Working in mental health, I don’t disclose a lot of personal information about myself to my patients. This population already deals with a mixed-up understanding of personal boundaries. It’s part of who I am as a therapist to define what I do or do not reveal about myself that keeps these boundaries therapeutic. The question I never answer is, “How old are you”? It seems like a harmless question, and I really don’t mind people knowing my age, but as the therapist, it’s important to me that my patients understand structure and boundaries. My response is as polite as possible, often joking with them, but what I’m really assessing is: Does this information change the therapeutic relationship and/or the therapy itself? Usually, the answer is no, so I keep that information to myself.
But what if the answer is yes?
Two and a half years ago, I was diagnosed with Type 1 diabetes (T1D) as an adult. To say
that it came as a shock would be an understatement. T1D is an autoimmune disease and has nothing to do with your health, fitness, or your lifestyle as is commonly misunderstood. Doctors/scientists do not know where the disease comes from. All they know is that certain maladaptive cells in my body decided to attack themselves in my pancreas, so now it no longer produces insulin. Insulin helps to breakdown the glucose (sugars/carbs) in your body to provide it energy. If glucose is not broken down in your body, it leaves the system without being processed properly, and your body begins to break down the fat storages instead. When this happens, it leaves you feeling hungry, tired, sick, weak, thirsty, and unimaginably irritable. You lose weight, your vision blurs, and your health becomes dangerous.
When I was diagnosed, I was scared but relieved to have an answer. Mostly though, I was angry that I had yet another thing I needed to advocate for. I’m pretty sure I immediately told a friend, “I am not going to be a poster child for this disease. Do not make me stand up and give a speech about it.” My entire career is already a thing for which I am passionate and requires me to continuously explain what it is, and advocate for its awareness. In my mind, there was no room for both music therapy and T1D. They both require the same amount of exhaustive explanation. I could not believe I would have to spend my life not only explaining my career to everyone I meet, but also my health. So, I made a very clear boundary between the two, and put T1D towards the back of my persona. I am a firm believer in person-first language and I applied this to my own thinking. I am not diabetic. I have T1D. Diabetes is not who I am as a person, it is an element of my life.
Having dealt with this chronic disease for only 10% of my life, it has clearly required some adjustments. One of my biggest adjustments has been to realize that I am not invincible. As a therapist, it is a difficult thing to accept that we cannot help everyone and that we have our own limitations. Our passion is to help others by sharing the tools (music) that we have in order to help people heal. As a new professional, you become much more aware of the elements of your patients that could be potential triggers for your own emotional and mental issues, and where your boundaries lie when working with them. If you don’t realize these areas, then you are not able to be objective in treatment, and you set yourself up for the possibilities of transference and/or counter-transference. Working in mental health, I was surprised at the number of patients I received who also had a diagnosis of T1D. Unfortunately, dealing with a chronic disease over a lifetime can make you much more susceptible to mental health disorders, specifically depression. Having patients come in for mental health issues as a result of their T1D is not uncommon.
“Diabetes isn’t just a physical challenge with serious implications; it’s also emotionally demanding and can be extremely difficult to navigate mentally.”
Just like everyone else, I have my good days and my bad days. Some days I feel much more resilient in my own health and my mentalities, and I can easily interact with my patients without a second thought. Other days, I have to turn to my coworkers and say, “I can’t. I need a little extra help today”. I have to accept my vulnerability as a person and know that I am not invincible. I often say, “Everyone has something”, whether that’s an illness, a traumatic history, or a mental health issue. Regardless, you have to realize where your own boundaries lie.
For me, I do not share my T1D diagnosis with my patients. That is generally not information they need to know in order to benefit from music therapy. But sometimes, it comes up. The worst thing about T1D is that you cannot be prepared for it, despite your preparation. As I deal with my own coping skills for this disease and figure out better management, different issues arise unexpectedly. In music therapy, my job is to constantly be assessing. I’m assessing my patients, their environment, the music I’ll be using, how I will be using that music, my responses to my patients, and on and on. That in itself is a lot. But sometimes that work gets interrupted by T1D, despite my preparation and my prevention of disease difficulties.
I might I get low blood sugar immediately before a session, which means I’ll be late in order to treat it. Treating low blood sugar requires 15+ minutes of my time and cannot be ignored or postponed as it is extremely dangerous. Sometimes I get low blood sugar in the middle of my session and my brain becomes foggy, my motor skill reactions are delayed, and I feel like I’m “stuck” in motion, all the while still being in charge of facilitating a session. Other times, my obnoxiously loud insulin pump alarm goes off in the middle of group, and I have to either excuse myself without explanation, or apologize to the group for sticking my hand down my shirt in order to get the pump out and turn the alarm off. When these things happen, I have to simply accept that I am human. More specifically, I am a human with a fault, just like my patients, and the rest of the world.
Know that being a music therapist, or a healthcare professional of any kind, does not mean you are above your patients, or unlike them. We all have something. It takes practice, patience, and a little bit of courage to be honest in order to identify your balance as a professional and as a person. I wouldn’t go as far as to say this is my music-therapist-living-with-T1D-poster-child speech, but part of my acceptance of myself is in acknowledging my uniqueness (despite the fact that I’d rather not be this unique). Recognize that you can not only #livebeyondtype1 but that you can also be a music therapist with shortcomings. Successfully.