Therapy or Entertainment?

Hey everybody,

I should probably say that this blog post is not intended to be demeaning to musicians who entertain. There is a lot of validity to being an entertainer. I use music to entertain often, and enjoy it. This post, however, is an attempt to discern the difference between therapy and entertainment for my work.

I'm writing this post as a way to process a recent "dilemma" I've encountered. The problem is: Where is the point where therapy becomes entertainment? I'm asking myself this question because I am trying to make a conscious effort at work to see people who are benefiting more, more often. What does "benefiting more" mean, though?

There are some instances where is might seem fairly straight forward. If someone is cognizant and really is only interested in hearing someone play guitar, they might be using music only as entertainment. As a therapist, then, I have to do some adjusting to my sessions to encourage therapy to take place. Some people, however, have no interest in the therapeutic aspects and just want music to be played for them. Other times, it is more difficult to distinguish. Let's say there is a client who is bed bound, does not take part in activities, was once very social, but now cannot interact well with the people they know. If I go in, talk with them for a while, and play music for them or listen to music with them, who's to say that is not therapeutic for them? Perhaps it could be giving someone control over their environment or a way to get back to the way they used to be.

Most of these little mental conflicts happen for me when I am not working on emotional, physical, or spiritual goals. Social goals are the gray area. Increasing social interaction is great, but at what point is the social interaction something that a volunteer could provide? At some point, I could go see someone who I am sure is benefiting from my therapeutic services.

I guess, it very much depends on the person's abilities and my intuition as a clinician. That's difficult for me. I'm not very good at trusting myself, sometimes. Whenever people are involved, there will be gray areas, because people are not just "this-or-that" creatures. Another reason it is difficult, is because it forces me to take a step back and really ask myself, "What did I help my client accomplish in that session?" If the answer is nothing, then I really need to evaluate my session and make necessary changes to attempt to facilitate a music therapy session, not a music entertainment session. As clinicians, we need to be doing this anyway, but that doesn't mean it's easy to do. We should constantly be striving to improve ourselves so that our clients can receive the best possible services from us. This means, though, that you will have to be pushed out of your comfort zone often and will be forced to learn new skills and approaches.

I guess I should conclude, because I feel I'm beginning to ramble. This is something I'll be wrestling with for a while, I feel. If you have any suggestions or can relate to this concept of "therapy vs. entertainment", please comment. I'd love to hear your thoughts!

Music to Cope

Music is a a very effective way for many to cope, myself included. Working in hospice care, coping needs to become an everyday activity in order to avoid burnout. This activity is different for everybody. My coping activities are usually a few different things. I enjoy being outside, exercising (which I do outside), and music. I suppose music is a no-brainer at this point. When it comes to music, there is so much that can be said, both about music's healing effects and about the ability of music to express emotions. I don't want to go into those aspects, but really want to talk about one song I've written and its back-story.

A few weeks ago, I lost two clients whom I had built a strong connect with throughout our sessions. One had been on hospice for around three years and the other had been on hospice for five months, or so. I knew that to protect myself, I needed to have boundaries and should not become emotionally attached to them. I usually do a good job of this. However, when I would be with those clients, I would forget and realize after the fact that I was putting myself in dangerous territory. Long story short, they both died in the same week after a very fast decline. The next week, I was on family vacation, so I was unable to attend, and play for, the funerals, even though I had been asked. This saddened me greatly and I needed to cope. I found it difficult to find songs that talked candidly about death and what it's like to be a caregiver for the dying. Let's face it, it's not a popular subject in our culture. I decided, therefore, to write my own. What came out was a song that many of my co-workers have found a connection with as well. I have decided to post the lyrics and a link to the song.

I Know - Bryan Odeen

I know that I won't see you again, so I'll say "Goodbye, my friend."

But I will not let you go

I know that you're better off at rest, I hope you know that you'll be missed

I hope you know how much I cared

And I know you're up there shining like the stars in Heaven do

But the thing I know more clearly is how much I will miss you

I know we didn't know each other long, but the bond we built was strong

And the friendship we had grew

I knew that someday you would die, so it begs the question why

I let you get so close

And I know you're up there shining like the stars in Heaven do

But the thing I know more clearly is how much I will miss you

I wouldn't give away all the the moments we had along the way

All those moments are all I have

And I know you're up there shining like the stars in Heaven do

But the thing I know more clearly is how much I will miss you

Now for the shameless plug: I'm in a group called Little Bluestem. We recorded this song in my living room on Wednesday, so it's a rough cut. If you like the song, check out our Reverb Nation page at http://www.reverbnation.com/littlebluestem. We're also on Facebook and Myspace or follow us on Twitter (@LBluestemMusic).

