Cultivating a culture of respect

Our “Window to the World” series deals with music therapy and/in culture. There are so many definitions of “culture”, and so many ways to look at it, so for this month’s topic, I decided to write about a culture of respect towards our clients, in relation to the concept of informed consent, while studying. It seems like a no-brainer, but often when you’re studying and trying to fulfil your requirements, there are important concepts that might slip through the cracks when working with clients for the first time. I am a white, English-speaking South African woman, and that is the perspective that I write from, but even if you can’t identify with my exact situation, cultivating a culture of respect for clients is important for all of us.

I’ve been a qualified music therapist for nearly 4 years and the clients I face in the private sector now are very different, in so many ways, from most of the clients I faced as a student. I am so grateful to the institutions that allowed me to intern with them, but I was also very aware that these were mostly public institutions, where patient autonomy was not necessarily as honoured as it is in the private sector. Of course there were exceptions, but I want to talk specifically about these experiences. Many of the users in these institutions lived in a lower income bracket, and had lower levels of education, than I or my private sector clients. I found that in many cases, the clients I worked with spoke very little English, and when I requested the help of institution staff to translate why I was there, they sometimes seemed to provide clients with only basic information, often imploring them to sign their consent forms without adequately explaining that they were in no way compelled to do so. Of course, when working with these clients, I did everything I could in-session to ensure that they felt honoured and respected, and most of them expressed how much they enjoyed and benefitted from the process. However, the fact still remained that in many cases, they may have felt obligated to sign up in the first place. I had to ask myself about the ethics of working with “underprivileged” clients in this way, as sometimes it felt as though the only reason I could work with them as a student therapist was because they were “available” and had less of an opportunity to say “no” as private sector users may have. I had to balance my need to reach my course requirements with my obligation to ensure my clients’ wellbeing came first.

Of course there are many aspects that a student therapist needs to be aware of when working with clients for the first time, but here are some things I have thought about to create a culture of respect, based solely on the idea that you may, and probably do, have at least a few clients who were not able to adequately give informed consent for similar reasons to those mentioned above:

• Firstly, we are not here to “save” anyone. Our clients are their own people, with histories, knowledges, thoughts and ideas that we will never be able to fully understand. We need to respect that they are the experts of their own lives, because they are the only people that have to live them.
• Our clients’ wellbeing should take preference over our need to fulfil a quota. In real-life therapy, a client is free to terminate therapy if the therapist is not the best fit for them. When studying, though, you may feel the need to keep working with a client, otherwise you might seem like a “bad” therapist. This only happened a couple of times for me, but it’s alright if you don’t gel with absolutely all of your clients. However, you have a responsibility to your client to ensure they receive the best care you can provide, even if that means terminating therapy. Be open with your supervisors and try to find the most ethical way forward, even if it means you may have to put in a few more hours, starting over with another client.
• Ensure, to the absolute best of your ability, that your clients are able to give informed consent. If your client speaks another language, have the consent forms translated by someone proficient in both languages and in the ethical considerations involved. If your client does not have a good understanding of the technical language used on your forms, simplify it, while still ensuring that all the relevant information is included.
• If you are working with a translator, speak to them beforehand and explain how important it is that your clients feel autonomous and honoured, and that consent is not mandatory.
• If you are working with verbal children, remember that a child is a whole person, deserving of the right to autonomy, and that even if they don’t fully understand what you are doing, it is your responsibility to explain it as fully as possible. In cases where the child cannot understand, it is essential to go through the consent process, as thoroughly as possible, with their guardian.
• KEEP CHECKING IN WITH YOUR CLIENTS. Therapy is an on-going process, and so is consent. Things can change, and you need to remain open with your clients and ensure they feel comfortable enough come to you if they feel it is not benefitting them as it should. Safe, two-way conversations are essential to providing adequate therapy.
• Leave all your issues at the door. Before you step into the therapy space, remind yourself that for the next 45 minutes (or however long your sessions are), you are here for this person. Not yourself, not your supervisor, not your parents, your partner, your grade, or even your future.

I’m sure this list could go on for pages and pages, but these are just a few things I found (and continue to find) essential to music therapy practice. At the end of the day, if you are studying music therapy, you probably feel strongly about helping people through our amazing medium. So we all need to remember, at every step, to honour and respect the people we are privileged enough to join on their journeys.

Caitlin Schulze
WFMT Executive Assistant/ASD