Musical Endings: Music Therapy in Palliative Care

Monday, Nov 25, 2013

Written by Dr. Amy Clements-Cortes, PhD, MT-BC, MTA, FAMI

 

Music Heals is excited to present to you a picture of the beautiful music therapy work done by Amy Clements-Cortes, PhD, MT-BC, MTA, FAMI. Amy is an assistant professor University of Toronto; music therapy instructor and graduate supervisor at Wilfrid Laurier University; Senior Music Therapist/Practice Advisor, Baycrest, Toronto; Past-President CAMT; and WFMT Clinical Commissioner. She is also Co-Chair of IAMM Conference 2014 and Chair CAMT Conference 2014. We thank Amy for demonstrating such an inspiring passion for her profession!

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I am a music therapist, music therapy educator and researcher who specializes in older adults and those suffering from a terminal illness. The need for palliative care services throughout the globe is growing due to the increasing aging population, and the upsurge in disease and terminal disorders. The needs of clients in palliative care vary but there are common issues which clients might present, including pain management, symptom control, anxiety, maintaining dignity, and cultural, spiritual and emotional needs (Halpin, Seamark, & Seamark, 2009; Higginson, Wade, & McCarthy, 1990; McKinnon, & Miller, 2002). Common emotional/psychological needs consist of adjusting to fear, sadness, perplexity, and anger. If these issues are not addressed, they may lead to serious psychiatric disorders, including depression, anxiety, and confusion (Lloyd-Williams, 2008).

 

Music therapy is a recognized treatment in palliative care that offers an innovative approach benefiting clients throughout the dying process. Music therapy interventions range from passive to active techniques and include music listening, lyric discussion and analysis, Guided Imagery and Music, improvisation, songwriting, musical life review, production of legacy gifts, relaxation, and singing/playing instruments. Music therapy can help clients going through the dying process to improve communication with family and friends and gain a sense of legacy and finality near the end of life. Music therapy has proven effects on anxiety, pain, mood, quality of life, heart and respiratory rates just to name a few areas.

 

Working in palliative care I find it exceedingly important to learn about the lives of each of my clients in helping them face death. Walking down that road with each of them and their significant relationships has been an honour and privilege that has changed me. Facing one’s own death can be a time of significant growth and transformation. Reflecting and reassessing accomplishments and regrets often brings numerous emotions to the surface which may be difficult to deal with and process. At times clients prefer to keep emotions buried because they may be complex to work through. Fortunately, music is a powerful tool in being able to both bring those emotions to the surface and successively process them.

 

On a daily basis I see the importance of dying persons’ need to express sentiments and final thoughts to loved ones. This often involves the expression of key sentiments such as “I love you” and “thank you”. One might not think these words are challenging to express but they can be; and music is one way that helps patients to express these emotions while also providing an avenue to leave behind a legacy gift such as a musical recording for their family and friends.

 

Reminiscence is another important area of clinical focus in palliative care. Jonas (2005) states music for reminiscence can reinforce the patient's self-identity and promote communication between patient and family, and particular songs used for reminiscence may evoke memories of childhood, teenage, and adult years. Re-connecting to identity is important for many clients at end-of-life when so many changes have taken place affecting their independence, physical appearance and ability to make choices due to impairments in cognition. Another key indicator for using music for reminiscence is if the client shows signs that he/she could benefit from life review. Creating a musical life review can bring different generations together in interactive, meaning-making ways, as well as aid in emotional connection, remembrance, and creating meaning for one’s life (Berger, 2006).

 

I use music with my clients in various ways at the end-of-life. For example, I had a 40-year-old client who wanted to create a scrapbook for her children but did not have the energy in her last weeks to complete this project. Together we wrote a song which I recorded for them and we shared it at a family music therapy session together before she died. The song became significant to her family, was played at her funeral and is the theme song on her tribute website.

 

Another client I worked with wanted to express sincere gratitude to her husband for the care and support he provided to her in her last months of life. She knew he understood she loved him, but it was imperative for her to express this gratitude and love in a unique way that he could treasure once she passed. Together over several weeks, we selected pre-composed songs and also wrote songs to express gratitude and love for their life journey together. We performed these songs for her husband at a “mini-concert” in her hospital room. Her husband was so moved that his wife had written songs for him. I recorded these songs and gave them to her husband after she passed away.

 

Over my years of work I have witnessed clients who gain insight in their last days by opening themselves up to expressing emotions and thoughts through clinical improvisation and I have sung at the bedside with family members who are accompanying their loved ones as they let go of this world. These are two examples of the work I am privileged to be a part of. I never underestimate the power of music when implemented in conjunction with a therapeutic relationship to bring healing. I am so honoured to be a music therapist!

 

Written by Dr. Amy Clements-Cortes, PhD, MT-BC, MTA, FAMI

 

References

 

Berger, J. S. (2006). Music of the soul: Composing life out of loss. New York: Taylor & Francis Group.

  Halpin, D. M. G., Seamark, D. A., & Seamark, C. J. (2009). Palliative and end-of-life care for patients with   respiratory disease. European Respiratory Society Monograph, 43, 327–353.

Higginson, I., Wade, A., & McCarthy, M. (1990). Palliative care: views of patients and their families. British Medical Journal, 301(6746), 277–281.

Jonas, J. (2005). Reflections: Music therapy in palliative care. Human Health Care, 13(3).

Lloyd-Williams, M. (Ed.). (2008). Psychosocial issues in palliative care. New York: Oxford University Press, Inc.

McKinnon, S. E., & Miller, B. (2002). Psychosocial and Spiritual Concerns. In B. M. Kinzbrunner, N. J. Weinreb, & J. S. Policzer (Eds.). Twenty common problems in end-of-life care (pp. 257–274). New York: McGraw-Hill, Inc. 

 

Note: This post is used with permission from the author.

 

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