早前我寫過數篇文章,包括《在英國讀音樂治療的日子》、《Fresh grad from UK》和《一篇短文: 與瑪麗醫院癌症中心一位治療師共事經驗分享》,而這回我則會跟大家談談我與瑪麗醫院合作的第二份工作。
在詳細介紹當中的個案及工作前,我想先分享一下我對這個行業小小的看法,以及一些我認需要處理的問題,才能令這行業有突破。這篇文章只反映我的個人意見。
關於我自己
這是我從事兼職音樂治療師的第3個年頭,生活依然忙碌,工作量當然也一直上升。現時我平均每星期要會見6位單獨客人和一個小組;而除了參與外展活動外,我亦擁有自己的治療中心—Music for Life。
作為一名兼職音樂治療師,我很滿意現時的工作量。我發現即使我每星期只有7小時治療時間(不包括交通時間),我仍要花雙倍時間去擇寫報告、進行檢討工作,以及備份每節治療時拍攝的錄影片段。至於其他行政工作則包括為籌募經費而寫建議書和籌備講座等等。
關於香港音樂治療行業
本港對音樂治療的需求日漸上升,而市民對其的認識亦有所提升;然而,我仍認為本港的音樂治療業只處於起步階段;因此,除了多做研究工作外,我認為應在教育市民方面多下工夫以提升民眾對音樂治療的認知。
瑪麗醫院癌症中心個案分享(2014年10-12月)
在這個個案分享中,大家要留意的並非病人,而是治療過程及我對治療工作的想法。以下我將解釋每個治療過程:
招募、進行治療 及評估
招募:這個程序是由中心的社工進行的。與社工溝通是一項很重要的過程。包括討論參與治療小組合適人選的條件,以及量度治療效果的方法和工具。
而以下各方面則是我會考慮的因素:
- 時間
- 在寧養服務治療環境中,時間是我最注重時間的問題。我該如何快捷地營造一個安全、健康,且適合群組活動的環境?最直接的方法是去尋找每位組員的分享中的相似之處,這可以是他們的年齡層、性別、家庭,以及他們的願望等等。
- 年齡層
- 現時患癌的病人愈來愈年輕,而由於不同年齡層的人對音樂有不同偏好,因此我們必須考慮治療小組成員的年齡。此外,旅遊經歷及人生履歷不同亦會影響參與者對生活的態度。
- 性別:全女性、全男士,還是男女混合小組?
- 我一向比較喜歡男女混合小組,因為這樣能稍稍平衡小組活動。我發現女士通常較情緒化,而男士的思想則較理性,我總希望男女混合小組能平衡這個問題。
- 我們也能以一個有趣的角度想想,若全男士的小組中只有一位女治療師,以及一位男治療師面對全女班的小組這兩個情境,相信兩者給予人的感覺會完全不同。
當選出了小組成員後,我會要求中心在小組開始前先向我提供病人的簡單檔案,這包括了他們的性別、年齡、健康狀況及家庭背景。
進行治療
如早前提及,我最主要的考慮點是時間,以及治療師與患者的良好關係。
因此,除了心理/生理因素,如年齡、性別及健康狀況外,我亦需要了解治療者分享其他方面的事情,例如我發現對於某些治療小組而言,家庭及養育問題會成為治療重點。
- 家庭
- 與西方相比,家庭在中國文化中佔有重要地位,更極端而言,在部份人眼中,家庭,尤其是媽媽,能推動他們的生命。若小組中的組員一同分享為人父母這個話題的話,則能更快地建立組員間的關係。
- 健康因素
- 有時候當病人開始講述自己的病情時,我有時感到不知所措, 有一點被抽離的感覺。例如當他們在講述自己無法正常呼吸、或是提及藥物的副作用時,自己會很難參與討論,我無法給予他們情感上的支持,我甚至感到自己無法勝任治療師的工作崗位。然而,當我想到治療小組的目標是為了向病人們提供一個地方,讓他們能互相支持時,我的自我懷疑便會頓時消失。
評估
病人無法參與定期的治療是經常會發生的事情,我以往在8位病人當中,只能成功收集到4位病人的治療前和後的資料。然而,當我能成功收集到那些資料後,所有參與者對自己的自我認識都有所提升,他們不像以往般焦慮,而且與親友間的溝通也較治療前有改善。我對於這個結果感到非常滿意。
結論
我認為與醫院職員的溝通很重要,而治療期間,治療師也必須要清楚理解自己的想法。
文章由註冊音樂治療師張潔瑩小姐撰寫
電郵:carolkycheung@hotmail.com
Previously I have written several articles – 在英國讀音樂治療的日子 , ‘Fresh grad from UK’ and ‘一篇短文: 與瑪麗醫院癌症中心一位治療師共事經驗分享’. This time I would like to talk about my second project with Queen Mary Hospital.
