Nicole Frederick, MA, MT-BC
Music Therapy in the Infusion Center: How to Build Instant Rapport
An infusion center, or clinic, is a place where people receive treatments through infusion.
Let's set the scene...
Patients are brought into a small cubicle with wall dividers and curtains for a privacy. There is typically a large chair in the cubicle for patients to recline and feel comfortable. There are small tables for patients to rest their personal items; and sometimes - televisions! Folks are there to receive various infusions, including: iron, immune system boosts, and chemo treatment.
I have unknowingly entered the room when it is someone's first day, and other times I have joined for their last. I see some folks regularly, and some with hardly any frequency at all.
No one is there with the intention of participating in music therapy, and an overwhelming majority of people have never heard of it.
There is a short window of time to explain why I am potentially interrupting their TV show -- from the first tap on the wall divider to entering their cubicle and sitting down to play. It can feel quite vulnerable. When I walk in with a guitar and offer to play music for the patient, it can feel incredibly intimidating and even a little too close for comfort. Those few moments of introduction are crucial.
I have experimented with different ways of greeting and explaining what I do. So far, I have not noticed any specific causation between accepting music therapy and how I say, "Hello my name is Nicole, would you like to hear some music while you are waiting?" That initial 'yes' or 'no' seems to be more dependent on the individual and/or circumstance.
Sometimes people are very tired and unable to engage. A session for listening or relaxation seems like too much.
Some people have brought work and would prefer to multi-task.
Some folks are unsure what our time together would look like, and the uncertainty of a new experience can feel uncomfortable when they are already feeling both emotionally and physically vulnerable.
There have been occasions when I meet patients who speak a language I am entirely unfamiliar with and I wonder if they believe they might have a hard time connecting with the song selections I am able to offer.
Perhaps this is my own projection, but... I think sometimes when I offer music to middle-aged men, there is a certain "toughness" they feel obliged to show. The lady in the flowy sweater with the guitar might interrupt that narrative - not to say that is my experience most of the time!
There are so many cultural, social, and personal reasons people decline, and I cannot begin to guess what their reason is, nor would it be appropriate.
So, how do I develop instant rapport in those crucial introductory moments?
I have noticed some patterns of when clients seem more engaged based on the interaction immediately after agreeing to receive treatment.
I enter each room with a warm, accepting presence and use my body language, vocal tone, and volume to convey this. Too much talking can be unhelpful and distracting, but just enough communication to humanize myself seems to assist with developing a certain level of rapport. Additionally, it is typically more challenging to create connection if my energy does not match the client's energy.
Something I have learned over time is that HUMOR goes a long way (especially from working with teenagers; but also a great suggestion from Melissa, the CEO of Harmonic Changes)! Making a joke is a quick way to alleviate tension with a patient.
Song selection is also important to consider. While I always ask if clients want to hear a particular song, I also ask if there is any music they absolutely dislike. Then, I ask whether they want an upbeat song or something more relaxing. Those few questions assure the patient this interaction is about their experience and not my own, and gives them a chance to voice their opinions or concerns.
Many times, patients will ask me, "What do you like to play?" Rather than listing off my top ten favorite songs and why I love them, I typically select a well-known tune that fits the mood and respond with, "This is a good one to start us off!" There have been times when I picked a song that the patient did not connect to. Sometimes they are open to other suggestions I have, and other times it has led to the end of the session. It has taken some time to recognize this as a learning opportunity and not a failure. For all I know, it had nothing to do with me anyway!
I have also experienced moments when a patient becomes emotional during a session. I have held space for them as they have cried and shared things that are going on in their treatment and their life. As a music therapist who has also been working as a 'talk therapist' for the last few years, I am working on holding the space for those clients and remembering to label how music is a great vessel for connection and emotional release. Validating this sudden shift in energy and acknowledging the vulnerability is important for developing therapeutic rapport.
Fortunately, there are some clients who do return each week and have learned that they can incorporate music therapy into their treatment. In those cases, it has been a great opportunity to share some psychoeducation about music therapy, including the history of past cultural use of music in healing and also to explain how music has been westernized. With the returning patients, it is a great opportunity to learn their musical preferences and songs that may be important or relevant to them for their next visit, which allows true rapport development.
Spoiler alert, there is no formula for, or maybe even such a thing as, "instant rapport."
But... there are certainly things not to do. Immediately playing a song based purely on the energy in the room and no conversation (with verbal clients who have cognitive function to express their likes and dislikes) does not help the patient to feel heard or seen. Even if it is a great song and fits the mood, people want to feel like they are a part of the process.
As music therapists, we are trained to not discuss aspects of our personal lives, but being too closed off is not helpful in this scenario. There is such a short window and the patient is not coming to the infusion center for the purpose of therapy. Learning to set enough of a boundary to establish therapist-client roles, but humanizing yourself enough to encourage this person to engage is vitally important.
Although instant rapport may be a myth, it is necessary and important to quickly develop safety and connection to patients in this setting. This will be a journey that I learn from over time and look forward to sharing more!