Doing With or Doing To?

Happy Friday to you!

Think with me for a moment about the last time you visited your doctor, or underwent any kind of procedure in the hospital or doctor's office.

For me, that was a fairly painful but brief biopsy. Now, a question: was your perception of that visit or procedure one of having the medical professional do something to you or were you perhaps conscious of a relational element, a sense of doing with?

I think these are very important elements of healthcare and therapy to consider. Chances are, when you undergo "standard" medical care, the dynamic is one of doing to. Think about the language we use: provider and patient, procedure, undergo. As critical thinkers in the helping professions, we know that the perception of care provided is nearly as important as the care itself.

That biopsy I mentioned? The longest. five. minutes. of. my. life. We know that learned helplessness and the feeling of powerlessness is one of the most damaging psychological elements of experiencing trauma. When undergoing a painful procedure, it seems as though there are some traumatic elements "baked in," due to the very nature of needing to allow someone to do something painful to you.

I can't even articulate what a difference it would have made for me to have another music therapist there to engage me in some element of choice and control for that five minutes. I could have chosen my favorite, super intense music to provide a clear signal for my brain to focus elsewhere besides the procedure. One enormous swath of the total experience of that exam room environment would have been under my control, determined entirely by my needs and preferences, and not "standard procedure."

I posit that one of the elements of music therapy intervention and process that sets it apart from other modalities that may address the same or similar goals is the degree to which an MT-BC is focused on doing with.

(Even the cats want in on the instruments for doing with!)

Music is an inherently social process and phenomenon. There are so many ways an individual or group can engage with or in music. You can sing with it, move to it, mouth the words, play an instrument, play what's written or improvise around it, think about the lyrics, analyze and talk about the lyrics, experience and share nostalgic memories in response to it, or just be present and mindfully listen to it. In the presence of live music, some part of you (and many parts of your brain) engages WITH what's happening.

In my work with hospice patients and their families, part of my approach is to include them as co-music-makers to whatever extent is comfortable and desirable for them. And there again, their individual needs and preferences are a driving factor in how our musical interaction takes shape. It's part of my initial clinical assessment: What music does this person prefer and relate to, and how do they relate? Are they a toe-tapper, a crier, a lyric-discusser, a belt-it-out-at-the-top-of-their-lungs-er? Some combination of all of the above?

So when I hand someone with Parkinson's an egg shaker, and they experience tremors, I adjust my tempo to include their tremors. It becomes part of the music. There's relational support. We are doing with, together. Or when someone is more fatigued and they decline to make their own song choices, I don't just decide what music I want to use that visit - I remember and consider what they have responded to and preferred and chosen in the past and keep an eye on their affect, breathing, etc. as I incorporate their previously-expressed preferences and autonomy. And even when someone is only capable of lying still and resting while listening to music, I am carefully watching them for responses - a change in facial expression, breathing rate, motor activity, visible muscle tension - to give me direction. They are still co-creators in this musical experience because what they indicate will determine what we do next.

It's important to remember that I am never providing music "at" someone, but always seeking to engage in music with them. This musing raises the broader question for me of how this unique perspective might translate across the other modalities of healthcare. Could we transform someone's experience of having a procedure "done to them" simply by including MT and the elements of doing with?

Please let me know what you think in the comments and thank you for stopping by!