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Music offers relief from anxiety and pain
Therapy program reconnects patients, family
The woman was young for dementia. In her late 50s and suffering from end-stage dementia, she was lethargic and uncommunicative.
After talking with the husband, the music therapist learned that the couple had enjoyed karaoke throughout their marriage. On her next visit, she brought a karaoke machine. It did not take long for the patient to sing along with the songs she and her husband always had enjoyed.
Although the patient responded only to music, finding this method of communication improved the husband's ability to communicate, says Diane Tomasi, director of community relations for Big Bend Hospice in Tallahassee, FL. "The husband wrote love songs for his wife so he could convey his feelings for her in a way that she heard," she adds. "Music brought them back together at the end of her life."
Music therapy is an integral part of the services offered by Big Bend Hospice. "We offer music therapy to all patients upon their admission," says Jennifer L. Haskins, MT-BC, manager of music therapy at the hospice. "We use guitars, keyboards, and other instruments, as well as singing, to improve the patient's quality of life," she says. "About 60% of our patients choose to receive music therapy," Haskins adds. Even if a patient declines music therapy at first, nurses and social workers can offer it to the patient later, she notes.
Music can relieve anxiety, regulate breathing when a patient has trouble with shortness of breath, and decrease pain, points out Haskins. "There is also a social aspect to music, so it can be used to increase bonding between family members and patients," she says. Because family members might not know how to interact with the patient, music can give them a way to participate during therapy by singing along or just by listening while the patient talks with the therapist, Haskins adds.
True music therapy is more than playing a CD or listening to an audiotape, explains Haskins. Music therapy is a recognized discipline with an educational component and a board-certification process, she says. "Music therapists have practicums and internships that are required for licensure," Haskins says. In fact, one way a hospice can build a music therapy program is to use interns as a way to enhance the size of the staff, she suggests.
There is no typical therapy plan for a patient, says Haskins. "It is a very individualized plan with a specific goal," she says. Depending on the patient, music chosen for therapy might range from classical to country-western, and instruments can be guitars or portable keyboards, Haskins points out. "The key is to keep the goal in mind, such as pain reduction or relief from anxiety," she says.
Therapist part of team
The key to a successful music therapy program is involvement of the therapist in the multidisciplinary team, says Haskins.
Even when the patient initially chooses not to see a music therapist, there have been instances when the team is discussing a patient's progress, and the music therapist identifies an issue that music might solve, she says. "The therapist asks the nurse or other members of the team if they think the patient might agree to a visit, and the nurse introduces the idea to the patient or family," she explains.
Introducing music therapy to other staff members requires education because it is a misunderstood field, admits Haskins. "It doesn't take long for other clinicians to see the positive benefit of the therapy," she adds.
Music therapists continue through the bereavement support with the family, often playing favorite songs at the patient's funeral, says Tomasi. "We see this as a continuation of therapy," she explains.
At Big Bend, music therapy also is an important part of the agency's fundraising and community outreach efforts, says Tomasi. "We use music as part of all of our community events, and we have songs written by our therapists for specific events," she says. The hospice's foundation solicits funds specifically for the music therapy program, Tomasi adds. "We often have family members designating gifts to the program because the music meant so much to them and the patient," she says.
Music therapists also will perform "living room" concerts as part of fundraising efforts for the music therapy program, but their performance always is educational, says Tomasi. "We do get requests for our therapists to perform at luncheons or other events because all of our therapists are talented musicians and singers, but we have to be careful to focus on the educational aspect of the performance," she says.
If a hospice manager is evaluating the addition of music therapy to the hospice's services, Haskins suggests starting with one board-certified therapist. "After the therapist has been at the hospice for a year, the program can offer internships," she says. A therapist can increase the size of the program by another two full-time equivalents without the cost of hiring another board-certified therapist, Haskins explains. "Interns don't receive salaries, but they are often offered a stipend and expense reimbursement," she adds.
Finding qualified music therapists is not a problem for Haskins. "We do have Florida State University in our community, and the school has a well-established, well-known music therapy program," she says. But even if a hospice doesn't have a nearby university with a program, it is easy to post job openings with the American Music Therapy Association, Haskins says. "Don't use local papers to advertise the position," she warns. Qualified, certified therapists use the association web site to find positions, so the local papers are a waste of time and money, Haskins says.
Although establishing a music therapy program takes time, planning, and fundraising, it is worth the effort, says Tomasi. "Music therapy is a true value-added service for our hospice patients," she says.
Need More Information?
For more information about music therapy, contact:
Jennifer L. Haskins, MT-BC, Manager, Music Therapy, Big Bend Hospice, 1723 Mahan Center Blvd., Tallahassee, FL 32308-5428. Telephone: (800) 772-5862 or (850) 878-5310. E-mail: firstname.lastname@example.org.
To post a job opening, contact:
American Music Therapy Association, 8455 Colesville Road, Suite 1000, Silver Spring, MD 20910. Telephone: (301) 589-3300. Fax: (301) 589-5175. Web: www.musictherapy.org.