Developing relationships between care staff and people with dementia through Music Therapy and Dance Movement Therapy: A preliminary phenomenological study

Abstract

Background

There is an increasing focus on providing effective psychosocial interventions to improve quality of life in dementia care. This study aims to explore the attitudes and perceptions of staff who participated regularly in Music Therapy (MT) and Dance Movement Therapy (DMT) groups for residents with dementia in a nursing home.

Method

In-depth interviews were conducted with seven members of care home staff. Data were analysed using interpretative phenomenological analysis.

Results

A representation modelling the impact of MT and DMT in a nursing care home. Three main themes were identified. 1) Discovering residents' skills and feelings; 2) Learning from the therapists to change approaches to care practice with subthemes: time, space and pace, choice, following the residents' lead; 3) Connection between staff and residents.

Conclusion

The model indicated that both interventions performed in parallel helped staff to discover residents' skills and feelings. Although it is a small sample size, this study strongly suggests that MT and DMT can have a positive influence in helping care staff to provide a meaningful care environment.

Keywords

Music Therapy Dance Movement Therapy dementia staff training dancing psychosocial interventions

Background

The National Dementia Strategy in the UK (Department of Health (DoH), 2009) promotes quality treatment for people with dementia and outlines the need to support and enhance the input of care staff. Best practice guidelines have increasingly endorsed the value of a holistic, “person-centred” approach that aims to address the emotional, relational, sensory and spiritual needs of those with dementia (Age Concern, 2007; DoH, 2001, 2006; DoH/Care Services Improvement Partnership (CSIP), 2005; National Institute for Clinical Excellence (NICE), 2006). The person-centred approach pioneered by Kitwood (1997) has led to much greater interest in the value of a wide range of non-pharmacological, psychosocial interventions in dementia care (Cooper et al., 2012; Douglas, James, & Ballard, 2004; Kverno, Black, Nolan, & Rabins, 2009), amongst which arts therapies such as dance and music are continuing to develop a more robust evidence base.

Music Therapy (MT) and Dance Movement Therapy (DMT) are highly accessible for those with a cognitive impairment, even at an advanced stage, owing to the emphasis on non-verbal forms of expression and interaction (Aldridge, 2000; Clair, 1996; Coaten, 2001; Newman-Bluestein & Hill, 2010; Nyström & Lauritzen, 2005; Ridder & Aldridge 2005; Ridder, Wigram, & Ottesen 2009). MT research in UK National Health Service settings points to emotional, psychological and social benefits for people with dementia (Moss, 2003; Odell-Miller, 1995; Powell, 2006); a recent study of MT in care homes (Hsu, Flowerdew, Parker, Fachner, & Odell-Miller, under review) demonstrates significant improvements in the wellbeing of people with dementia receiving individual MT.

Systematic reviews of MT in dementia identify a number of studies showing its positive effects on behavioural, psychological and cognitive symptoms of dementia and on physiological, social and emotional functioning (McDermott, Crellin, Ridder, & Orrell, 2013; Vink, Bruinsma, & Scholten, 2013). Additionally, an effect on encouraging relationships between staff and residents, and the influence on the community environment (Powell, 2006) and in care home settings (Hsu et al., under review; Pavlicevic et al., 2015; Powell, 2010) have been found. A few studies have explored the effects of MT on both paid and unpaid carers, finding that they report satisfaction and show increased engagement with the person receiving care (Bright, 1992; Brotons & Marti, 2003; Clair & Ebberts, 1997).

Similarly, a systematic literature review of a range of dance-based interventions in care homes (Guzmán-García, Hughes, James, & Rochester 2012) identified different dancing approaches such as Dance Movement Therapy; Psychomotor Therapy; Social Dancing and Dance Therapy, and from these only seven qualitative and three quantitative studies were found to decrease behavioural and psychological symptoms of dementia, and to improve the quality of interaction between staff and residents. Kowarzik (2006) used observational assessment of clients, video analysis of sessions and interviews with trainees to evaluate a training programme for residential care workers, which drew elements from DMT to support people with dementia; it was found to open up new possibilities for communication both for residents and care workers.

Guzmán-García, Mukaetova-Ladinska, and James (2012) interviewed residents and staff after a dance psychomotor therapy intervention led by a therapist and facilitated by care staff. Residents reported that dancing made them enjoy the care home environment and staff stated that it brought benefits to their caring skills and facilitated social interactions. Research into dance work is increasing; Karkou and Meekums (2014) are currently conducting a Cochrane Review to assess the effect of different types of DMT on people with dementia.