Before I go into details about the case work, I would like to share a little bit on my views on how this field is progressing and what needs to be done in order to move forward. Again, this article only reflects my personal opinion regarding these matters.
A little bit about myself
I’m approaching my 3rd year working as a part-time music therapist. Life is hectic as usual. Work load has definitely increased. On average I am seeing 6 individual clients and 1 group per week. Apart from doing out-reach work, I have also set up my own centre, Music for Life.
As a part time therapist, I am satisfied with my workload. I realised that although I have 7 hours of therapy work each week ( excluding travelling time), I actually spend double the time writing up reports and re-viewing and backing up videos taken from sessions. Other admin work will include writing proposals for funding, organising talks etc.
A little bit about the music therapy field in Hong Kong
I definitely see an increase in demand of music therapy and its importance has been recognised more. Having said so, I still think that our field is in its very infantile stage. Apart from more research, a lot more work needs to be done on educating what music therapy is to the general public.
Case Sharing Queen Mary Hospital: Cancer Centre Oct- Dec 2014
The focus of this case sharing is not focusing on the patients, but more about the execution and my thoughts behind the work. I will discuss the work by each process
Recruitment à Implementation à Evaluation
Recruitment: This procedure is done by the social work at the centre. It is important as a therapist to communicate the concerns of who is eligible to join the group. The criteria that I have considered are listed below.
· Time
In a palliative setting, I am most concerned about the time. How can I establish a safe environment with a healthy group dynamic quickly? The most direct way would be to discover the similarities that the member shares. This could be their age group, gender, health concerns, their family, their wish and hopes etc.
· Age group
More and more younger people are being diagnosed with cancer. It’s important to consider the age span of the group, as people are exposed to different type of songs. Their attitude towards life may also be different by how much they have travelled or experienced life.
· Gender: All female, all male group, or a mixed group?
o I always prefer a mixed group as it balances out the group dynamic a bit! I realised that females tend to be quite emotional whereas male think rather logically. Hopefully in a mixed group, these aspects can balance out.
o It is is also interesting to think about the group dynamic if it’s an all male group with a female therapist. This may create a totally different dynamic if it was a male therapist and vice versa.
After the members have been selected, I ask the centre to send me a short profile of the patients to study before the group starts. This includes their age, gender, status of health, their family background.
Implementation
As spoken before, the main concern for me is time and establishment of therapeutic relationship.
Therefore, apart from the physical / biological factors, such as age, gender and health status, it is important to know about other aspects they share. In this particular client group, I realised that family and upbringing were the key themes.
- Family
Chinese culture values family a lot more than the west. To be extreme, family is the motivation for life for some people, especially to mothers. If the group shares this common theme of being a parent, it will be a lot quicker to establish a relationship between the groups.
- Health concerns
There were times when I felt out of place when patients started talking about their problems e.g. can’t inhale properly, side effects of the medication. I found it hard to join in the conversation and cannot offer emotional support, and started to feel I am failing on my job. But when I thought about the purpose of the group, which was to offer a space for mutual support for the patients, then the doubts instantly vanished.
Evaluation
It’s always a problem when patients fail to attend sessions. I was able to collect pre and post data with 4 out of 8 patients. However with the data that is available, all participants shown an increase in self-understanding, less anxiety, better at communicating with family and friends. I am very happy with the result.
Conclusion
I reckon that communication with the staff at hospital is very important. It is also important to understand and constantly think about therapist’s own state of mind whilst conducting the therapy work.
Written by Registered music therapist – CAROL CHEUNG.
Email: carolkycheung@hotmail.com