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!
Friday, May 11, 2012
Saturday, May 5, 2012
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.
---
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.
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.
---
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.
Saturday, April 28, 2012
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":
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.
--
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.
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.
--
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.
Friday, April 20, 2012
Music as a Coping Technique
I had an interesting session on Monday morning with a client. She's fairly young, in her late 60s, and had a rough weekend. One of her medications causes some blood thinning and she got a cut that would not stop bleeding. It had slowed and stopped by Monday, but emotions were still raw for her. She was very anxious and, literally, afraid for her life. Another bleed like that could be her cause of death. When I got there, I saw that she was attempting to convince me [and possibly herself] that she was doing okay. One thing I do feel I excel at, however, is reading people's emotions, and I was picking up that she was not feeling positive about her situation.
We talked for a bit and I began to offer song choice for her, which is one way that I've found to read people's emotions. This client, generally, chooses the song that reflects how she feels. I would offer a "happy" song and once that I felt seemed to reflect what she was feeling. She always chose the reflective song. After a few of these songs, I began to make reflections on the songs and "pry" into her emotions. After she realized what songs she had been choosing what she perceived to be "sad" or "negative", she began crying. I let her cry, without interrupting, and, when she had finished, I said, "It seems like the music is helping you cope with your emotions, but not in the way you thought it was." She agreed and discussed how she used music to "help me when I'm really down", but hadn't realized that by reflecting what she felt, she was coping.
I think a misconception of using music as a coping technique is that if you play happy music, it will make you happy. Conversely, in this scenario, if you play sad music, it will make you sad. People do not want to be sad, generally, so people may only play happy music. This coping technique, sometimes called avoidance, may be useful for some people, but they do not realize there are other ways. Reflecting the emotions, and owning up to them, can also be an effective way to handle emotions.
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Blog for the week is Music Therapy Source. It's run by a great hospice music therapist out of Iowa City.
We talked for a bit and I began to offer song choice for her, which is one way that I've found to read people's emotions. This client, generally, chooses the song that reflects how she feels. I would offer a "happy" song and once that I felt seemed to reflect what she was feeling. She always chose the reflective song. After a few of these songs, I began to make reflections on the songs and "pry" into her emotions. After she realized what songs she had been choosing what she perceived to be "sad" or "negative", she began crying. I let her cry, without interrupting, and, when she had finished, I said, "It seems like the music is helping you cope with your emotions, but not in the way you thought it was." She agreed and discussed how she used music to "help me when I'm really down", but hadn't realized that by reflecting what she felt, she was coping.
I think a misconception of using music as a coping technique is that if you play happy music, it will make you happy. Conversely, in this scenario, if you play sad music, it will make you sad. People do not want to be sad, generally, so people may only play happy music. This coping technique, sometimes called avoidance, may be useful for some people, but they do not realize there are other ways. Reflecting the emotions, and owning up to them, can also be an effective way to handle emotions.
---
Blog for the week is Music Therapy Source. It's run by a great hospice music therapist out of Iowa City.
Saturday, April 14, 2012
Regional Conference review
Yesterday, I went to the Midwestern American Music Therapy Association regional conference at the University of Iowa. It's a multi-day event, but I only went to it yesterday. My employer offered to pay for one day there and reimbursed one day's worth of registration fees. It was a really great thing for them to do. As this was the first day of concurrent sessions, there was an opening session, with a keynote address outlining the accomplishments of music therapy advocacy over the past year. It was by Dr. Mary Ellen Wylie, who is the president of the American Music Therapy Association. It also featured the Afro-Cuban drum and dance performance group at UI, which was really interesting and fun to see and hear.
There were two times of concurrent sessions, which means that there were multiple presentations going on at one time and you get choose which you attend. It is always a tough decision, however, because there are usually more than one presentation that sounds interesting. Because there are multiple music therapists that work for Iowa Hospice, we sat down and decided we'd each go to one, take notes, and pass them off to each other at a later day. Then, overall, we all get more useful information. My first session, then, was entitled "ENGAGE in Advocacy: Your Role in State Recognition." To make a long story short, music therapy "task forces" in 38 states are trying work with state governments to become a licensed or registered profession according to state law. This would increase music therapy awareness and make it easier for people to become involved in music therapy, either by becoming a music therapist, becoming a client, or letting music therapists [potentially] be reimbursed through Medicare/Medicaid. There have been a few successes, the most recent in Georgia, where a bill passed through their state Senate licensing music therapists. This would increasing the regard for music therapists by the state government. Iowa, where I call home, is planning a Hill Day next year where we can, perhaps, meet a state representative who will sponsor a bill for us. Overall, this was a very informative session and, to be honest, much more interesting that I had anticipated! To take part in advocacy, the presenters encouraged us to ENGAGE, stands for the following:
Educate everyone
Nurture relationships
Grassroots networking
Access for clients
Grasstop connections
Empower people
The second session I attended was called "Therapeutic Music or Entertainment: A View from Health Professionals and our Response." This presentation outlined an in-service provided by two music therapists to hospital and hospice employees. They educated on the differences between music therapy and entertainment and between music therapy and other therapeutic music practices. The three other practices they discussed were music practitioners, music thanatologists, and harp therapists. All these practices have some similarities with music therapists, in that they have training programs, use music, work in medical settings, and are generally misunderstood by the public as entertainment. Music therapy differs from the other practices in that music therapists actively engage clients, can work with mental health, have measurable non-musical goals, document outcomes, and have the longest training period. These other practices are not widely known in the Midwest, but are becoming more well-known on the coasts. As music therapists, then, we not only need to establish ourselves as health professionals [as opposed to "entertainers"], but also be able to educate on the differences between music therapy and these other fields. It is important to respect these other practices, but be able to differentiate and educate the public so they can make informed decisions.
