Reflections on Being a Music Therapist and a Gay Man
I was recently asked to contribute to a book on music and trauma about my work with clients living with HIV/AIDS. During the planning stages of this chapter and as I began to formulate a title, I found myself reflecting on my personal journey as a gay man in relation to my development as a music therapist. This intrigued me, as I knew if I identified myself, as being gay, I would then have to discuss the correlation between being gay and being a music therapist. There was a sense of nervousness yet elation that I could be open about both perspectives of my life. Never before had I thought about writing on this topic or indeed, if being gay had had any importance in my work and role as a music therapist. This rather foolish assumption rapidly changed as I began to unearth my own journey as a human being and relate it to my fellow gay men as they traversed the confusing and frightening world of HIV/AIDS.
In sharing my work in HIV/AIDS, both with students and at conferences, I always identify the main client group of my work as being gay men. I try to be open about my sexuality in relation to my clinical work, if questioned, though always give the proviso that if the question is too personal I can decline to answer. It is important to state that I never offer information about my sexuality and the potential importance of my identification as a gay HIV negative man, unless asked. In clinical work, it would also seem clear, in my role as therapist that I should never bring or introduce my sexual orientation into sessions unless raised by the client. In the few instances this happened, I would always bring the theme back to the client. I would never lie but similarly I would never allow this to affect the direction of therapy. This, what I considered an ethical mandate, of not bringing in my personal issues, was always central in the developing therapeutic relationship. The centre where I worked made it possible that I could be identified as an openly gay man and music therapist. This meant that I did not need to explain or introduce this aspect to my work. In truth, my own sexual orientation rarely became a problem in working with clients. Rather it became strength. For the first time in my life I could be balanced and at peace as a therapist and gay man.
In this essay, I would like to explore some of the personal aspects of growing up being gay and how this influenced and benefited my clinical work, then secondly make some assumptions about the potential role of being gay and a music therapist. What I have come to realize is that even though being gay is has, on one the hand, nothing to do with my role as therapist, it has, on the other hand, everything to do with how I approach and develop my relationship with clients especially gay men with HIV/AIDS. Being a member of minority group gives me insights into what it is to be alone and marginalized. If I can use the experiences of these fundamentals in my work then I can bring the advantages of being gay into the therapeutic process and relationship.
In a recent discussion with a graduating student, who had a year earlier completed her major research paper on a theological theme, we talked about how God influenced her work and life, and how fundamental her belief was to her everyday sessions. During our discussion, I urged her to be true to these beliefs. We talked about how it was healthy to allow God to influence her work if this brought strength to her role. I did not suggest for one minute that she bring the actuality of prayer, for example, into sessions, but rather that she allowed her essence to color the work authentically. To take God out of her humanness in entering music making to me felt akin to taking her physical presence out of the sessions. What I realized during this conversation was that I too needed to acknowledge the core of who I am as a gay man, and that it is healthy to know this fully and allow it to influence the therapeutic relationship. Perhaps God and the human realities of being gay are just two sides of the same coin. Her belief that music therapy contains a sense of the divine and mine that how one is humanly made is a gift given from God, could perhaps be utilized to provide a truly authentic sense of two beings caught in music. For me music is a manifestation of the divine and as such linked to God however, we decide to explain it.
Growing up, as a part of a minority group, be it gay or otherwise, is hard. I do not think anyone has an easy passage in this regard. I remember so well that feeling of isolation and exclusion from the world and that one’s feelings are estranged and different. For a time one is caught in a state of confusion and seclusion. These feelings are normally complex and multi-layered. This time seems to last forever and is fundamental in coloring the rest of your life. How you remember this time and contextualize it affects your maturation toward adulthood. Coming into therapy as an adult who has faced these hurdles has advantages and disadvantages. On one hand, it can make your openness and sensitivity to the isolation of others more sensitive and direct. It is this potential resonance however that can also be the Achilles heel of the music therapist who is gay, if s/he becomes too sensitive to the dynamics of isolation from others. I often found myself resonating so deeply with a client’s pain that aspects of counter-transference could potentially become damaging to the therapeutic alliance and my emotional health as therapist. All therapists must tread carefully and take note of issues of transference and counter-transference. This is never more apparent than when the therapist draws upon and is affected by his/her personal journey and growth in life. Being gay and a therapist therefore can be both a blessing and a hindrance if not considered carefully and sensitively.
