You can lead a horse to water...

Multi-disciplinary working, or, putting it more bluntly, talking to other people in the line of work, has all sorts of positive connotations. We want to know, for example, what else is going on in a client’s life, so that we can make sense of the 30-50 minutes a week that they spend with us. Also, we hope that we can reciprocate. How a client is in music therapy might provide new and surprising information for those people who know them only outside the therapy room. All of us want to make sure that we are helping as best we can, which is quite right. This is not without difficult implications for the clinical work. How does the client feel about the fact that we talk about them with other people? This might happen in front of them, such as at a CPA, or an annual review meeting in school, or it might happen without them there, maybe without them being aware that it is going to happen. There’s plenty of scope for paranoid fantasies about the therapist’s betrayal of their confidence. However, on balance it’s usually a good thing. Therapy shouldn’t take place in a bubble, removed from all contact with the outside world, and we shouldn’t pretend to our clients that it does, because that would be dishonest.

Sometimes teamwork seems to have another function. I am working with a child whose family have a lot of social care involvement, along with a number of other agencies. The social worker is getting exasperated by the lack of progress of the parents. He’s doing his best, but “you can lead a horse to water…” At one core group meeting you could sense the frustration of these various professionals as it became evident that certain messages were not getting across. How can we make things better for these ‘children in need’, without the co-operation and understanding of their mother and father? There’s a sense that the parents are looking around for people to take their place, even be a parent to them. This isn’t stated overtly of course, because it’s probably unconscious, but it’s a strong dynamic. The professionals are left feeling that what they do can never be enough, that there is a bottomless abyss of need. A least, though, we have each other. Yalom describes a ‘welcome to the human race’ feeling that can happen in group psychotherapy (what he calls ‘universality’ in his therapeutic factors), but this goes for multi-disciplinary work too. If none of us can, with our combined skills and experience, fully give these people what they need, then at least we all know we tried our best. We can’t fix everything.

A recent occurrence in this same case illustrates something else that’s helpful about working with other professionals. I had a phone conversation with the social worker where he told me that the client had told dad that “music therapy isn’t working”. This was in the context that pressure was being put on him to “talk about his issues” in therapy. The parental hope was that music therapy would make him better behaved, easier, that it would take the strain off at home. In his next session, I tried to bracket this. I didn’t want to make the session all about what he’d said to someone else, quoted out of context. But I was more alert to possibilities in this area. He began to talk about a friend of his who should be having music therapy. I suspected that he was really talking about himself and the conversation developed in new directions. We were able to think about why he is here, what music therapy might be for. “How might music therapy help your friend?” opened us up to interesting speculation. Maybe we would have got there anyway, but my awareness of recent events outside the session was a useful influence. Perhaps it’s about striking the right balance between the inside and the outside. The outside shouldn’t encroach, dictate the session before it’s begun, but it also shouldn’t be ignored.