One More Reason

I met with a fairly new client this week. I've never seen him awake, really. He's always been sleeping or unresponsive. He does have several family members who, although they seem to rarely get along, are very loyal to him and are around pretty much constantly. They are the ones who actually requested my visit this week. They connect very well with the music and are able to release their emotions through singing and talking about their father between songs.

When I got there this time, true to tradition, he was sleeping. He had recently been placed on RLC care, which is a designation we give to people who the nurses feel are imminent, or close to being to it. His family hadn't seen him awake for quite some time. He had 2 daughters with him and they began sharing memories, singing with me, and shedding some tears. Although it was hard emotionally, it was actually why I got in hospice care. Then, the coolest part happened. He started to wake up. When I left, he had his eyes open and he said the only thing I've heard him say: "Thank you, buddy. I enjoyed it." It was really touching to me. It meant that: a] he had heard me and b] he used whatever limited energy he had to let me know my visit meant a lot to him.

I think that people have all heard stories of other people who "come to" for a brief moment when it seems they never will. It's something completely different, though, when you're there to experience it. Chalk it up to another great reason I love my job!

A Little Out of my League

This week was really hard in some spots. I had a GPS stolen from my company car, almost killed a few times by people pulling out in front of me, and had a particularly hostile encounter with a client's son. Those weeks happen and I'm admitting that it stressed me out quite a bit. However, I refuse to let that define my week. Here's a story from Tuesday that was a bright spot in my week.

I got a new referral over the weekend and went to go complete the assessment. In case I haven't covered this in a previous post, I'll do a quick review of what I look for in an assessment. I am assessing how I can help a client with my services, so I look for their needs and how I can use my role and their strengths to help them meet that need. I look for social needs [such as isolation or loneliness], emotional distress [anger, depression, anxiety], physical discomfort [pain or agitation], and spiritual concerns [questions of afterlife or suffering]. I can meet these needs through a variety of means on a case-by-case basis.

Okay, back to the story. This woman is in her 60s, which is fairly young, but not unheard of. She is very aware of her situation but is having a difficult time coping. She regularly spoke of wanting to "get better". When I was able to bring up the subject of music, however, her whole demeanor changed. She likes classical music, which is something you don't hear often in northern Iowa. Usually, I get a response of "Lawrence Welk" or "country western" with an occasional "jazz music", all of which I am well stocked. Classical music, though, is something different. We started talking about it and she enjoys not just little guitar etudes, of which I have a few, but she started throwing about composers like Wagner and Vivaldi and operas like La Boheme. Way out of my league as far as playing ability, although I do enjoy listening to them at times. She described the music as having the ability to "make my heart soar" and she loved to sing. She did not study music or perform, but always had a deep seeded love of that style. At the end, she did state that she likes "little swing tunes, too" which gave me something to play for her. She would close her eyes, bob her head around, and smile when I was done and she'd talk about her experiences in music. It was a good session, not in that a lot of emotions were processed, but in a rapport building sense. I feel she really opened up to me, which will be a huge tool in my favor going forward.


With the knowledge I now have of her, I'm planning on trying to provide a CD player and some classical music for her to listen to. To help with her grief, I'm going to try to lead her in some guided imagery, which I'll try to blog about when it happens. That's definitely a topic I'd need another post to do even a hint of justice to. Until then, here's some more reading for you to do. Check out The Mindful Music Therapist to read up on some great music therapy conversations!

Wind Beneath My Wings

This week, I met with a client I've had for a while and was trying to get her to open up more. I was hoping we could really process her situation, as it is rather hard. She's in her 50s and has a disease process where she understands what is going on, she's completely aware of her situation, but cannot do anything to stop it. She's at the age where she feels that she should be starting to take care of her parents and helping her son get ready for his wedding, but instead her parents and son are now having to take care of her. It's hard for her to stay in bed when she'd rather be outside, or rather, would rather be anywhere but a nursing home.


She enjoys the music she listened to when she was younger, which happens to be 80s popular music. With that in mind, I pulled out Bette Midler's "Wind Beneath My Wings", which you can listen to below.

Before I sang it, I asked her to think about who this song describes for her. After the song was finished, she said, "That's easy. It makes me think of my parents." We began talking about her parents and she was saying how they were such good people and really had tried everything to help her. As she was talking, her expression seemed to show that she was thinking very hard. At one point she stopped and said, "Me being in this situation must be really hard for them, too." I was so glad she made that shift in perspective. Not that she was complaining about herself before, but now it seemed that she was aware that her parents were grieving for her and it helped her to appreciate them that much more. She shared some stories of how they have helped her and then we discussed plans for her to tell them how much they mean to her. 


