Of Parents, Attachment, and Surprise Outcome, Part II

A friend asked me recently, "How do you work with the children you have and not get attached?"

Oh, this is such a good question. It takes me back to my earliest undergrad classes, to my earliest work experiences where the mantra was "Keep your distance. Don't get attached."

I will admit, a certain amount of detachment is clinically necessary when one is assessing and treating a client, whether child or adult. You can't let your wishes for that person cloud the very objective data of what he or she is truly capable of at that moment, even if it is far below where we wish they were. That's why we do therapy; to increase their levels of functioning to an optimal level. I once had a tender-hearted freshman music therapy student who was having trouble separating a child from his disability. In her youth and inexperience, she felt that making note of "negative behaviors" or "inability to perform certain tasks" was a personal affront on the child as a whole. I tried to explain to her that the objective, clinical words were what we used to describe the manifestations of the disability, not the child as a person, but I could tell she wasn't buying it. It took some weeks, and a lot of processing, before she could even begin to think of separating the clinical versus the personal. In one supervision session, she almost defiantly told me, "But I'm still going to like him. That can't be changed!"

Well, of course not. I assured her that it was more than acceptable to like this little boy, and in fact, that made me feel confident about her ability to eventually work with him therapeutically. The trick, I told her again, was to be cognizant of her subjective feelings, and to remember to keep her clinical judgement first and foremost. Difficult? Especially for the novice, yes. Doable? You must. If you cannot separate your "wishlist" for the client from what is reality, you will be ineffective as a therapist.

Back to the aforementioned mantra from my bright but emotionally disconnected first music therapy prof: "don't get attached...don't get attached." Um, are you for real? If I did not get attached--in other words, if I didn't care beyond my goals and objectives for each client with whom I came into contact, exactly what good would I be? Does that mean that I am going to develop a symbiotic relationship with the client, and his or her family? Of course not. That would be counter-therapeutic.
So is it counter-therapeutic to enjoy my clients, to be moved by their personalities, their cuteness? No, not as long as I remember why I'm there. Have I had my heart torn out? Absolutely. I've lost tens of children over the past 12 years. I've seen horrible abuse, cruel injustice. For sure, it will happen again, and again. I accept this as part of the package. So I try to keep myself healthy, to find colleagues with whom I can trade reality checks, and to have as solid a marriage and social support system as I can. When something bad happens, I have to face the bad feelings, and yes, the grief. Then I have to move on and continue to be a therapist. To me, that is the most honest thing to do.