Story: "I'm So Glad I Saw This"

This is just a little, rewarding story from the other day. I went to go see the last client I was going to see yesterday at a nursing home in a small Iowa town. This client has a form of dementia as a hospice diagnosis. She is oriented only to her name and starting to become more and more lethargic. She enjoys pushing herself around the halls in her wheelchair and has maintained a strong faith system through attending the facility worship services. I usually sing hymns with her and have grown fairly used to her singing along on most of the well-known hymns, like "Amazing Grace", "In the Garden", and "The Old Rugged Cross." She doesn't remember all the words, but always the majority of the first verse. When she isn't singing, she has a hard time putting six words together into a coherent order.

Yesterday, when I came for a visit, her daughter was there. I had never met this daughter and learned that she lived about 3 hours away. The daughter only visits every few months, so I was quite excited that he happened to be there. She, however, did not seem to be excited about visiting her mother. I suppose I can empathize. I understand what it's like to visit someone regularly, investing a lot of time and energy into their lives, only to have them ask you the same questions over and over because they don't remember you or what you told them earlier. The daughter seemed to have run out of energy, run out of things to talk about, or was just about to justify leaving. When I entered the room, I introduced myself and what I did and asked if she would stick around for a music therapy session, and she agreed.

From the very first song, my client sang with all the gusto she could muster. She even made hand motions and gestures that reflected the words she was singing. She wasn't waiting for me to start the words for her and, in fact, I had a hard time keeping up with her tempo. Eventually, I just plucked the chords on the downbeat of each measure. I've never heard "Amazing Grace" sung to intensely and deliberately as the well-known hymn was turned into a waltz tempo hymn, and I hung on to my client's every word. She proved this was no fluke, as she did the same for all the songs in the session. Not just the first verse, but sometimes the second, third, and even fourth verse were sung out. I can't help but feel that her session was a way of telling her daughter, "I'm still here. I'm still me. Don't worry about me. I remember you!" After the session, the daughter appeared to be mentally trying to wrap her head around the "performance" she had just witnessed. She looked on the verge of tearing up, but stopped herself and said to me, "I'm so glad I saw this!"

She didn't seem interested in continuing the conversation in a deep fashion and, instead, exchanged pleasant little comments about the power of music and faith. I left the room and went to do my charting and, as I left and walked by the client's room, I heard the client's daughter engaging her mother in conversation about music and faith. I can't be entirely sure about a lot of aspects this story and probably can't take full credit in the experience, but I do know one thing. I know that the daughter meant it when she said, "I'm so glad I saw this!" I'm glad I could give her mother back to her for a short time.

...silence...

Wow. It's been far too long since I've posted, and I apologize for that. My life has been filled with family camps and day trips, so I haven't really had a chance to do this for a few weeks. Needless to say, I haven't been hearing a lot of silence lately. This will be the last topic in my little series of how I use music therapy for myself.

"What does silence have to do with music therapy?" you might ask. To be honest, I think it might be one of the most important things about music therapy. Have you ever talked with someone who never lets any space get into the conversation? Or been forced to listen to the radio for hours on end without any respite or change in programming? Or gotten home from a hard day at work or school and just wanted to sit and remember what it feels like to have quiet? If you've answered yes to any of these (and I believe most people will have said yes), then you know how relaxing and centering silence can be. Even in regards to music, silence can be important. Claude Debussy is quoted saying, "Music is the space between the notes." Even Miles Davis is credited for saying, "Don't play what's there, play what's not there."

Working in hospice, I think silence may be even more important. Regardless of cognitive functioning or aphasia that can be found in some clients, many of my clients seem to enjoy my visits because I leave space. Space to think. Space to reflect. Space to breathe. Space to be. Just be yourself without any extra noise cluttering up your mind, which we often do. Think you don't have too much clutter noise? Try turning off all gadgets you have around you right now, like your TV, computer speakers, radio, even the air conditioning. Try to just sit there and see how you feel. Think about what you did that day. Focus on your breathing. Notice all the extra sounds that living provides, like traffic noise. I know that every time I do this, I'm amazed at how noisy I let my life become.

I know there have been studies that have linked excess noise with stress. Stress has been linked to a plethora of different maladies. It makes sense, therefore, to make steps to reduce noise and increase silence in your life. As a music therapist, I need to be mindful of this. People often turn off their TVs when I get there, which many of them haven't done all day. As long as the TV is off, then, I can take some time to allow space within the music therapy session where there is no sound. Where to leave the sound is personal and could be a different post entirely, so I won't go into that aspect this time. The important thing is that silence is present and that you and the client are present in the silence. Be aware of the lack of noise and how you feel when it's happening. I'm betting there isn't a person out there who wouldn't benefit from a little silence now and then.

I hope this little series gives you ideas of how to use music to help yourself. This is by no means an exhaustive list, but just the ones I use most often. What would you add to this list if you were making it?