I don't know if she has or will let them know how much they mean to her, but I know that she really is grateful for them and I just hope they know it.


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New blog to check out is : Bliss Music Therapy. She hasn't updated her blog for a while, but what she has posted is good information!

One More Session

Every once in a while, a nurse gives me a call and asks me to see a client who has taken a quick decline. Many times, patients who need extra support are given an "RLC" or "Radical Loving Care" designation for a short time. This is texted out to everybody in the office so they know who needs the extra help at that time. We all try to make it there, but I'm not always able to be there before they die. Many times, that is the end result of RLC, but sometimes the decline levels off and they may not need they extra support as much as initially thought. On Monday, I got the call before the text was even sent out, so I know it was important for the client and family that I be there, so first thing I did was stop there. This is the client who I spoke of in Play One More. When I got there, there were 3 daughters and some of their children, as well as the client's pastor. That is always a big red flag for me. Pastors always have people to see and things to do, despite all the jokes implying they only work for one hour on Sundays. If a pastor is just sitting in a chair in the dining room, waiting for something to happen, then I always assume something will happen soon. I got set up in the patient's bedroom [she lived in her own home] and invited everyone into the room. I wanted this to be a group session. I wanted to not only help the client relax [something she was not very good at in the past], but also to allow the family to communicate with the client, share stories, and feel the support that they were all providing for each other.

It started off with the family members showing little interest in being a part of music. Despite my encouragement, I was pretty much singing alone to the client. I began to engage the family more by asking them questions, specifically about music and their mother. They all seemed to recall a song she enjoyed, a story of the her dancing, or [for those that were there for my previous sessions] how she would light up during our sessions. This began a nice time of sharing and music. People would talk about songs she liked and I would play the ones I had. While playing, though, only one other person was singing. The only time I got them to sing was on the last song, "Jesus Loves Me." I set up by saying, "I can really feel the love you have for your mother. She's so lucky to have you here with her. This is an important time to spend with her and I know that she knows you're here. I know she's very happy you're with her. Let's sing this one like we're taking her place for a moment, thinking about what she's feeling right now." We started singing and everybody else joined it, tearfully making their way through that familiar tune. Even the pastor was getting misty, which speaks volumes about his connection and dedication to this family. After this, I tried to encourage them, told them to call with any concerns or changes, and left.

The patient died about an hour after I left. I will remember her fondly, as someone who walked in the first time assuming I'd be kicked out and was really welcomed with open arms, both in a literal and figurative sense. I hope Lillian's family knows how much their mother meant to everybody who got to see her.

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New to the music therapy blogosphere is The Traveling Songstress. Check out her new blog and give her some support!

Grief Group Self-Review

Yesterday, I led a grief group in place of the bereavement coordinator. I haven't led a group for quite some time, and had never led solo. I wanted to just talk a bit about what I did and what I would have done differently.

I started off with "The Rose", which I did some research on. Apparently, the song was voted #83 of American Film Institute's "100 Years of the Greatest Songs" in 2004. This song was written by Andrea McBloom, but was made famous by Bette Midler. Other covers done by Conway Twitty, Leann Rimes, and Westlife.

I sang the song and we talked about different lyrics of the song that stood out to them and compared them to their grief journey. It turned out that this song was used for the funeral of the mother of one of the participants, so it already carried quite a punch. We talked about the lyrics and it sort of went on a few rabbit trails after that. I tried to concentrate on coping strategies, especially when they talked about being angry or depressed. At the end, I tried to lead a relaxation exercise, but it didn't really work out very well.

I think some of this next section may be due to walking into a new group. I had never met any of these people before and some of them had other issues that they were dealing with. I try not to blame others, but one lady in particular tended to dominate the conversation, which was actually a bit of help at first. In the end, however, I wish I had attempted to take a little more control so I could include others, one in particular who didn't actually say anything. Another thing I would have liked to see happen is some realizations toward the end. I understand that everybody works at a different pace, but I felt as though the participants were more depressed when they left.

Despite this, I do feel that there was a lot of great sharing. My intentions were good and I felt I did stay mentally present throughout the entire session. I felt that I was able to take a tangents and connect them to some lessons that I've learned working with patients. I especially tried to show that they were very connected through their grief and I encouraged them to lean on each other when they are feeling depressed or needed to talk.

I guess that's all I have. Sorry for the ramblings, but this blog is great for me to process how things went. That's important for anybody to do.

A Losing Battle?

