I say no, asks me for a hug at least 3,462 times a day. I have a patient who likes to touch my arm. I have patients who ask me for my phone number. I’ve even had a patient try to lock me in their room.

However, the driving force behind this post today is none of them. The driving force behind this post is Mr. 20 Questions.

Mr. 20 Questions is, albeit, a pretty cool kid when he’s not falling head over heels in love with everything that walks in the door (see: boundaries). He likes lots of older rock which falls right into my personal tastes, and he seems to purely enjoy music and actually attempt to get meaning from therapy. This is what makes it so difficult at times to maintain boundaries, because I really want to just be his friend.

However:

How’d you meet your husband?

How many people did you date before you got married?

You’re so gorgeous.

Do you have a sister?

and the winner of this week that might just put him in the ranks of my conduct boys:

How young are you, Mrs. Crazy Music Lady?

When I deflected on the question by asking how it was relevant to our current conversation, he even took the time to accentuate the fact that he asked how young and not old. “It’s a nice way to ask a woman’s age”.

I repeated my earlier statement with a bonus “Old enough to be married and have a job”. Gotta give the kid something for smoothness.

At this point, the awesomeness ensued. I get called lots of things from kids who hate authority, but I’ve never had an attempted insult be so nice.

You’re so by the book! Hold us at arm’s length. You’re just text book everything! It must suck to be so bland and boring all the time.

What I love is that I am the opposite of bland and boring at work. I’m fun and energetic most times, but still maintain boundaries. Of course, my response to Mr. 20 Questions was “Do you really think I present me in real time here?”

To which he paused. Thought. And replied: “Yeah, no one can be that happy all the time.”

Learned you have, young master.

Also be looking out for my Cast of Character’s page. Dr. White made a request to be re-included. I had unfortunately not attended to this since the Great Crash since scheduling has taken Dr. White and Dr. Black both out of my day to day life.  Know that this brings me much sadness.

Since beginning the planning of this endeavor, it’s made me look at this blog again and [...]]]> Kimberly, over at Music Therapy Maven, has been posting a wonderful series about starting your own private practice.  She actually managed to run this series so that it directly coincided with my plans to get the hell out of dodge.

Since beginning the planning of this endeavor, it’s made me look at this blog again and again. It’s been a short, bumpy run of it, yes, but what should I do with it? Should I strip it down to nothing and start all over proclaiming myself for who I am and have it be the blog of me the public Music Therapist? or should I shut it down entirely, start a brand new page and blog as my public face? I’m kind of hooked on being the crazy music lady. But I’m wondering how to handle this as an entrepreneur.

Any ideas?

PS. Name my private practice. I was hooked for a bit on the idea of using the word modulation, because I wanted the name to have the idea of movement (especially upward) incorporated into it. Now I think that word might just be a bit too unwieldy. If you can come up with an awesome name that makes me happy, I might just send you a bag of M&M’s. Current front runner is a facebook suggestion of Total Harmony. All names are mine until I veto