The Gift of Intuition

Any clinical professional knows that we study certain rules and guidelines for assessing our patients and clients and then determining appropriate interventions for them.

One such guideline for music therapy for determining appropriate preferred music to use in therapy is that we generally stick to music that was popular when our patients were 15-25 years old. Research shows that this decade of life is when our brains tend to be most susceptible to forming intensely nostalgic, emotional connections with music. The rule tells me I am far more likely to get engagement for therapy when I can find music that likely played on the radio in someone's first car than if I use music their grandparents went out waltzing to.

I have had great clinical success with the process of consciously applying this guideline and sifting through all the available data on each patient to arrive at some great educated guesses to get started. And we know that a responsible MT is going to assess actual responses to music and keep sifting through that data and always take a patient's expressed preferences as the most important information.

And yet...

There are moments when my internal dialogue keeps pestering me with something that falls outside of the rules and guidelines for what "should" be preferred by any given patient. My intuition persistently demands that I ask them, that I offer this music and just see if they even know what I am talking about and if they want to engage with this music. Some of the most powerful clinical responses I have ever gotten have occurred as the result of listening to those intuitive nudges.

And music therapy is not the only area of clinical practice where a departure from the standard procedure occasionally yields a strong result or critical finding. How many physicians can tell stories of that time they ordered a test for a patient for no reason that made logical sense to them, but their gut just insisted? They just "had a feeling" they needed to order the chest x-ray or the bloodwork even though nothing in the presenting symptoms clearly pointed to this?

What exactly is going on with clinical intuition? I want to unpack that a bit. So many of us explicitly trust our logical, linear thinking processes that consciously sift through data and apply theories and guidelines, and thus implicitly remain a little wary of anything intuition tells us.

I recently read The Gift of Fear by Gavin De Becker. This book completely changed the way I view intuition as a subconscious cognitive process (and not as mystical, otherworldly, "hunches.")

Imagine your reflexes for a moment. They operate outside of and faster than conscious awareness. The other morning, I brushed the back of my hand against the slow cooker. My arm flew up and away from it faster than I could realize why. I didn't have to consciously think, "This is hot. I know that this temperature will damage my skin and cause pain. I should move my hand now." It just happens.  Later that morning, I was on a run and happily inside the reverie of my mind, almost in a meditate state. Suddenly, I felt my legs seize up and my body jerk backward, milliseconds before I became aware of my head turning and my eyes and ears consciously registering the oncoming car. My instinctive reflexes operated on behalf of my best interests before my conscious, logical mind had any say whatsoever. And good thing, too.

What does this have to do with intuition as a cognitive process? Imagine it like this: your conscious, logical, linear mind is a bit like a teacher giving a lecture to the rest of your brain. "We are going to take this data today and apply these rules to it and that's how we will know what to do for this patient." Your intuition is all the other unconscious parts of the brain, the room full of students busily gathering sensory and memory data and passing notes to one another in the classroom. By the time these students have generated enough flurry to get your conscious attention and you intercept the note, you can be reasonably sure they have something worth your attention. Yes, intuition is sometimes wrong, but it learns. That error will be stored away for future use and used to inform those busy little students for next time.

This is how the process played out for me in a visit with a patient: By all the "rules," she should like rock and pop music from the 1970s and 1980s, and she does! No problem there. So why, when she mentioned an image from her childhood, did I suddenly feel an overwhelming urge to offer her a cowboy song from 1935? There was no logical reason for my mind to go there, but I had just intercepted a note from my subconscious that said I really must. So, I asked. I said her words had brought some lyrics to mind, and did she know anything about this song? She said it sounded familiar and asked me to please sing it.

She burst into happy, nostalgic tears at hearing this song and told me her grandmother used to walk through the house, singing it all the time, and she had mostly been raised by her grandmother. From there, we discovered many of the other songs she learned at Grandma's piano. The biggest increase in her subjective self-report of her well-being and quality of life happened in that session, using music that I never would have arrived at by only considering the data from my conscious mind.

Somewhere under the surface, my intuition was sifting through everything I had ever learned about this patient, the CDs I had seen in her apartment in passing, statements she had made, and I don't even know what else. But finally, my intuition had something important enough to bother me with, to interrupt the teacher's lesson and get caught passing me that note.

I'm so curious what other clinicians have experienced with the role of intuition in their practice. Drop me a note in the comments and thank you for reading!