Special Feature
lnformation
DIANE SNYDER COWAN
The impact of the therapists personal needs on any thera
peutic intervention is always present despite the therapists
awareness, or lack thereof, of these needs. One of the most
powerful events of the approximately 100 music therapists
who have interned at Saint Lukes Medical Center (SLMC) has
been the assessment of their needs as therapists and the im
pact of these needs on their work with patients, whether that
impact is beneficial or harmful. The purpose of this article,
which illustrates the needs assessment process for music ther
apy interns at SLMC, is to encourage educators, clinicians,
and most importantly, interns and their Clinical Training Di
rectors to examine how personal needs impact performance
in work related settings.
Saint Lukes Medical Center is a 400-bed teaching hospital
providing services in general and specialized medicine, gen
eral and specialized surgery, trauma, obstetrics and gynecol
ogy, pediatrics, psychiatry and adult day care. It is on the near
east edge of Cleveland and in a culturally diverse neighbor
hood.
The Music Therapy Intern is assigned to one or two medical
floors, psychiatry, and the adult day care program. Before the
internship, the therapists experiences are limited, especially
with gang related violence, trauma, teen pregnancy, and
abuse, as well as the natural course of aging and illness in the
forms of oncology, AIDS, and cardiac illness. The intern is
suddenly thrust into a culture that is quite foreign. Interns
might then approach patients with questions such as How
do you feel about this?, Tell me about your support sys
tems, and Lets explore some coping strategies. These ques
tions lead to self exploration.
In an initial meeting within the medical setting, the music
therapist must quickly assess the patient, implement an inter-
Diane Snyder Cowan, M.A., RMT-BC
apeutic Arts and Clinical Training
Cleveland, Ohio.
0 1996, by the National Association
Sharing
Meeting Whose Needs?
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The Personal Needs of the Therapist
Saint Lukes Medical Center, C/eve/and, Ohio
vention and provide closure because the patient may expire
or be discharged that same day. While some patients are
housed for up to ten days and others for several weeks due to
placement problems, the majority of the patients are in the
hospital on a short-term basis. The patients needs, whether
they include feeling expression, sensory stimulation, or pain
relief, must be immediately and appropriately addressed. For
instance, how appropriate is it to sing songs and give guitar
lessons to a teen who has overdosed purposely because she
was angry with her mother and will most likely be discharged
to her mothers care later that day? Identifying support systems
and positive coping strategies through song writing or lyric
analysis may be more appropriate or beneficial. The music
therapist who feels comfortable recognizing and meeting her
own needs easily adapts to this ever changing and challenging
clientele and, consequently, provides appropriate intervention
rather than feel good songfests.
The exploration of ones needs is not addressed in the music
therapy undergraduate curriculum (Petrie, 1993), nor is it
found in the music therapy literature. The nursing literature
speaks of the therapeutic use of self and implies that the
way nurses view themselves impacts their therapeutic rela
tionships (Nicoll, 1986). Needs assessments of forensic psy
chiatric nurses have been studied to determine what these
nurses need to know to have a sense of accomplishment and
a satisfying experience (MacDonald & Gorgin, 1991). While
working with mentally ill patients in a forensic setting, art ther
apist Geiser used her art to cope with and explore her reasons
for choosing to work in corrections (Geiser, 1989).
Though the process of exploring personal needs benefits
professional and personal growth during the nurturing learn
ing experience of the music therapy internship, it is important
for all therapists to reassess their needs from time to time.
is Manager of the Department of Ther
Personal Needs
Director at St. Lukes Medical Center,
No matter what profession one chooses, personal needs af
for Music Therapy, Inc. fect ones performance in that profession. Exploring the need
50
Personal Needs of the Therapist
to be a therapist can reveal in what ways the profession is
personally satisfying. In turn, investigating these needs helps
the therapist become more aware of how needs influence
what one does as a therapist. Gaining awareness of how needs
affect behavior will help the therapist monitor and control her
behavior so that the primary goal of the therapeutic relation
ship is helping the patient and not the therapist (Augelli, Dan
ish, Allen, & Conter, 1980).
A need is a necessity, a want, a desire, a wish for something
that is lacking (Augelli, et al., 1980). Maslows Hierarchy of
Needs identifies five specific categories of needs: physiologi
cal needsfood, water, sleep, and shelter; safety needs-safe
ty from threat, and fear of the unknown; love and belonging
need-love, affection, closeness, and acceptance; esteem
need-self-respect, self-esteem, achievement, self-worth, and
recognition; and se/f-actualization need-the need for chal
lenge, variety and introspection. According to Maslow, unmet
needs interfere with growth, while satisfied needs promote
growth (Maslow, 1970). From a holistic perspective, unmet
needs could lead to or aggravate physical or mental illness
(Marriner-Tomey, 1989).
Effects of Needs on Performance
Outlined below are examples from Augellis et al., Helping
Skills that address how needs may affect the therapists be
havior positively and negatively. The need for power and con
trol may cause the therapist to be very manipulative. She may
use advice, questions, and influence to keep control and
predetermine the outcome of the intervention. This could cre
ate a controlling or dependent relationship. However, the
therapist could use this need to be clinically prepared for the
intervention.
The need to be depended upon or needed may also build
a dependency relationship and/or extend the relationship too
long; the patient could become over-reliant on the therapist.
In a positive light, the patient would always be able to count
on the therapist.
The need to be seen as competent and knowledgeable may
create a situation where the therapist might not be willing to
admit mistakes, or would self-disclose or advise excessively.
A positive way this need affects the therapists behavior in
volves working very hard to know as much as possible and
to always strive to do her personal best.
The need to be liked and admired, and the need for ap
proval, may cause the therapist to not be completely honest
with the patient. The therapist may not be assertive or con
frontive when appropriate for fear of hurting the patients feel
ings. When this need manifests itself positively, the therapist
would be very accepting of the patient.
Notice how each need can be seen in a positive or negative
light. Needs are not good or bad; a need is a need. It is This combined with the significant incident and a lengthy dis
the behavior that can result from an unfulfilled or unrecog
nized need that can be harmful. Whether we can recognize
51
the need or not, it is there, and consciously or not, we are
seeking ways to fulfill that need.
The understanding of ones needs for helping others is a
process. As awareness increases, more personal needs will be
discovered. With more experience, the needs will change. For
example, a beginning therapist may have a need to be liked
while a more experienced therapist may have a need for rec
ognition, both of which relate to self-esteem.
The reasons for entering a profession differ from ones per
sonal needs. Reasons for helping are not equivalent to per
sonal needs that are fulfilled through helping others. However,
looking at the reasons often begins the self-exploration pro
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cess. Although the reasons for entering the profession of music
therapy are diverse, the following are repetitive themes that
SLMC interns have shared over the past ten years:
I wanted to combine music and psychology.
I wanted to combine music and medicine.
I did not want to be a music educator.
I wanted to combine my love for music and helping others.
I was not good enough to be a performer.
I never heard about this until I started college.
My mother has a mental illness.
My father was a minister.
Again, the reason for entering music therapy is different
from how music therapy meets ones personal needs. Exam
ining the reasons acts as a stepping stone to discovering what
is it about helping others that is so satisfying.
Introducing the Needs Assessment
Before addressing this issue with the interns, seeds con
cerning needs are planted from the onset of the internship. A
weekly written significant incident allows the intern to pro
cess some meaningful or striking event that has happened dur
ing the week. The incident includes interactions with health
care professionals and/or patients. Statements such as The
patient thanked me or I felt like a member of the team
elicit questions from the supervisor such as What needs of
yours were met? How were your needs met? How important
is it for you to hear thank you? How important is it for others
to show respect, to be treated as a team member? and so
forth. Consequently, when the interns are asked to explore
their needs they are not taken completely by surprise. Some
interns have long been on the journey of self-discovery, others
have never given it a thought.
The interns at SLMC begin the needs assessment assignment
after completing the first four stages from Augellis, et al. Help
ing Skills: A Basic Training Program. They have successfully
learned and have been using helping skills as well as have
been writing verbatims of these skills. A verbatim is the doc
umentation of a conversation between therapist and patient.
cussion of needs acts as a precedent for this process. The
needs assessment is a written narrative similar to the sonata
52 Music Therapy Perspectives (1996), Vol. 14

