A Natural Vehicle for Patient-Centered Care
by Laura Kanofsky | Board Certified Music Therapist and Licensed Clinical Social Worker
Patients on hospice service, their loved ones and the professionals who work with them often experience a need for sources of comfort and avenues of communication that go beyond the pharmacological, verbal, and even the linear. Music Therapy, a professional discipline that was formally established in the U.S. in the 1940’s, but has existed, less formally, since biblical times, is remarkably well-suited to address many of the issues that arise for hospice patients and families.
In hospice, music therapists focus primarily on psychosocial issues, as well as spiritual and physical needs. Music therapy, even in the absence of verbal language, can decrease feelings of isolation, and provide a sense of familiarity and comfort. It can help someone maintain a sense of control through decision-making about most musical aspects of the session. The associations and feelings evoked by music can facilitate reminiscence and life review. Music can create a connection with one’s history, one’s faith, one’s unconscious. It can reach a person in a deep and highly individual way, yet it can transcend differences and awaken a sense of universality.
The following are a few common goals and corresponding approaches/interventions:
Goal: Provide vehicle for expression and containment of grief and other feelings
Intervention: songwriting (to familiar or co-created melodies)
When a patient is well enough to participate in this process, it can provide needed catharsis in a creative and supportive context. If starting from scratch is too daunting, substituting lyrics into known melodies can be utilized. This process can also serve to validate a patient’s sense of purpose or meaning in life.
Goal: Facilitate access to long-term memory (to connect to emotions and to experience sense of mastery)
Intervention: Singing songs that held meaning in patient’s youth/young adulthood (and if relevant and possible, in the patient’s native language so as to provide cultural affirmation)
Since music serves as a direct link to long-term memory, this type of music therapy, often with instrumental accompaniment, is common in hospice work. It is exceedingly moving for all involved when someone with advanced dementia becomes more alert and animated, more connected those around him, and more dignified due to even a fleeting moment of heightened lucidity brought about by music. Families and friends sometimes experience music’s profound ability to recover speech and memory as “magical”.
Goal: Improve/help heal family relationships and provide family support
Intervention: Semi-structured group musical improvisation; singing/lyric discussion
Hospice provides the opportunity for family members, even formerly estranged ones, to come together. Improvisational songs and chants, possibly with untuned (rhythm) instruments, enable family members to share thoughts, feelings and wishes for the patient and each other.
Selecting songs to sing or music to listen to that have had special meaning within the family can carry a symbolic message or create a collective sense of unification, as life preceding the patient’s illness may be recalled. This also provides a way to be with the patient that doesn’t rely solely on language.
Goal: Provide comfort, solace, support of pt’s faith through traditional forms of worship
Intervention: Singing of hymns, chants or playing of other liturgical music
Goal: Help alter perception of pain/induce relaxation
Intervention: listening to live music that is soothing, or recorded music, possibly with suggestion for imagery; musically matching and guiding breathing
Although there are several theories to explain how it is accomplished, research has shown music therapy to be effective in altering the perception of pain.