I hear you, my friend. But I don't know what you're saying.

I switch on the digital recorder and direct a few pleasantries towards my client ("K") whilst I set up a djembe, some bongoes, and a tambourine. I tie on some ghungroo leg bells. K does not speak, not really, not in the usual way. He speaks with odd words here and there, movements of his hands and his legs and occasionally his head. He opens his eyes to look at me but the orbits are clouded with cataracts. He sniffs the air instead.

It's important to always wear the same perfume when I come here.

I tell him that the tambourine is on the floor, just in front of his toes. He explores it with his foot, then kicks it towards me. I thank him. I begin to play a drum. I'd like to say 'by mutual consent', but the only way I can judge an affirmative from K is if a negative is not forthcoming. I mirror what he's doing with his hands, as well as his rhythmic sniffing and exhalations. We've made music from that kind of thing before.

He vocalises. Two noises, which I've decided before now to take as encouragement. I move the tambourine back to him and he plays it, then kicks it. I begin to play it instead. I make up a song - "Foot on the floor, hands on the chair. I can hear your music playing, everywhere." This is a variation of an old favourite.

In the recording I can hear K's incessant movement in his chair. He only stops moving when he's asleep.

The words fade out and I play the bongoes as well as the djembe. I get a little too ambitious and lose what I am doing. Then I relax, phase out. I'm in the zone. Hopefully K is there with me too. His foot reaches for the tambourine again.

I try to follow the random patterns his hands and feet make but I've never managed to both watch him and "play his movements". I can only manage an approximation of it. The rhythm roams all over the place, every now and then returning to my holding form. I feel brave enough to bring the bongoes in again and sing, based on some of his vocal noises.

K begins to look more relaxed. His hands stray to his belly, a sign that he's sleepy.  A transition point will come soon. Something will ... happen. Three times more his toes touch the tambourine.

Back to the "foot on the floor" song, in an effort to stave off the looming transition stage. My playing, I realise now, sounds hesitant. I'm expecting K to start complaining (which is what normally happens) and I begin to sound nervous. After 12 minutes the outburst comes. He could be shouting "Tired"; he could be shouting "Toilet." I try to sound calm but firm - I don't want to finish the session early. This is typically what his old music therapist did, every time he began shouting or braying. K never had a session with her that lasted more than 20 minutes.

I've already told K that I won't do that, and I have the full backing of the support staff he lives with. This shouting, they tell me, is K's "behaviours." I know that. I know he is communicating, and feel lousy at still not really knowing what he's telling me, so stridently. The staff insist that he is 'just trying it on', whatever the hell that means, but sometimes I still get uncomfortable .. is he bored? Is he fed up? Is he just trying to manipulate his environment in any small way he can? Is he looking for attention? I assure him that I am still there, and listening, and that I can hear him.

After a little while he calms, settles, and we return to the music. It's as if nothing happened. The session continues for the entire half hour without any further incidents. But I am left wondering, again, if I have done the right thing.

(from a session on a Monday morning, early in January 2012)