What I realize from this writing is that, in fact, my identification as a gay man and music therapist has always been apparent in my work. It has been an unconscious, silent guide and protector. It has colored my responses to clients verbally, musically, and relationally at a deep and detailed level. The question then becomes ‘why have I never formally acknowledged and embraced being gay as a part of my counter-transference responses in the therapeutic relationship?’ Is it because I am ashamed of my identity as a gay man in a fundamentally heterosexual world? If I identify myself internally and externally as a gay music therapist, would I damage my professional credibility and respect within the profession? While these questions and thoughts on the one hand may seem ridiculous, on the other, they are a reality in the Western world that we all inhabit.
Music therapy is a profession largely comprised of white heterosexual middle-class women. While this statement is not meant as a criticism is does raise some fundamental questions about the nature of the profession. How can music therapy be open to the different fabrics of life when the profession itself is so limited in an orientation to the diversity of sexual preferences? Do we need to be aware of these cultural limitations as our profession grows into new client groups that could require therapists from other backgrounds? Do gay men and lesbian women therefore need to be more aware of the journey they have traveled to be more effective as clinicians in the face of ever more complex diagnoses and pathologies? I would argue that no individual therapist should ever feel the pressure to divulge his or her sexual orientation. I would like to suggest that if a therapist considers their personal journey to be significant, then the links between the therapeutic process and the process of coming to terms with being gay could be significant. Such an approach would advance our clinical work.
I knew, entering the field of HIV/AIDS, that I would work mostly with gay men. The world pandemic that ensued in the late 80’s and early 90’s has mostly affecteda group that is essential to my core identity. I remember my first day of assessments at London Lighthouse, a centre facing the challenge of AIDS, where I started sessions working with clients living with HIV/AIDS. Suddenly the people I might meet socially, at parties and in bars, would be my clients. As they expressed their fears of the illness and uncertainties for the future, deep within me welled feelings of intense counter-transference. Instinctively I knew I would have to deal with these dynamics in my own professional therapy and supervision if I was to survive this work. The overriding feeling that I needed to "save the world," to somehow make things better and stop the mayhem that had begun through offering music was strong. These humanistic notions needed to be acknowledged and addressed. That aside, these feelings felt the healthiest yet terrifying since I had entered the field. For the first time since becoming a music therapist, I began to understand the dynamics of facing a client naked, open and vulnerable.
Through all of these beginning stages, music was my bridge and anchor. In music, the therapeutic relationship found a balance that was my guide through all the times of not knowing and uncertainty. I placed my trust in music, as it was my only constant in the often-frightening layers of complex human ambiguities that were being unearthed in the therapeutic process. Music is immediately emotional and as such cuts through to the core of many clients who are open to the dynamics of music. Clients would often jump into a musical-communicative-spiritual essence with immediate abandon. I found myself in that space of heightened musical expression that happened only occasionally in my earlier work in learning disabilities and mental health. Because of these constant states of what I call "moments of awakening," my own emotions were often left raw and vulnerable. These feelings were not unlike those I myself had explored through music, alone in my youth, as I came to terms with my own sexuality. In my own times of distress, music too was a constant mentor. The link between what I was experiencing with and for my clients was therefore akin to what I myself had experienced and as such gave me different and more acute experiences of counter-transference. The connections between: music - loss, music - emotional pain, and music – hope were all now heightened in the face of HIV/AIDS.
In 1996, I published a single case study book entitled Music at the Edge. The Music Therapy Experiences of a Musician with AIDS. (Lee 1996). The case describes Francis, the kind of client we experience only once in a lifetime. His presence in my professional life remains to this day and our work has become a benchmark upon which I base my teaching, clinical work and research. My goal in desscribing our work was to present the therapeutic process without interpretation or bias. The strength of this focus was at the same time the reason for the misinterpretation of the book by some, within the profession. At that time, I did not consider myself to have competent knowledge of psychotherapy and therefore felt I was not professionally able to provide psychotherapeutic interpretations of the process. I wanted the narrative to reflect, as accurately as possible, what it was like for both client and therapist to travel the course of therapy. I thus included all aspects of the work, mistakes, successes - every detail, warts and all.
