Taking Cues

Sometimes, I get a chance to see a video that really affects my work. Last week, I saw a YouTube video of something called "validation therapy", which was very interesting. I don't necessarily subscribe to every aspect of this video, but really liked a lot of the concepts. Give this a watch before reading on.

Notice how Naomi Feil used touch and music to connect with Gladys Wilson. It really seemed that through the two aspects, she was able to put herself in very deep relationship with Gladys. Although not music therapy, this was definitely therapeutic. The changing of tempo with Gladys's is a concept very common in music therapy called the iso-principle. "Iso" means same, similar, or alike in Greek. The idea is that by matching someone else's cues, we can incorporate someone in a music therapy session who may not be able interact in other ways. It can also be used to affect and judge non-verbal signs of pain or anxiety. For example, fast shallow breathing at the beginning of a session may signify some level of anxiety, but by the end of a session using the iso-principle, the client may have slowed their breath and may be breathing comfortably.

I tried to incorporate touch and music into one of my sessions this week. A new assessment with a patient with dementia left me wondering what to do. Many times, with a hospice diagnosis, which is the diagnosis that makes them appropriate for our services, dementia, little interaction, if any, can be had with them. These are times when I generally try to just provide a compassionate presence, which I wrote about last week. This time, I sang unaccompanied and held the client's hand. I did not get a huge response from the client, but I did feel much more connected to the client. I used the client's breath rate to direct the tempo of my music. As I stated, there were no huge breakthroughs, but I can say that I felt very close to the client at that time. I think this is something I'll be doing more often.

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This week, I've enjoyed the posts of the Music Therapy Tween. She's a fantastic music therapist who also is part of a great podcast called the Music Therapy Round Table.

Thoughts on Being a Compassionate Presence

This week, I had a new nurse shadowing me. Every time a new IDT [interdisciplinary team] member signs on with Iowa Hospice, part of their orientation is to shadow me [and the other disciplines as well]. This is show them the roles of their other team members. As we were driving to see a client, she asked me, "What are your goals if someone cannot respond to you at all? What if you've never heard them talk or seen them respond? Do you still see them?" I responded by saying, "Well, then, if I see them, it is to provide compassionate presence." Then I had the task of trying to define what that looks like and the rationale for that little phrase "compassionate presence."

I like the way this Edge Magazine article defines "compassionate presence":

"Being completely present with one who is suffering means being able to be present with the suffering itself. This, you may recall, is the very definition of compassion. True compassionate presence is not about denying someone his experience with the dark realities he is experiencing; instead, it provides illumination that allows him to explore all the aspects of his situation with clarity."

That sounds very holistic and spiritual, right? This is something I strive to be in my professional and personal life, but what does that look like in a medical setting? What does that look like? How does one become or provide a compassionate presence? I am by no means an expert on the subject, but I would like to take some time and discuss how it plays into the care I provide for my clients.

It's a hard thing to see happening, first off. If someone walks into a session where the goals are to provide compassionate presence, it may just look like I'm playing guitar for someone who is sleeping. The music may sound pretty, but it's hard to see what is being accomplished. I hold the belief, however, that part of showing someone they matter and giving them the dignity that is due all people is spending quality time with them. Essentially saying, in not so many words, "You matter! If you did not matter, I would not be here spending time with you." It is being empathetic, aware of how they may be feeling, even if they cannot tell you, and being a part of their journey for a short time. This may be accomplished simply by breathing with someone or talking with someone about the things that matter, or used to matter, to them. Being completely present with someone, not worried about what else you have to do or where you should be, is a gift that everyone can bring.

In the medical field, even hospice [although not to the same degree], a lot of emphasis is placed on results. Is this medication working? Do we need to adjust their visits? What is the problem and how do we fix it? All this is most definitely valuable, but does not give people much time to just sit and be with someone, not thinking about the laundry list of other tasks to be completed in the day. Simply focusing, instead, on the patient. This makes them more than a patient with a diagnosis and poor prognosis, but transforms them into a person, capable, or once capable, of so many things. This levels the playing field, bringing people to their most basic role - being people who help people.

My challenge for you, then, is to take some time this next week, and really try to be a compassionate presence for someone. Whether that is your spouse, friend, co-worker, parent, or child, give it a try. It may be hard, but, like everything, it takes practice and the dividends are great.

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As you do this, which I hope you do, take some time to read up on another great music therapy blog called Mindful Music Therapist.