This week, I met with the daughter of a client of mine to discuss some goals the daughter had for her mother. The hospice nurse had informed me a little of what she wanted to accomplish a little beforehand and I was slightly discouraged. The daughter would like her mother to be able to talk again. On the surface, this seems admirable. The client has a very unusual brain disease [so unusual that I am not going to mention it's name, due to HIPPA regulation] which robbed her of her speech about a year ago. This, understandably upset the daughter, but she found that her mother could sing little songs, like "You are My Sunshine", long after she had lost the ability to talk. The daughter will come in a play music and occasionally get a response from her, such as humming, smiling, or hand movement. I was able to get responses like that in my assessment, so that was normal, as far as I knew.

The daughter, however, has known her mother talking, joking, and singing for much longer than she has known her in this state. She does not like what has been happening to her mother and wants to fix it, which is completely understandable. The chances that the client will talk again, however, are quite slim. In hospice care, we look for decline. Not to sound morbid or as though we like that aspect of our jobs, but if patients improve, then they are inappropriate for hospice care and we are required to discharge them. I would call it a flaw in the system, but that's the system we work in. That being said, I was quite wary and probably did not give the daughter the attention and time she deserved in our meeting. I attempted to listened closely, be supportive, and empathetic, but if I'm being honest with myself, I was quite skeptical. We had a short music therapy session with the client afterward and we got some results, mostly some brief smirks, eye contact, and a little vocalization.

When we were done, I got back in the car and, as is my general practice, I processed the session and realized how unfair I was about our meeting. I realize that I did not give her the time or attention she deserved to express herself. I also realize that the daughter is probably in some denial about her mother's situation, but who can blame her? That's the coping mechanism that is helping her and, if or when her mother's health declines, all I can do is continue to be supportive and let her know that she always tried her best. Trying your best is worth a lot, I was reminded, even if the results will be hard to attain. Therefore, I am going on the record that I am going to try to help her regain her speech, but with a realistic view of her situation. I cannot guarantee that it will be successful, but if this will help the daughter cope or process her mother's situation, then that is the best that I can do. I am not the perfect person, and I never pretend to be, so I hope my mistake can be corrected and my apology accepted.

An Impromtpu Memorial

This week's story is one that really caught me by surprise. I came to a facility just in time to see one client before it was time for lunch, so I chose who I wanted to see. I was a little disappointed when I found out that he was getting a bath right before lunch, so I was unable to visit with him. I had another person in the facility, however, so I went to visit her.

This client, who I'll call Susan, is relatively young for hospice care, in her 60's, and easily converses, which is something I don't see all the time. I started the session much the way I usually do, silently reassessing her needs as we catch up. She said she had a headache, which is common for her diagnosis, but is also a sign of stress. I also noticed that she was knitting, which is not out of the ordinary for her, but she seemed to be a little extra shaky. Without a real reason for it, I asked how her family was doing, and that question opened the door to what was really bothering her. "I got a phone call about 10 minutes ago," she told me, "and they told me that my last aunt died of pancreatic cancer last night." She went on to explain, becoming tearful as she spoke, that her family had always been close and that she had lost her parents and all their siblings in the last decade. Susan's aunt had been the last of that generation to die and the funeral was too far for her to travel.

Grief is a reaction to loss, and Susan had lost a lot in the death of her aunt. She lost the last remaining member of her parents' generation. She lost someone she loved very much. She lost a sense of hope, that is her aunt could miraculously overcome her disease, then Susan could overcome her's. I sat there and listened to Susan pour out all these emotions, this intense grief, and wanted to help her. But, what do you say? What can you do? Distraction/redirection wouldn't take away this issue, so I saw no other option than to address it directly. I quietly asked, "Would you like to have a memorial service for her right now, right now? Just the two of us?" She agreed and we started out upon this impromptu memorial. Susan is a very spiritual person, so she started off by praying, and then I played "Amazing Grace" and "As the Deer", two songs that Susan finds very meaningful. I then encouraged her to talk about her aunt, a eulogy of sorts. During all this, she was very tearful and I just sat and listened. I tried to be fully present in her grief and listen quietly. After she wanted to stop talking, I played "On Eagle's Wings" and "You Raise Me Up", which I tied in with her eulogy. After those songs were done, she prayed again. Her headache was getting worse [it was time for her medicine again] and it was time for lunch, but she thanked me profusely for visiting. She said, "I can't believe you came when you did. God really was looking out for me today. I only got the phone call 10 minutes before you came. Thank you so much." With that, we parted ways and I'm sure our minds wandered on to something else, me to my paperwork and Susan to her overwhelming grief. But, for that hour, we were both present, sharing grief and stories, together.