form. A need is stated, explored and restated. In the following Geiser, R M (1989) Reflections. A Therapists Exploration: Face to Face with the
Dark Side. The Arts in Psychotherapy, 16, 133-136.
meeting, usually one week later, the interns share their self-
MacDonald, R.. & Grogin, E. (1991). Personal accounts of satisfying and unsatis
assessments and those are explored further. fying nursing experiences as a needs assessment strategy. Journal of Continuing Ed
While the interns needs vary, common needs that have ucation in Nursing, 22, 11-15.
been shared by many SLMC interns are often related to self Marrlner-Tomey, A (1989). Nursing theorists and their work. St Louis. The C.V.

esteem issues. These include the need to be liked and the Mosby Company.
Maslow, A. (1970). Motivation and personality, 2nd ed. New York: Harper and
need for recognition. Interns often ask what is the next step
ROW.
now that they have identified these needs. This is a difficult Nicoll, L. (1986). Perspectives on nursing theory Boston: Little, Brown and Com
question. The importance of recognizing and monitoring ones pany
behavior is crucial to how the intern defines her role as a Petrie, Ill., G. E (1993). An evaluation of the National Association of Music Ther

music therapist. If other more pressing life issues are revealed apy Undergraduate Curriculum: Part II. Journal of Music Therapy, 30, 158-173.

as a result of the needs assessment, then the intern may benefit

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from further counseling.
Monitoring the therapists behavior after recognizing her
needs can be easily achieved. For example, if an intern has a
need to be in control or to always be successful, she can be
prepared with an activity to meet every possible scenario.
Therefore, she will have set the stage for more control and
success and be well prepared when doing medical interven
tions. In an acute care setting, needs change constantly. Flex
ibility is still a must, but once the therapist is open and able
to assess the need of the patient immediately, she can then
implement a pre-planned activity.
Personal crises always affect our lives. Sometimes the ther
apist needs to express her feelings, and she can to a certain
extent meet that need in the context of doing a feeling ex
pression activity in a group setting. In this case, it is not ad
vised that the therapist share her deepest feelings and con
cerns as this would be an inappropriate time for self revela
tion, but that she, in her own private way, express herself
through the music.
The need to be liked can interfere with appropriate and
therapeutic confrontation. Therapeutic confrontation is gen
erally conducted in a nurturing atmosphere. One intern ad
mitted to not confronting her medical patients about lifestyle
changes or how they were coping with their terminal illness
for fear of hurting their feelings and not being liked. She traced
this back to growing up unpopular as a band nerd. Once
she became aware of her need, she was able to challenge
herself and began to confront others appropriately and
achieve positive results with her patients.
Personal needs are manageable and the feelings of self-sat
isfaction are increased when needs are met. Acknowledging
and meeting ones needs promotes growth and enhances ones
sense of well being. When needs interfere with the therapists
level of functioning and impede treatment, they need to be
immediately addressed. Needs are not something to be fearful
of nor a reason for embarrassment. They are simply needs and
constitute the makeup of human beings,

References

Augelli, A., Danish, S., Allen, H., & Conter, J. (1980) Helping skills: A basic
training program. New York: Human Science Press