Monday, 30 April 2012

Music Therapy and Intellectual Disability

I once supported a young man with an intellectual disability, unable to communicate verbally using words, who cried every time he heard the Canadian national anthem. No one involved in his life knew why, and he unfortunately couldn't tell us any in any other way. Something about that piece of music obviously touched him deeply, for better or for worse.  I don't think that anyone would deny that music is powerful, least of all Music Therapist Roia Rafieyan.  I heard a fascinating interview with Roia on Friday about her work with individuals with intellectual disabilities.

Roia Rafieyan's Work

Roia Rafieyan is a music therapist in a state institution for people with intellectual disabilities. Many of the people that she supports are on the autism spectrum and don't communicate verbally, yet come to her with deep issues like abandonment or trauma, and it's difficult to establish a therapeutic relationship. Roia uses a therapeutic approach called "object relations" to work with clients through song and music.

Object relations is very process-oriented. Clients have goals, such as learning to indicate appropriately when they want to end a session, or making eye contact. Ultimately, however, therapy is more about building the relationship between the therapist, client and the music. Ideally, people will want eventually want to engage in any goal behaviours because they're in a relationship that means something to them.

Roia uses singing and music to let people know that she's listening to what they have to say, and to give people ways to respond to her. She gives choices about what their responses can be: "If you'd like to continue, look at me, and if you'd like to do something else, tell me with your voice." She talks about having a conversation with a person who doesn't communicate verbally using language with her in session, but with bells.

Person-Centred in a Non-Person-Centred Environment

I think what really delights me about Roia Rafieyan's work in the context in which she does is that it's very person-centred. It puts the client and their needs at the centre of the session and lets them make choices, which is the essence of person-centred planning in any context. She talks about how life in an institution is usually "Do this" instead of "What would you like to do?", and about how being in dialogue with someone else is often a new experience for the people with whom she works. Roia says that she has to model "dialogue" and show people what's involved with it.

Roia's work in an institutional setting gives people who don't get much choice in their daily routine or opportunity to express themselves to be in control of their experience for a brief period. The fact that Roia *does* cultivate relationships with people and be in dialogue with her clients in a testament to how powerful her person-centred approach actually is. The key to this powerful approach is careful listening, which Roia says is 95% of her job.

"I think our clients really understand a heck of a lot more than they're able to convey to people," Roia says.

I find Roia's approach very intuitive, and her work is very exciting to me.  She obviously has a deep respect for her clients and a passion for her work, and it's so interesting to hear her speak about what she does. I've only touched on the interview's major points here. It's really worth a listen.

Roia Rafieyan's blog:

Roia Rafieyan's music site:

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