By Melanie Kwan, LCAT, MT-BC
Patients who are chronically or terminally ill face all kinds of physical and emotional challenges, and need support for a myriad of needs. A bio-psycho-social-spiritual approach may be useful to integrate the needs of the patient as a whole person. According to Dileo (2005), a biopsychosocial paradigm “embraces the interrelationships” of physiological, psychosocial, cognitive and/or spiritual need areas. This perspective takes into account the physical fatigue and discomfort or pain that comes with medical treatment and/or battling a chronic illness with no good prognosis in sight; the mental stress of figuring out the logistics of caring for loved ones and/or being cared for; and the emotional worry of how the sickness has and will impact self, family and friends. Music therapy accesses this biopsychosocial framework easily because various music elements may reach, engage and impact the different levels of awareness and consciousness directly or indirectly, engaging as many or as little of the senses as the patient is able or willing to take part in. In particular, songs may be a powerful medium and vehicle of such access.
Portenoy, in his foreword to Music Therapy at the End of Life, described music therapy as a “science and creative art modality that can contribute to the growth and development of palliative care as a comprehensive discipline” whereby
“music therapists who understand the challenges posed by the seriously ill can alter the perception of pain and suffering for patients, and at the same time provide relief for their families in unique ways. . . the level of care and intervention should be intensified in the setting of advanced illness ensuring the patient and family that comfort will be a priority, values and decisions will be respected, psychosocial and spiritual needs will be addressed, practical help will be available, and opportunities for closure and growth will be enhanced.” (Dileo, 2005, xii)
The benefits of music therapy in hospitals, hospices, and in palliative care are supported both anecdotally and empirically (Bailey, 1983; Curtis, 1986; Whittall, 1989). A meta-analysis of 18 studies (Dileo & Bradt, 2006) reported significant mean effects of music therapy interventions (with patient-preferred music) on dependent variables associated with cancer, AIDS, and terminal illness which included pain, nausea/vomiting, mood, and depression.
Through inspiring lyrics, lush orchestrations or scoring, and singable melodic lines, songs have the capacity to bring hope and comfort to a patient who is terminally ill. In particular, songs that have a powerful association with significant events in the patient’s past may bring back memories, and strengthen bonds with loved ones. Songs may further communicate support where words fail, and convey, “I get it” in a subtle but deep way to the patient’s experience. Appropriate lyrics at an opportune time may help connect the mind and body so that the patient may feel integrated, when his/her body is struggling not to fall apart. This may be empowering as the patient’s body gradually deteriorates and the organ systems begin to shut down. In offering choices to the patient, it is important to consider the stage of the therapeutic relationship (initial, established, transitional, or closing), and to match the patient’s mood state and needs (for example, relaxation, rest or release). In the early sessions, familiar songs facilitate trust in the relationship. The content of songs may be discussed using lists and songbooks. As the relationship progresses, songs may be used to reflect and affirm the patient’s mood state i.e. not offering “Joy to the World” to a patient who appears agitated; or loud, fast tempos to a patient who is feeling hopeless or blue. Songs may offer opportunities for patients to connect with parts of self that are healthy or well, and to affirm healing experiences.
Lyrics may be substituted with themes that the patient and family finds meaningful. This becomes even more significant as the patient loses function. Later, the music therapist may offer to keep coming back and singing for the patient, even after the patient becomes less able to respond, setting up pre-arranged cues such as a hand squeeze, or a pre-determined number of blinks of the eyes, “I know you’re still listening, and I’ll keep singing your favorite songs.”
Patients may wish to write their own song, and express whatever is on their mind or heart. By doing so, they may mourn the losses that come with having a chronic or terminal illness. Songs may express hope, or affirm their coping resources. They may also want to leave messages or song legacies for their loved ones. In that case, the MT can help the patient organize thoughts, feelings and intents into verses, and the main theme into a chorus that repeats. This helps the patient to release repressed feelings, and open up to parts of themselves which are healthy or whole.
The experience of singing or vocalizing songs shifts and focuses the patient’s energy into channeling and letting go. Toning, chanting along with other vibrational modalities may result in an internal response. The iso-principle of matching the patient’s energy, affect and/or breathing may lead to a change in (slower, deeper) breathing. This may help relax both the mind and body, which brings in other levels of awareness, relaxation, and relief. Singing with others may help decrease feelings of isolation, and may help patients bond and connect with their caregivers and family.
Spontaneous song improvisations around specific themes or questions may be affirming or starting points for the patient’s spiritual journey, of clarifying meaning or purpose, marking growth through the course of the disease, or achieving a state of harmony and balance.
Music and songs may be associated with various life events, and have unpredictable effects on patient’s feelings, i.e. the patient may choose a song for pleasure and respond with feelings of loss. Continual assessment in the moment allows the MT to facilitate appropriate song experiences, and respond to the patient’s needs for reminiscence, telling their story, pleasure/joy/celebrating, expressing various feelings, hoping; or at end stages, mourning losses and/or anticipatory grieving. Patients are supported as they confront the emotional tasks of giving or receiving forgiveness, conveying thanks or appreciation, and saying goodbye.
Bailey, L.M. (1983). The Effects of Live Music Versus Tape-recorded Music on Hospitalized Cancer Patients. Journal of Music Therapy, 3 (1), 17-28.
Curtis, S. (1986). The effect of music on pain relief and relaxation of the terminally ill. Journal. of. Music Therapy, 23(1), 10-24.
Dileo, C. (2005). Music Therapy at the End of Life. NJ: Jeffrey Books.
Dileo, C., & Bradt, J. (2005b). Medical Music Therapy: A Meta-Analysis & Agenda for Future Research. Cherry Hill, NJ: Jeffrey Books.
Whittall, J. (1989). The impact of music therapy in palliative care. In Martin J (ed.): The Next Step Forward: Music Therapy with the Terminally Ill. New York: Calvary Hospital, 1989.
Author: Kwan, S. M. (2007)