It is unclear to what extent residents and staff may benefit when both MT and DMT are provided in long-term care settings simultaneously and where professional therapists are supporting staff. Provision of these therapies varies greatly in care homes and there are few opportunities to explore such collaborations. The present study examines the experience and perceptions of both qualified nurses and healthcare assistants who took part in either MT or DMT groups. It seeks to understand how staff involvement in MT and DMT could influence the care environment.

Method

Participants

The study took place in a nursing home in North London where the first author had been working for two years and the second author for 10 years, running MT and DMT groups, respectively. These groups were therefore part of the weekly programme of activities and therapies and the therapists were in regular communication with the staff team. Following a service review, a need to develop and evaluate ongoing therapies provision in the home was identified. The music therapist and dance movement therapist focused on how to work more closely with staff. Eight of 34 staff members (14 nurses, 20 care staff) were recruited following an introductory session attended by 15 staff. This session provided information about the study and a brief practical introduction to MT and DMT. Recruitment criteria consisted of ability to speak and read English; employment as a permanent member of the staff team for at least six months, in order to have accurate knowledge of the residents and any changes that took place; ability to commit the required time and agreement from the home manager. One staff member did not complete the study due to illness.

The nursing home housed 12 men and 18 women with an average age of 76 and a diagnosis of dementia in 90% of cases. Fifteen residents had moderate dementia and 12 were at an advanced stage. The staff to resident ratio was 1:3. Table 1 shows staff demographic information.

Table 1.

Staff demographics.

Staff	Qualifications	Dementia care experience (yrs)	Gender	Age	Ethnicity
A	Registered Mental Nurse (RMN)	20+	F	50+	SE Asian
B	Diploma in Mental Health Nursing	10–15	F	35–45	Black African
C	NVQ3	12	F	25–35	Black African
D	NVQ3	10–15	F	25–35	SE Asian
E	NVQ3	20+	F	50+	Black Caribbean
F	NVQ3	7	M	25–35	White British
G	NVQ3	6	M	25–35	Black African

Intervention

MT and DMT group sessions were carried out in line with ongoing practice established by the therapists within the home. The groups were open to all residents; weekly attendance figures ranged between 8 and 12. A total of 24 residents attended at least one session during the period of the study. MT groups were held on a different floor each week in the main sitting area and DMT groups were held in a separate activities room. Approximately 60% of residents attending the groups could mobilise independently or with support from staff and the others were in wheelchairs. Groups lasted 50–60 min. In the sessions, the Music Therapist and Dance Movement Therapist recognised and facilitated spontaneous self-expression and developed interaction through live and recorded music, movement and verbal responses. There was no prescribed routine in either approach; the work followed the pace of the participants, allowing time and space for musical, physical, verbal and emotional responses to be developed, choices to be made and individual wishes to be respected.

The MT group began with a greeting song such as “Red Red Robin”, played by the therapist on a piano keyboard to stimulate recognition and a sense of connection between individuals. Subsequently the music therapist played and sang from a wide musical repertoire including popular music from 1920s to 1960s, folk tunes from different cultures to reflect the diversity of the group members (e.g. British Isles, Italian, Greek, Jamaican, African) and well-known classical themes such as Beethoven's “Ode to Joy”. Group members were encouraged to join in and to make their own requests and suggestions. The therapist also provided a variety of percussion instruments and encouraged all group members to choose, play and share instruments, taking part in whole group improvisations, and in dyads with the therapist or a member of staff, when closer interactions could be developed.

In the DMT group, therapist invited residents to sit in a circle, and started with a ball game or a movement of their choice, in order to develop eye contact and awareness of others. Residents could then choose from a selection of recorded music played on a CD player, for instance familiar songs and dance tunes from 1920s to 1960s and music from different cultures, such as Ireland, the US and the Caribbean. The therapist mirrored people's body movements and encouraged them to share each other's movement, thus developing interaction between group members. Some residents would stand up and dance, supported by staff when needed.

Procedure

The design was an exploratory qualitative study in which MT and DMT group interventions were separately conducted by a Music Therapist (first author) and a Dance Movement Therapist (second author) once a week, respectively. Each therapist was supported by two staff members who assisted in running the group interventions for six weeks. Prior to the study, staff participants were asked to fill in their demographic details and a short questionnaire on their understanding and expectations of the project. At the end of the six-week intervention, each of the four staff members took part in an in-depth individual interview based on a semi-structured interview schedule. Interviews lasted between 45 to 60 min. Questions were developed by the first two authors; they were constructed in order to prompt narration, reflection and evaluation of staff experience of taking part in the sessions.

