25 years has passed since I entered my first palliative care room. Today, like all the other days in the past, I was unfamiliar with the person I was about to meet – all I knew as I walked through her door was that her name was Sheryl and she was the same age as I was.
Although support for hospice palliative care is almost unanimous, with the vast majority of Canadians (96%) being supportive, only 16% to 30% of Canadians who die currently have access to or receive hospice palliative and end-of-life care services – depending on where they live in Canada.*
Palliative care is a philosophy and a specialized approach to care that encompasses the physical, emotional, social, psychological, spiritual and financial needs of residents living in long term care homes and their families. Fundamentally, Palliative Care aims to enhance quality of life for residents who are experiencing progressive and life limiting chronic or terminal illnesses – World Health Organization
Music therapy is a discipline in which credentialed professionals (MTA*) use music purposefully within therapeutic relationships to support development, health, and well-being. Music therapists use music safely and ethically to address human needs within cognitive, communicative, emotional, musical, physical, social, and spiritual domains. – Canadian Association of Music Therapists
My first encounter in Palliative Care , early in my career, was a weighty and memorable experience. Gwen invited her daughter and sister to her room with the intention of having a memorable afternoon of saying goodbye. Gwen was the conductor of her final weeks and had asked me as the Music Therapist to learn her 12 signature songs. As I played through each of the songs the ladies painted a canvas of flowers later to be pressed on over 150 CD labels along with the 12 signature songs, to be given to every person attending Gwen’s funeral.
Today’s session, 25 years later, the sessions still seem weighty. Sheryl is 46, with her 21 year old daughter doing homework in the corner and her mom reading a book quietly beside her. She looks at me with a familiar twinkle – that knowing look shared by people of the same age that says “I know you will understand – can you help me?” – without saying a word.
Sitting close to Sheryl and asking her a few music-based counselling questions her music preferences are quickly identified (and mocked by her daughter). Small smiles are soon witnessed and songs begin to be sung, followed by the stories that are closely hinged with each musical memory. I have witnessed these bonding moments more times than I can say. It happens quickly. The book and homework are quickly tossed to the side, and the four of us begin to feel a meaningful connection that transports us to another place – one that feels almost like home.
At one time, Music Therapy was documented as a ‘technique’ used by many professions – but the complex nature of music coupled with the therapeutic relationship with a Music Therapist required Music Therapy to become a specialized discipline – requiring its own standards of practice and code of ethics. As with all human service professions, research has revealed the reasons behind many of the clinical stories being experienced – with the core reason in Palliative Care settings to be mood and memory support:
- Curtis conducted an empirical study to evaluate the effects of music on pain relief and relaxation of patients with a terminal illness. Curtis SL. The effect of music on pain relief and relaxation of the terminally ill. J Music Ther. 1986;23:10–24.
- Whittall conducted an empirical pilot study documenting the effects of music therapy on anxiety among those with a terminal illness. Whittall J. Songs in palliative care: A spouse’s last gift. In: Bruscia K, editor. Case Studies in Music Therapy. Phoenixville, PA: Barcelona Publishers; 1991. pp. 603–10.
- Longfield conducted a quasi-experimental study measuring the effects on mood and pain in hospice patients receiving music therapy. Longfield V. St Louis, MO: Saint Louis University; 1995. The effects of music therapy on pain and mood in hospice patients. Unpublished master’s thesis.
- Calovini’s master’s thesis in music therapy studied the effects of participation in one music therapy session on state anxiety in hospice patients. Calovini BS. Cleveland, OH: Case Western Reserve University; 1993. The effect of participation in one music therapy session on state anxiety in hospice patients. Unpublished master’s thesis.
As Music Therapists, it is our role to listen well, show compassion in a useful way, translate what we hear into action, and create a session that is all-inclusive to those in attendance. Music Therapy is for all persons, regardless of where they are on the spectrum of their first to last breath.
Kathy Kortes-Miller trained as a Music Therapist and now an internationally renowned Death Educator says, “Music Therapy is closely aligned with the philosophy and vision of hospice palliative care because it concentrates on bringing forth the personhood of the individual who is dying. Music can illicit memories, emotion and decrease anxiety and experiences of pain. Music Therapy can also support a connection between the music, the memories and social supports important to a person who is dying.”