I usually don't have a perfect idea of what will happen in a music therapy session. I usually have to be flexible and quick-thinking. This session, however, completely blindsided me. I had no idea what I was walking into and, if I would have known, I may have done a few things differently. I think, however, that this is one time where the bulk of what I did was what I needed to do for her. I do not claim to be the perfect music therapist, but it feels really good when I get something right and can help someone like that.

Story - "He Came Through Like Gangbusters"

It seems that my blog, lately, has become mainly a collection of stories from my work. I never really intended it to become so, but I don't think I mind it. I guess sometimes the best way to illustrate what I do is to see [or in this case, read] it in action. I hope that these stories do not sound vain, as I am truly not meaning to boast in myself, but to give a brief glimpse into the world of music therapy and hospice.

That being said, this story happened in my internship at CarePartners Hospice in Asheville, NC. My wife and I still miss it there and we hope to visit again soon, but no real plans. The client I was visiting was named Helen. She was fairly young by hospice standards, only in her early sixties. She and her husband were always welcoming to me, although, if I am going to be honest, they really intimidated me at first. Until that point, I could pretty much assume that the people I visited would want to hear either hymns, country, or Lawrence Welk-style tunes. Helen and her husband, however, loved music from the 60's and 70's. Learning Jim Croce, Chicago, Bob Dylan, and Pete Seeger was fun, but much different than what I had been playing. I slowly started adding them into my repertoire.


Although every session was pretty good, I vividly remember one session in particular. Helen's husband was not there, although he usually was, and I was enjoying talking with Helen. I steered the conversation to her husband, intending to get her to talk about him and process her anticipatory grief. She felt as though she was leaving him. In a segue, I played "Time in a Bottle" by Jim Croce and she broke down crying. If this were to happen now, I would feel comfortable confronting it a little more efficiently, but at that time, I was not. I finished the song and we both just sat there, staring at the floor. After what seemed like several minutes, she broke the silence. She explained that "Time in a Bottle" made her think of her husband and she began to explain her emotions. For several years, she said, she wondered whether or not she had made right decision to be with him. Just as she began to regret her decision, she was diagnosed with cancer. Helen said, through tears, that "he came through like gangbusters for me." She knew, after that event, that she had, indeed, made the absolute perfect decision. 


About a week or two later, Helen had a pretty fast decline and was declared "imminent" by her nurse, which means that the rest of her life could most likely be counted in hours, not days. I visited her and it was hard. She was once very full of life, but now she was unresponsive. Her husband, as well as her daughter, were there by her side, and agreed to let me sing for her. I hesitated before leafing past Jim Croce and decided to go for it. I told Helen's husband of our conversation earlier and how much his being there meant to her. As I started to play the song, everyone in the room [myself included], began to cry. We were all going to miss Helen very much. I finished my session and left. She died an hour later.


I guess this still is a strong memory for me, because I'm on the verge of tears again while I recount this story. Tears are not always a bad thing, despite what our culture may say about them. They are not weakness, they are not evil. They are natural, as natural as the love any one person can have for another. They are an outpouring of emotions that cannot be expressed in words, although music may come close. Tears are one way that I know what I do really matters.

Loss and the Holidays

I don't have a very long time to write, as I am at my in-laws with a little down time. I wanted to take a little time to talk about dealing with people dealing with loss around the holidays. For a majority of people, the holidays are seen as a time of family, fun, and celebration but for many people, holiday celebrations are just a reminder of the loved one whom they may have lost. It's important that we give people space, acknowledging their loss, but still not alienating them if they should still want to celebrate. In my experience, people who aren't grieving may have misconceptions of how the bereaved person should cope. Some want the bereaved to "get over it" and join in the fun, while others assume that the bereaved will not want to take part in anything even remotely associated with happiness or joy.

I played at a memorial service for a client who I had only seen once (in which she was unresponsive), so I did not have the opportunity to build up a great relationship with her. Her daughter, however, wanted me to play at the memorial service. When choosing music, she said she wanted celebratory songs and at least one Christmas song. I chose "Away in the Manger" because of the last verse: "Be near me Lord Jesus, I ask thee to stay close by me forever and love me I pray, bless all the dear children in thy tender care and take me to Heaven to live with thee there." I thought it was very bold to want a Christmas song and, as I was playing it, I could feel the tension in the room. It's very hard to reconcile the joy of the holiday season with the grief of loss and it's something that thousands of people struggle with every year.

I guess the point this little story is this: Don't assume that everyone is having a "merry" Christmas. If you know someone who is grieving this holiday season, don't assume you know what's best for them.