Table 2 shows the topic guide questionnaires.

Table 2.

Topic guide questionnaire.

Pre-interventions • Describe why you are interested in taking part in the project

• What is your understanding of the aims and approach of MT and DMT? • What do you find most rewarding in your work with the residents?

Post-interventions

• Describe in your own words what happens in a typical MT/ DMT session? (Prompt: if I was present in the session what would I actually see happening?)

• Tell me about one incident or event in the sessions that is especially memorable to you? What was important to you about it?

• Tell me about how it has affected your own work with the residents?

• What do you think the residents gain from the sessions?

• Were your expectations fulfilled?

• Has your understanding of MT/DMT changed in any way? If so, how?

• One of the main aims of this project is to enable staff to learn more about MT and DMT. What changes or improvements would you suggest to make it more effective?

The above procedure was repeated with a second cohort of three staff. To avoid bias, the music therapist conducted interviews with four staff members who attended DMT groups, and the dance movement therapist conducted three interviews with staff who attended MT groups. The project was submitted to North Central London Research Consortium (COREC) to be registered as a service development project focusing on staff development.

Data analysis

Data were analysed using interpretative phenomenological analysis (IPA) (Smith, Jarman, & Osborn 1999; Smith, 1996) as follows:

Data were tape-recorded, transcribed verbatim and analysed by the first author (RM) who then compiled a list of themes from readings of the first interview, assigning codes to each identified theme.

For subsequent interviews, themes were matched to existing codes, with new codes created for novel themes. The first analysis comprised nine thematic clusters which through a process of re-reading and re-organisation were reduced to four principal themes, each with subthemes. The first two authors reviewed the analysis. Utilising their professional experiences to interpret the data, they reduced the number of themes and linked them into a theme matrix.

To ensure data validity, an external researcher (AG) categorised the theme matrix to reach agreement and validate the main themes and subthemes of the study.

Results

Three principal themes were identified from merging MT and DMT interviews as follows:

Theme 1: Discovering residents' skills and feelings

Staff reported that the MT and DMT groups engaged the residents and stimulated participation. Residents demonstrated often unexpected ability and motivation to engage and express themselves in many different ways, allowing staff to gain new knowledge about residents' feelings and about previous and existing skills and abilities. Many residents who had previously appeared withdrawn, unmotivated or unsettled, were seen to participate fully in the sessions and enjoy themselves.

“Everybody enjoyed that, such great fun, it went down a storm, actually…. they were really enjoying the sessions, participation is good” (Participant E)

“The residents had an enjoyable time […] it was really entertaining, helped to enhance their minds […] to experience the beauty of the music” (Participant A)

Physical, mental and sensory stimulation and the activation of memories were seen to be important aspects of the sessions:

“If they want to exercise […] lifting legs and hand and neck and rocking … making rhythm, using her foot and dancing” (Participant A)

“It stimulate their (residents) brain […] with the music, it means they remember the songs they used to sing with their daughter or husband or relative” (Participant C)

“To give them the opportunity to touch what they haven't touched before” […] it bring them together, to know what each of them like”. (Participant G)

Staff saw the residents communicate and express themselves more freely:

“It builds confidence, they're able to talk in the group and they're able to talk one to one with a co-worker or another resident, you know … because Z (resident) at one time never used to talk to anyone….. on the floor, she sulks a lot, but in groups I find [she] does very well, like a flower, you know, she just opens up, gets involved”. (Participant E)

“they start to explain their feelings, relating their ideas and views, then the whole team warms up and you will find out each one's feelings…. Their moods began to change… they tend to be a bit brighter, more focused, uplifted … some service users will come in very low in mood, very subdued, very tired, very tearful, but by the time they are leaving here, they're all right, they're fine” (Participant B)

One staff member described how the group provided a supportive atmosphere to communicate feelings of anger, frustration and loss:

X [resident] got so angry and was just talking, talking…we couldn't understand a word…. but it was just facial expression, body language, all that, and Y [resident] was sitting here, and just said “oh we all have our days, that is exactly what happened to me last time” (Participant B)

As the residents revealed more of themselves through their participation and engagement, staff witnessed the impact of the intervention. For example, one resident, described as socially withdrawn, became talkative and alert, and a man who usually appeared frail and unmotivated displayed physical strength and talent as a dancer:

