By Rylie T. Webber, MT-BC
What is Music Therapy?
Music therapy is an allied health profession that provides evidence-based and person-centered treatment for numerous populations. Music therapists are professionally trained to understand how music can affect activity in several areas of the brain, including but not limited to the amygdala, nucleus accumbens, hippocampus, Broca’s area, and the Wernike’s area. Music therapists use this knowledge to implement interventions that address individualized goals, including those in the physical, psychological, social, emotional, cognitive, and/or spiritual domains.
To become a music therapist, one must obtain a bachelor’s degree or higher from an American Music Therapy Association (AMTA) approved university, completing studies in a combination of musical, psychological, and clinical realms. After graduation, a 1,200-hour supervised clinical internship with a professional, board certified music therapist is required. Lastly, it is necessary to successfully pass the national board examination given by the Certification Board for Music Therapists. Just like other allied health professions, music therapists are required to engage in continuing education, as well as follow and practice by AMTA’s standards of clinical practice, code of ethics, and professional competencies.
What does Music Therapy Address in Hospice Care?
Music therapists in hospice care work with patients and their families to increase physical and emotional peace during the end-of-life process. Just like much of hospice care, music therapists in end-of-life care focus on promoting the highest quality of life. For these reasons, common goals in hospice care often address a combination of physical needs, such as pain or agitation, social/emotional needs, such as anticipatory grief or depression, and spiritual needs, such as anxieties or fears relating to death.
What Might You See in a Hospice Music Therapy Session?
If you were to walk into a hospice music therapy session, there is a high chance that you might witness one of the following interventions – whether you realize it or not:
Shared Music Making: A common misconception is that music therapy is congruent to passive listening of music, whether it be live or recorded. Although it might appear this way – especially in end-of-life care due to reduced physical functioning – in reality, music therapists are continuously following the patient’s lead to actively engage them in the music.
A clear way to observe this would be through the interventions of joint instrument play or therapeutic singing. Within these interventions, music therapists adapt instrument play and/or singing to meet the abilities of the patient. For instance, a music therapist could lay an autoharp on the lap of a hospice patient and gently hold their hand to support them in strumming the strings (perhaps with an enlarged, thickened version of a guitar pick that is easier to grasp). To facilitate singing, a music therapist might adjust elements of the music, including but not limited to the key, range, tempo, and musical cues to make vocalizing more readily accessible. These interventions could be used to address several goals, such as promoting fine or gross motor movements or increasing opportunities for meaningful interaction.
Music Therapy Entrainment: Even if physical abilities are diminished and instrument play is no longer the best suited intervention, music therapists still aim to actively engage hospice patients. One of the interventions commonly utilized at this stage is known as music therapy entrainment, which can be used to address several goals, including decreasing agitation or steadying a patient’s heart rate or breathing pattern. As those who work in hospice care know, breathing at the end-of-life is often irregular, unsteady, and labored. For these reasons, a music therapist might utilize entrainment to synchronize with a patient’s breathing pattern (reflecting all breathing irregularities in the music), and gradually steady the breathing by steadying the music over time.
A different way to use music therapy entrainment is known as the iso-principle technique, which can be used for several purposes in music therapy, including improving mood. For instance, if a patient with dementia is presenting as anxious as evidenced by rapid, repetitive phrases, a music therapist would likely not play “Ac-Cent-Tchu-Ate the Positive.” Rather, a board certified music therapist might use the iso-principle to match the mood presented by the patient musically (potentially by playing at the same tempo as the patient’s speech on the guitar, singing the verbalizations of the patient, and/or by playing a song that reflects their emotional expression). As the music therapist continues to reflect the patient’s mood, they are able to gradually bring the patient to a place of emotional validation, eventually bringing the patient to a more relaxed state.
Life Review, Reminiscence, and Legacy Projects: Similar to some of the work done by chaplains and social workers, music therapists in hospice care often address emotional, social, and/or spiritual needs through life review, reminiscence, and legacy creation. These processes occur through many music therapy interventions, including but not limited to therapeutic songwriting, lyric analysis, musical discussion, song dedications, and song-chaining. For example, patients might be supported in a structured (or less structured – depending on the needs) songwriting process that aims to reflect a certain period of their life or an expression of love that they would like to leave as a legacy for their family members. Life review could be facilitated through the creation and analysis of a live or recorded song collage of musical pieces that are associated with different stages of their life. Similarly, reminiscence might occur through active recreation and processing of songs from a patient’s childhood, adolescence, or other significant time from their past. Each of these interventions focuses on supporting emotional and/or social needs at end-of-life by providing opportunities to process through the stages of death and dying.
Why Include a Music Therapist on Your Interdisciplinary Team?
The value of having a board certified music therapist on your interdisciplinary team is becoming more and more well known as research shows that music therapy supports needs in physical, social, emotional, psychological and spiritual domains during end-of-life care. If you or your team members are treating patients with complex needs, consider reaching out to the AMTA, or the Tennessee Association for Music Therapy to see how a music therapist might help you meet and address your patient-centered goals as a hospice and palliative care provider.
Rylie Webber, MT-BC, is a board certified music therapist that has experience working with individuals in hospice and palliative care, adolescents and adults with mental health and/or substance abuse disorders, children with medical complexities, individuals with intellectual or developmental disabilities, and individuals with various neurologic disorders. Webber recently joined the staff of the Patient and Family Centered Care Department at Monroe Carrell Jr. Children’s Hospital at Vanderbilt, and she continues to serve patients in a medical/mental health agencies through her small private practice in Nashville. For more information, please visit childrenshospitalvanderbilt.org/information/music-therapy , tnmusictherapy.org, or marigoldmusictherapy.com.