I learned a lot from these sessions and, if you want more information, feel free to ask me. I took copious notes throughout the sessions. I've learned how to more effectively advocate for myself, as a music therapist, and my profession. It was great to see a bunch of other music therapists from around the country. When I work alone so often, it can seem that I'm a "lone ranger", but I'm not! It was good to connect with other MT-BCs and I look forward to more conferences in the future!
By the way, I will begin giving links to other music therapists' blogs at the end of my posts to give my colleagues some love. This week's blog is Soundscape Music Therapy. Rachelle presented the advocacy session I attended yesterday.
Friday, April 6, 2012
Perspective on Goodbye
A few weeks ago, I visited a woman who I have only seen a handful of times. Despite her fairly short time with us so far, we have built a very strong therapeutic relationship. This is dangerous for me, because I know that one way or the other, she will leave our services. She will either get better and be inappropriate for hospice services or she will decline further and die. This is the hardest aspect of hospice care. As a hospice worker, I need to be able to protect myself, keep boundaries between myself and my clients. Every once-in-a-while, however, I don't do a very good job.
This particular client played organ for 30+ years in her church and enjoys a lot of hymns that I've never heard before, so she's been challenging me and stretching me musically. She's still very gracious, though, when I mess up. She still has her cognitive abilities, so she converses easily and I do not feel like I need to "perform" or pretend to be extroverted in our sessions. It's one visit I know I can be myself. I say all this to say that during our last session, she was tearful when we were saying goodbye. She had a pretty quick decline for a few days and she was saying what she thought would be our final goodbye. She shook my hand and said, with tears, "I don't know that I should say 'See you later' this time." I thought for a second and said, "It doesn't matter to me what you say. Either way, whether we see each other or not, I'm glad we've had this time. If we have more time, I'll be very happy, but we can't count on that. We should be grateful for the time we've had and take it one day at a time." That seemed to put it in perspective for her and we said our goodbyes.
Those conversations are always hard to have with people. I guess, on some level, it's a conversation we should all be having all the time. There are so many things that could happen - car accidents, disease, etc - that could make "see you later" not applicable. I know a lot of people take Easter weekends to spend time with family and friends, so I encourage you to take this to heart. Nothing is guaranteed, so make sure every goodbye is suitable for be the last.
This particular client played organ for 30+ years in her church and enjoys a lot of hymns that I've never heard before, so she's been challenging me and stretching me musically. She's still very gracious, though, when I mess up. She still has her cognitive abilities, so she converses easily and I do not feel like I need to "perform" or pretend to be extroverted in our sessions. It's one visit I know I can be myself. I say all this to say that during our last session, she was tearful when we were saying goodbye. She had a pretty quick decline for a few days and she was saying what she thought would be our final goodbye. She shook my hand and said, with tears, "I don't know that I should say 'See you later' this time." I thought for a second and said, "It doesn't matter to me what you say. Either way, whether we see each other or not, I'm glad we've had this time. If we have more time, I'll be very happy, but we can't count on that. We should be grateful for the time we've had and take it one day at a time." That seemed to put it in perspective for her and we said our goodbyes.
Those conversations are always hard to have with people. I guess, on some level, it's a conversation we should all be having all the time. There are so many things that could happen - car accidents, disease, etc - that could make "see you later" not applicable. I know a lot of people take Easter weekends to spend time with family and friends, so I encourage you to take this to heart. Nothing is guaranteed, so make sure every goodbye is suitable for be the last.
Friday, March 30, 2012
Just a Rose Will Do
A few months ago, I introduced the song "Just a Rose Will Do" to a client of mine. Since I've known her, she has been very spiritual and I spend a lot of my session listening to her talk about her faith and how it has helped her through all her struggles. I usually just listen and facilitate her discussion with songs that tie in with her conversation. With all her talk of the afterlife and faith, she never really planned out any of her memorial service. I thought that this song may be a good segue into that conversation. She took to this song very quickly and it soon became the song we start each session with.
In our session this week, she was pretty tearful. After this song and several other hymns that she enjoys, she would be wiping tears from her eyes. She's been on our services for quite some time and has just continued to decline, but very slowly. I wonder, however, if she knows something we don't. This session, after "Just a Rose Will Do", she began to talk about her funeral, specifically the music. She has group/congregational music planned out already, but asked that I sing it as special music.
I'm honored to do it. Obviously, the "event" has not been planned yet, but I think it's very important to plan these things out. In parting, I want to post the lyrics of this song, written by Porter Wagoner, as some food for thought. What do you want your funeral to look like? It's not morbid or depressing, it's a way for you to choose how your loved ones remember you.
When time shall come for my leaving
When I bid you adieu
Don't spend your money for
flowers
Just a rose will do.
Chorus:
I'll go to a beautiful garden
At last when life's work is
through.
Don't spend your money for flowers
Just a rose will do.
I'll need no organization
To make a bid to-do,
I'll need no fine decorations,
Just a rose will do.
Just have an old-fashioned
preacher
To preach a sermon or two
Don't spend your money for
flowers
Just a rose will do.
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