“any time before when I go there the lady always sit down quietly, she won't even say hello, she won't say a word, that day she gave us at least two or three songs, she was talking, she say [sic] oh I know lots of songs … . That day she was very awake, alert so she joined the group, I was so surprised, Oh, so she can talk, she can participate in music therapy, that really surprised me” (Participant C)

“but that day he was willing to come and then he just wanted ….. the therapist to play some dance music… and when the dance music was played, no-one said nothing, he just got up and started to dance and asked one of the staff to dance with him, and it was really thrilling and then they danced beautifully” (Participant A)

Theme 2: Learning from therapists' skills to change care practice

Staff commented on the positive outcomes of the project as a significant learning experience for their practice and three subthemes were identified: “time, space and pace”; “choice” and “following residents' lead”. Staff described increased knowledge and understanding of the therapeutic approach, which contributed to changes in how they approached the residents on a day to day basis.

The therapists were seen to pace themselves carefully in their approach and interactions with residents, allowing ample time and space for their responses.

“She hold the ball, look at it. Although she's seen it several times she'll be reading [the writing on] it … you learn to give time and space.. we go with them, at their pace” (Participant E)

“a lower tone of voice, being calm, approach the client on a 1:1, maybe eye contact … getting down with them at their level” (Participant F)

“you need to give them time and the opportunity to do things, you don't need to rush them, and talk to them, put yourself to their level, … but like I say, if they're sitting in the chair, ensure you're sitting facing them to have a good conversation, they want to know who you are” (Participant B)

In the busy nursing home environment, there was a clear contrast between the therapists' pace and that of the staff; Participant D and Participant A illustrate this in different ways:

“She have patience! Yeah she have patience! I don't think I could do her job as she have patience isn't it” (Participant D)

“We do give them a chance, but we don't give as much chance as [therapist] taught us to” (Participant A)

One staff member mentioned how residents were not compelled to attend the sessions each week. It was also noted how therapists offered individuals freedom to choose and to make their own decisions.

“We talk to them, if they're not in the mood to come we just leave them … … we say, who wants to come? Like, we don't force them” (Participant D)

“(music therapist) give them the guitar, to play with it! … [she] make them to have a choice of what to play with the instrument … instead of forcing them, to say oh you have it and control it” (Participant G)

This had an impact on how staff approached their own practice:

“So though I have been nursing for many years I just didn't know the importance of allowing them to make a choice, allowing them the freedom to make a decision … …. This has really really helped me … and it helps as well … when we give them a chance, they make their decision” (Participant A)

The staff noted how the therapists supported the residents in taking the lead as much as possible, facilitating a considerable degree of autonomy:

“We ask individually what they would like to do. Then they make their request and then we go along with the individual's requests…. so if they wanted to dance, we just carry on with the dancing” (Participant A)

They were able to develop a more open, flexible approach in interacting with the residents:

“My expectations have changed as well, you know, because, I mean, we always give them time and space and choice and all that you know, but you get to learn that you can also be more flexible yourself….. more choice … more space, more time, just leave them and go to somebody else…. you usually do that, but now I leave them and go to two, three people before, you know and then come back again” (Participant E)

It appeared that as a result of learning new approaches from the therapists, staff gained improved communication skills and an increased sense of confidence in running groups and activities themselves:

“better communication skills for the type of residents we have” (Participant E)

“In case the music therapist is not around, I can handle it … if you are not around, I can arrange it myself” (Participant G)

Theme 3: Connection between staff and residents

Staff reported how working closely with the therapists helped them to find out more about the residents' lives and skills. Having the opportunity to interact with them through dance and music allowed many of the staff to experience a greater sense of connection with the residents under their care. Staff demonstrated increased insight and self-awareness and a more reflective, empathic approach.

“when they are singing I join the group, I sing along with them, so I learned from there, sometimes when I'm doing something I still remember and I sing… .. maybe you have something bothering you in your mind and you are singing, like you are bringing it out, that's how I feel it” (Participant C)

Staff described an increased sense of empathy and emotional resonance with the residents, for example when one Irish resident wanted the whole session to have Irish music:

“And it was really really really heart-breaking and it was good, and how though she was living in England for 45 years, she's 85 now, she still had patriotism for her country, she really loved that session, so that was a point, a very valuable point…. how … their heart belongs to their native country…” (Participant A)

Participant G uses the metaphor of the MT group to describe a change of attitude, recognising that, like him, the residents are entitled to be heard and to express themselves:

“before maybe I'm trying to dominate… but now I see that it change my way to let them have their own say. Normally I have my own say, I bring my own song any time I like – let them bring their own song as well”. (Participant G)

The events and processes described in Themes 1 and 2 appear to have increased staff understanding of the therapies, helped them to develop insight into the residents' personalities and facilitated greater self-awareness. Staff began to make links between their own feelings and experiences, and their experiences at work with the residents, showing deeper insight into issues such as bereavement and cultural identity which in some cases may have had personal resonance. This led to an increased commitment to supporting autonomy and self-expression for the residents and a sense of closer connection with them as people who have an equal right to be heard. Figure 1 shows a model of the phenomenon found in the care home.

