Working in care homes I come across many different people. The older people I work with (clients), their relatives and friends, the staff who care for them and run the homes where they live, my fellow health care professionals and the generous volunteers. With so many people involved it can be tricky to get across what I’m doing, or trying to do, for the residents. In the complex jigsaw puzzle of the care system music therapy is a little piece, a lesser known allied healthcare profession when compared to the role played by carers or GPs for example. Raising awareness about what it is and how it can help can feel like a relentless hamster wheel, gently correcting and redirecting the well-meant but often mistaken assumptions that people have.
So I wondered if I could try to explain some of the common misunderstandings that I have encountered. Bearing in mind that for most music therapists the phrase “so, what is music therapy?” sends shivers down their spine, this could be easier said than done.
1) “It will make you happy”
Let’s start here, as to find or to have happiness is a worldwide pursuit. On my way to and from music therapy sessions with residents we are often stopped and greeted. “Have a good time”, “enjoy yourself” and “have fun” are amongst the civilities. In a setting where people are struggling with loss on multiple fronts - loss of identity, loss of occupation, loss of independence, loss of their home and possessions, as well as the losses felt by their relatives and friends - it can become vital for relatives and staff to be able to think of and see the residents being happy.
The focus of music therapy sessions is not to make someone feel happy, but instead it is to try to establish how a person is feeling and to be there with them with those feelings, whatever they might be. This is not to say that happiness is not important. It is. But so are all the other emotions that we can experience. People with dementia still feel the full spectrum of emotions that they have always had. However, their ability to cope with or process them may have declined which could lead to frustration, anxiety or agitation. Music therapy can offer a means of non-verbal self-expression, whether the resident is feeling happy or sad, wistful or excited, tired or animated. By using a mixture of improvisation and familiar music the communication of feelings and emotions can be given almost an alternative language.
2) “How did they do?”
There is no ‘right’ or ‘wrong’ way for clients to be in sessions. They cannot get it ‘wrong’ as sessions are person-centred and the therapist follows and supports them in whatever mood or state they are in. So I suppose the answer to this will always be that they did it perfectly.
I sometimes wonder if this also ties into a mistaken belief that I am there to teach the residents. Perhaps this is because music lessons are a more familiar concept than music therapy so people jump to that to answer what I do in their minds? The irony is that I am an instrumental music teacher. I have taught cello, sax and piano for years. But the two professions are worlds apart.
3) “You wouldn’t want to see them!”
…”they’re too challenging.” Staff can sometimes seem to be trying to protect me from the challenging behaviours that residents can exhibit as a result of their confusion/dementia. Often, these are the very behaviours that I am trained and employed to try to help the resident and home with.
Challenging behaviours can be anything from wandering or perambulating, to physical aggression and the whole spectrum in between. Imagine having a surge of emotion but not being able to understand what it is yourself, and also not being able to communicate it to anyone else. By the therapist’s intense observations of body language, facial expressions, tone of voice and any verbal interaction offered they can try to gauge how someone is feeling and to then meet them with music to support and validate those feelings. This can lead to the resident feeling responded to and understood which in turn can lead to their mood changing. But if it doesn’t change that is ok too, and we can remain in their current emotional state together rather than them being there alone and unsupported.
4) “Why don’t you see so-and-so instead?”
What is the saying about best laid plans? Seeing people for sessions in the place that they live in means that there can be a vast number of things that can prevent you from being able to have a session when you had hoped. The resident might not be up yet, or they might be doing something else or demonstrating their right to choose by not coming (it is important to respect people’s autonomy). Consequently, the usual boundaries of time and place associated with therapy may need to become flexible in order to facilitate sessions.
I work with individuals who have been referred to individual music therapy for weekly sessions. The referral process at my workplace (it will be different in other establishments) enables me to learn about the resident’s personal history, their medical diagnosis, the medication/s that they are prescribed and the potential side effects that they could cause, possible risks both to them or to me, the reason that the referral has been made and so on. After referral, six assessment sessions are offered. This process enables a more thorough understanding of the resident as well as the chance to establish therapeutic aims for the course of sessions. Seeing people for one-off sessions can be done, but it is a very different process without this background knowledge. That isn’t to say it is better or worse, just different. It is my priority to try to see the residents who have been referred to me and are ‘in therapy’.
5) “Are you doing music entertainment later?”
I run an open group therapy session each day. The term ‘open group’ means that anyone can come or go as they please. I’ve mentioned the confusion that people with dementia can experience. This, combined with the common hearing problems that older people can have and the difficulties with processing situations or events occurring around them, can make it problematic to run large open groups in the traditional improvisation-based manner. The structure and familiarity offered by pre-composed, well-known songs and tunes can provide residents with a feeling of relaxedness and comfort. This in turn can provide a foundation for increasing positive social interactions and communication between the members of the group.
Isolation is a common result of dementia. Depression can be a common secondary symptom too, which itself can lead to isolation, lethargy and apathy. Engaging residents with familiar music can promote opportunities for sociable encounters with others. And once people are engaging and interacting it can be possible to encourage improvisation. This promotes spontaneity and creativity which in turn can raise self-esteem and feelings of being skilled.
There are many more misconceptions surrounding music therapy, but more importantly there is a growing understanding of our clinical work. As staff see their residents respond to both the individual and group sessions they themselves become more interested and supportive of sessions, enabling residents to attend and offering them gentle encouragement if they seem unsure. We are able to work as a multi-disciplinary team, feeding back important observations and suggestions to each other. As music therapy reaches and helps more clients and their families, people’s understanding of it will continue grow.
Dementia affects an ever growing number of people and it affects each of them differently. Music therapy offers a person centred, non-drug based intervention which can be relevant in the early stages of dementia all the way through to end of life care; for those at home in the community, in hospital or in care homes, regardless of the challenges and difficulties that the client might be experiencing. As a profession we strive to continue to learn and keep our knowledge up to date in order to best meet the individual needs of our clients. No two sessions are alike, just as no two clients are the same. Our training enables us to tailor sessions to the ever changing needs of the individual. It is both a challenge and a privilege to carry out this work.