I hope everyone reading this has a very blessed Christmas and peaceful New Year!

Story: Unusual Christmas Request/Response

First off, I want to apologize for my little hiatus lately. Suffice it to say that my wife and I have moved and are having a baby in the very near future. Now, I'm going to try to get back on track.

I had an interesting experience yesterday while doing an assessment. For those of you who aren't familiar with a music therapy assessment, this is what music therapists use to assign goals and objectives for their clients. I assess four different needs to find appropriate goals: social, spiritual, physical, and emotional needs. I usually don't know what I'm getting into right away when I start an assessment, which can be a challenge for me as an introvert. I have to meet new people, figure out how to interact with them, and decipher how I can best help them. This can turn out to be an interesting experience, as this particular story indicates.

I met the gentleman on hospice care who I was assessing and he was basically unresponsive. His wife was sitting in the corner of the room, not by the bed, and I could sense that she was understandably very anxious with the situation. She did not seem to know what to do with herself and vented her anxious energy through talking very quickly and at length with me before we started the assessment about the food that people had been bringing her in the hospital for support. At this point, I was a little worried that I wouldn't actually get to play any music for my client because she would take up too much time. However, I was able to corral her thoughts to music. I mentioned that, around the this time of year, some people like hear holiday music, but that I had other styles like country, hymns, jazz, and traditional folk music. She said, "I don't think he's going to make it to Christmas," and began to choke up. I said, "Well, we could bring him a little Christmas now, if you want to." She jokingly inquired, "You have 'Grandma Got Run Over by a Reindeer'? We used to laugh every time that song came on." I did have that song, but have only played it a handful of times for the clients who I know wouldn't be offended by the song. I responded, "I sure do! Want to start out with that one?"

As I started playing it, her mouth began to curl into a little smile, but with very mixed emotions. Her face clearly showed her emotions, but they were very mixed. She seemed to enjoy the song, but then grew sad at the fact that he would not be able to laugh with her when this song came on anymore. She began crying and got up to hold his hand. She sat in the chair near the bed and stroked his hand, cried, and rested her head on the side of the bed. Her grief was evident, but still restrained. At one point, the clients' eyes fluttered a bit as she was talking with him and it filled her with such joy. I told her that the sense of hearing is the last to go and that I'm sure that the client loved to hear her voice. She began talking to him between verses of songs that I would play and it became this beautiful sharing moment between this old couple, these old friends.

Processing the session afterward, I was trying to pinpoint the moment when she began to open up, express her grief, and share with the client. I realized it was during that first verse of "Grandma Got Run Over by a Reindeer." I would never have chosen that one to kick off the assessment and realized that no other song would have granted me access to that response. No other song would have conjured up such an experience for my client's wife. No other song would have started the process of grief and sharing that I had just witnessed. As I thought of the session, I was reminded that music carries its own powers and emotions, and I am simply there to facilitate that process. I think it was a good lesson for me to learn again. I guess music can do a lot without my help and sometimes, I just need to get out of the way and let it do its work.

Septemer 11th - Music for national healing

Today is the tenth anniversary of the terrible attacks on the World Trade Center and, in some ways, the wounds still feel fresh. I specifically remember sitting in science class my freshman year of high school. It was early in the day and the teacher was watching television, told us to sit down and watch, and we did. We just watched the smoke billowing out of this building I had never heard of before. As we watched for the next two days, we learned a lot about life. We learned about hatred, we learned about resilience, and learned what real heroes looked like. We saw a plane fly into the second tower and could do nothing but watch as a few thousand people died, right on television. We saw police officers and firefighters fight the debris, trying to find jsut one more person they could help out of the rubble.

I know I'm not alone in my experience. The media still talks about it and a new sense of American pride began to manifest itself in songs about national pride. People took all stances to the mayhem. Toby Keith, very angry, states his case in "Courtesy of the Red, White, and Blue."

I personally don't agree with Mr. Keith. The anger, I think, was felt by millions of people, but the jump to immediate violence, I don't believe is the correct answer. I feel this anger is misdirected sadness and there are more appropriate ways to deal with this grief.

Others stood with stoicism and sang the Star Spangled Banner and Amazing Grace. It seems that everybody took these songs much more serious after 9/11. 

The song that most touched me, though, at this time was a song that seemed to symbolize the struggle of rebuilding and realizing that nothing would ever be the same again. This song reminds of the people who helped others during this time. To me, it talks about feeling invincible only to be knocked down and hurt. But it also gets back up. It's called "Superman" by Five for Fighting.

What were songs that you remember from that time? What meaning to they carry for you now?