Figure 1.

Phenomenological analysis of the impact of MT and DMT in a care home.

Discussion

This study aimed to explore the impact of MT and DMT sessions on care staff working closely alongside therapists and residents with dementia in a nursing home for six weeks. Results identified three themes related to the impact on staff: i) discovering capabilities and the emotional responses of residents, ii) identifying features of the therapeutic approach that could be transferred into their caring practice and iii) the increased sense of connection with the residents. These preliminary findings suggest that collaboration between music therapists, dance movement therapists and care staff could enhance staff/resident interactions and relationships in dementia care environments.

We have been unable to trace any previous studies that combine an investigation of both MT and DMT in a dementia care setting and which focus on the impact on staff who regularly collaborate with therapists in sessions. The present study points to ways in which music therapists, dance movement therapists and care staff can share skills and work together more effectively. It does not describe a wholesale transfer of skills from therapists to staff. Instead, the study suggests that there are certain fundamental elements of the therapists' approach, such as attending to individual pace, and supporting autonomy and choice, that promote good communication and relationships; and that these may be effectively imparted to staff through regular involvement in either MT or DMT sessions and subsequently applied in their own work.

Strengths and limitations

The number of participants interviewed was small, however no new themes were found after the seventh interview, suggesting that data saturation was achieved. The findings of this study are limited to this one setting, and thus may not have widespread application, but demonstrate clear benefits of MT and DMT as potential psychosocial interventions for dementia care, having a positive effect both on the residents and on the staff. Staff attendance rates were high, over 80% for the duration of the project. Despite their varying levels of experience, skills and qualification, staff supplied rich data in the interviews and this was validated by an external researcher with expertise in psychosocial interventions in dementia care.

One problem to emerge from the data was the apparent difficulty of accommodating the requirements of the research project with the requirements of the shift rota. This suggested that more work needed to be done with the home manager at the planning stages of the project. On several occasions staff attended the sessions when they were meant to be off duty. In order to continue or replicate this study, staff participants should be properly supported by being allowed release from their work rather than relying on their goodwill. There was little evidence of any other negative aspects of participation; this may have been because the interviews were conducted by the group facilitators known to the staff. Efforts were made to reduce bias by ensuring that therapists did not interview staff they had worked alongside. The external researcher played an important role in independently validating the data collected by the therapists; however it is clear that more objective data might have been obtained had it been possible to involve an independent observer to monitor staff–resident interactions during the sessions and to conduct further interviews.

The aim of the study was to investigate staff experience and therefore there was no attempt to gain feedback from residents about their experiences in the groups and relationships with staff. Future studies should incorporate interviews with people with dementia into the study design.

A further useful perspective could also be obtained through the therapists recording their own experience of the collaboration with staff, for example through keeping a reflective diary. This would allow for issues and developments noted in the sessions and in the reflective post-session discussions with staff participants to be documented, including both positive and negative feedback and how this was addressed. In the view of the therapists, the post-session discussions played a crucial role in the success of this project, by allowing time for reflection and processing of feelings which is rarely available to staff in the care home environment. Through their professional training and experience, both therapists were skilled in facilitating discussion and understanding of the emotional challenges which arise at times when working closely with residents.

Interpretation of the phenomenon

Findings are in line with previous work in MT which has shown increased carer engagement (Brotons & Marti, 2003; Clair & Ebberts, 1997) and positive effects on the care environment (Pavlicevic et al., 2015; Powell, 2010). Themes 1 and 3 reflect recent qualitative findings that MT interventions can help individuals with dementia to maintain their sense of identity and connectedness with others (Mcdermott, Orrell, & Ridder, 2014). Similarly, in the context of DMT, Theme 2 supports previous qualitative findings (Guzmán-García, Mukaetova-Ladinska, et al., 2012) on how dancing could improve staff caring practice, for example to reduce agitation.