There was a dynamic, however, that was not included in the book; namely that we were both gay men. Now some twelve years later, reflecting on our work and the book, I have come to realize that our understanding of each other as gay men and the therapeutic process/relationship were integral. I do not think my responses to Francis could have been as sensitive had I not understood, in part, the emotional pain of his rejection as an HIV positive gay man. Even though I was HIV negative, I knew directly what it was like to be ostracized and rejected for being gay. Theoretically, I suggest that similar humanistic experiences might make it inappropriate and unethical to work with such clients. I assert the exact opposite, that our closeness in experiences as fellow human beings was extraordinary and illuminating at every level. Through detailed supervision, assessment and self-analysis I was able to understand and offer Francis a path through the complicated maze of the therapeutic process. Our closeness and understanding became a force that was the backbone of our ongoing work.
To be authentic as a therapist means to know who you really are fully and honestly. To be authentic in the therapeutic relationship means to know and understand who you are in relation to the needs of the client. To be authentic in clinical music making means knowing your relationship to music, the client’s musical preferences and needs and how this affects the direction and potential outcome of the therapy. If am authentic on all of these levels then I can know and understand the needs of my clients as well as being true to myself. Francis’ authenticity was committed and pure, and as such, mine needed to be equally focused and clear. This huge weight of responsibility often caused me to consider our relationship deeply and clearly, and and to reflect on how my role as a gay man was a part of that process.
My responses to Francis were complex as a therapist, musician and gay man. Verbally, when reading Music at the Edge you will note that my words and interpretations of the process are minimal, whereas my music, when improvising with Francis, is full of questions and challenges. Not only did I know Francis innately as a gay man I also knew him as a strong musician. I felt through his words, there was an exactitude and eloquence of translation from musical experience into conscious verbal thought. His use of words was more enlightened than mine could have ever been. However, I felt his music more deeply. I understood his musical manifestations in improvisation in a way that I had never fully known with other clients. In my work with Francis, all the pieces of the music therapy "jig saw" puzzle came together. In our work, I found the final piece so I could see the whole picture with unerring clarity and color. I believe it was because I understood and resonated with his rejection as a gay man, that he was able to renew, in part and begin again his relationship with music. His musical rebirth was translated through his solo improvisations, which contain some of the most accurate and clear portraits of a dying man known in the music therapy that I have seen in the music therapy literature.
What can someone who is gay therefore learn about her/himself that relates to and supports the therapeutic relationship? Writing these ruminations has given me space to consider aspects of my life, my relationship with music and my beliefs about the human condition. I believe that to be open and vulnerable is a human strength and that in music these characteristics can be portrayed with a transparent delicacy that belies the true nature of creativity and life. My experience of being alongside gay men with HIV/AIDS in music therapy have been life changing at a fundamental level of my being. These men lead me towards an understanding of the balance between life and death. As therapists, we gain more than we can ever hope to give our clients. We are allowed to be with them at times of great uncertainty and distress. The privilege they give is to allow us to be with them at these crossroads in their lives. We should never take this honor lightly.
If my understanding of being gay can enlighten the path for clients and for me in music therapy, then this dynamic is worth acknowledging as a part of the therapeutic process. I am a musician, a therapist and a gay man. All of these parts of my life are integral to each other. None is dependent and non-are more important, they simply are. All human beings have different aspects to their existence and persona. It is how we understand each part and the relationship of the parts to the whole that makes our effectiveness as a therapist balanced and true. This short essay is not meant as an expose, a time to focus on my own personal issues of being gay. Rather I wanted to consider why it is important for therapists to acknowledge themselves fully, so they might enter therapy completely and embrace their own knowing as a therapist. If I leave being gay out of my proclaimed identity, then I will enter the therapeutic arena as less than who I really am. Being gay is only one aspect of me. However, it is important.. I am proud of the hurdles I have faced in coming to terms with my sexuality and I am proud of how this has made me more effective as a therapist. I am not asking other music therapists to be open and divulge their sexual orientation, and I am not asking gay therapists to form an alliance. Through this writing, I simply wanted to express my thoughts of what it is to belong to a minority group, and how that has affected my role as a music therapist.
Francis: "It’s almost as if we each have a song to sing. If you sing your song, your life has meaning, but if that song is either destroyed or not allowed to surface, then you are living very much a second-hand life. It was very much the recovery of my song. I remember I said, "I don’t know to sing? Where is my song? I cannot find it. Help me find it." ... I had seriously lacked the means of expression that was linked to my own feeling and my own emotions – centered in my own creativity ..." (Lee, 1996, p. 136)
Reference
Lee, Colin (1996) Music at the Edge, The Music Therapy Experiences of a Musician with AIDS. New York: Routledge
