Finding an ending
So, immediately after a post about beginnings, I feel compelled to write another about endings. Yes, transitions of various kinds happen in life all the time, and they are not always easy. In music therapy, it is the responsibility of the music therapist to be aware of how issues of transition/termination affect both the client and the therapist, as well as any parents, staff, or other people connected to the therapeutic relationship.
Clinical work with a particular client can come to an end for various reasons. Sometimes, the reason for termination is an anticipated, or even planned, part of the therapeutic process. This could be when a client reaches the scheduled end of a therapeutic program, when a client dies or is no longer benefiting from a particular program due to a decline in functioning, or when a client reaches the goals defined in the treatment plan and “graduates” from music therapy. Each of these situations requires different kinds of preparation for the client and reflection or mourning on the part of the therapist.
What can be more difficult is when therapy must end because of external circumstances, even when neither the client nor the therapist feels that the therapeutic work is complete. This happens when a funding source dries up, the client moves away, or the therapist changes jobs. In my current situation, I will be ending therapy work with some clients in preparation for the upcoming birth of my first child. After I take some time off to be with our newborn, I will be returning to clinical practice with different scheduling needs than I had before, and this means I cannot continue to see some of my current clients. This is leaving me feeling a measure of guilt and sadness, and I can imagine that my clients are feeling sadness, too, as well as anger, confusion, or indifference, perhaps. How should a music therapist manage this?
1. Start processing early
I knew some of my clients would be sad to be ending our music therapy sessions, and it was awfully tempting to wait until the last session to say, “oh, by the way, I won’t be coming back.” While this seemed like the easiest way out, though, it would probably have hurt both my client and myself. Plus, we would have missed the opportunity to do some powerful therapeutic work; after all, transitions are a part of life. Clients will vary on how much time they need to process termination – deciding how many or how few sessions are needed is an important clinical decision.
2. Acknowledge your feelings
Becoming aware of and working through your own feelings regarding termination is important both in caring for yourself and in helping you to be fully present with the client during your last sessions together. The first time I had a really successful group cancelled because of budget issues, I could barely sing during the last session because I was trying to hold back tears. I was concentrating harder on not crying than on what my clients needed in our last session together. Since then, I have focused more on working through some of these difficult feelings in advance, both through music and through conversations with supportive people outside of the therapy session.
3. Help your clients process their feelings, thoughts, and concerns
Once you have worked through some of your own feelings, you will be much more prepared to help clients work through theirs. Again, what clients need varies depending on the individual and the situation, but the music therapist should be prepared to help clients acknowledge feelings such as sadness, anxiety, anger, and fear. These can be processed through music-making and through verbal interaction. I also believe the music therapist should help clients with this emotional processing even if emotional issues were not a main focus of therapy. Making music together has a way of creating an emotional connection that has to be honored, no matter what the main focus of the therapy is.
4. Involve parents/caregivers
Parents, family members, and other caregivers (including nursing staff, teachers, aides, etc.) need to be part of the termination process in two ways. For one, even though the relationship you have with a caregiver is different from the therapist-client relationship, it still must be honored by giving the caregiver time to process the end of therapy for the client. This dovetails with the second reason why caregivers should be involved in the termination process: they are the ones who will be left once you are gone. Since the caregiver will be the one to support your client through the transition out of music therapy or to a new therapist, you as the music therapist should make an effort to address any remaining concerns before therapy ends.
5. Seek closure through music
Fortunately for us, we music therapists get to work through all of these issues through the powerful medium of music. Whether that is by writing a song with the client about the transition, singing favorite songs or reviewing favorite activities, listening to recordings from previous sessions, or just singing that ritual goodbye song one more time, we can let music be the container for the emotional processes at the end of therapy.
Transitions are not easy, but music therapists have the tools to help their clients and themselves approach those forks in the road with less anxiety.
What do you think? How do you manage termination of music therapy? Please comment below to share your experiences!
Rachelle, you make some excellent points in this post. I’ve had my clinical supervisor suggest that in every music therapy relationship we should begin with the end in mind. I work in a (very long term) institution, and when I went to graduate school (after having been a music therapist with some of my clients for 13 years), I had to terminate with half of my (at the time) 120 client caseload. It was difficult, to say the least, but I did learn it could be done, my clients would survive, and I’d survive.
I know this is an old post, but I am struggling to find information from other therapists about this topic! Thank you for your post – as I prepare to move this spring, I am already thinking about how difficult leaving my clients will be. It is nice to have some tips from others!
The issues don’t really change, Molly. It’s always challenging to end relationships with clients. I hope that your transition goes smoothly!
I am getting ready to finish my last week of Practicum III and I really appreciate this post. I am ordering a book that I used that all of the children enjoyed that I will sign and leave a note in for them. It is a book that is musical and we sang to it, used the stead beat, asked lots of Who, Why, What and How questions to initiate reciprocal conversation. I am also going to do some song writing with one of them, and give another little squirrel doll to a little girl who was in love with the squirrel puppet I brought during our Fall songs. We will do all of our favorite hello and goodbye songs and give options for their favorite things we have done together. Thank you for this!