The sessions offered a space away from the typically busy routines and demands of daily life in the nursing home. This supports the home environment, as the main focus is often on completing essential physical tasks (Froggatt, Davies, & Meyer, 2009). In contrast, staff taking part in the MT and DMT sessions could spend time with the residents, engaging with them in shared activities that focused mainly on non-verbal communication and did not aim towards set goals. This enabled residents to express authentic feelings and to reconnect with capabilities, thus helping staff to learn more about their personalities and skills prior to the onset of dementia.

It might be thought that there would be significant differences in the experiences of those staff who participated in DMT and those who took part in MT. However it is notable that the staff appeared to gain similar insights regardless of whether they had attended MT or DMT sessions. The therapists did not set out to compare and contrast the specific mechanisms of their respective art forms, but rather to focus on common aims, thereby helping to strengthen their shared professional profile as Arts Therapists. The project findings highlight the similarities of the MT and DMT approach and arguably support the basic, but often misunderstood, tenet of the arts therapies that the aim of the work is not to impart skills in the arts activity itself, but rather to facilitate emotional expression and the development of connections and relationships with others. This applies not only to the long-term dementia care environment but also to a wide range of other healthcare settings (Healthcare Professions Council, 2014).

As previously suggested by Coaten (2001), who found that dance and movement can help enhance existing communication skills for care staff, this study found that the main benefit for staff from the collaboration with MT and DMT was not acquiring the therapists' skills in dance and music, but rather enabling staff to build on increasing empathy and providing opportunities to develop connections and relationships with residents. Likewise, this study suggests that working with MT and DMT could help to promote staff understanding of residents' emotional experience and to develop more positive interactions and relationships, as highlighted in the psychosocial model of music in dementia proposed by McDermott et al. (2014). These positive interactions are ultimately the goal in long-term care, because they have a significant influence on quality of life for people with dementia (Bradshaw, Playford, & Riazi 2012; Brown-Wilson & Davies 2009; Clare, Rowlands, & Bruce 2008; Daley, Newton, & Slade, 2013).

Future directions and clinical implications

Lack of staff training and supervision is one of the barriers to adopting a relationship-centred approach to care (Bradshaw et al., 2012). The phenomenological analysis of the current study mirrors important elements of staff training in dementia care, developing knowledge and skills through music and dance which could be transferred into daily care practice. The therapists did not take on an actively didactic role, but rather facilitated a process of experiential discovery through participation, observation and reflective discussion. According to the home manager (in a personal communication), working alongside professional therapists and people with dementia in MT and DMT sessions in this way seems to have been an effective means of supporting care staff and developing their skills, as well as helping them to feel valued and to value their own work.

Conclusion

This study provides preliminary findings suggesting that a collaborative approach between MT and DMT and care staff can contribute to improving interactions and positive relationships between care staff and residents. It explores the phenomenon of involving staff to support and learn from professional Music Therapists and Dance Movement Therapists. Future directions will require a larger scale project which should aim to employ additional forms of data gathering such as video (subject to participant consent) that could capture subtleties of non-verbal interaction and facilitate more objective and detailed post-intervention analysis. Future research could also incorporate quantitative methods to support the qualitative findings of this phenomenological framework regarding skills transference, staff competence, morale and skills development.

Footnotes

Acknowledgements

Many thanks to the nursing home manager and staff who participated in the project. Also to Professor Helen Odell-Miller, Dr Elizabeth Newton, Dr Michael Larkin and Dr Fiona Nolan for advice and support.

Authors' Contribution

RM and CB designed the study and collected the data. AG reviewed and validated the data. RM and AG drafted the paper. All of the authors contributed to interpretation of the data, reviewed the paper and approved the final version.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ruth Melhuish qualified as a music therapist from the Roehampton Institute in 1991. Since then she has worked in NHS adult and older people's mental health services, as well as schools, homes and centres with people of all ages. She is active as a clinical supervisor, examiner, writer, researcher and musician, with a particular interest in the role of music therapy in dementia care.

Catherine Beuzeboc, SrDMP, MBACP is a senior dance movement psychotherapist, supervisor and counsellor with over 20 years’ experience working in adult and older people’s mental health, formerly of Camden and Islington Foundation Trust. She is currently running a private practice of Dance Movement Psychotherapy and arts therapies supervision.

Azucena Guzmán is a clinical psychologist and clinical researcher in Dementia Care at North East London NHS Foundation Trust. Her background is in Neuropsychology and Rehabilitation and she has completed a PhD in Behaviour and Psychomotor Therapy with older adults with dementia.

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