Journal of Palliative Care

Music therapists are constantly called upon to justify their work through research projects and evaluation processes. Rarely do we get the opportunity to talk personally about our work, the effects it has on us as music therapists, indeed, as human beings. This paper traces my own journey as a music therapist working with the terminally ill. Using audio extracts of music improvised with patients at the end of their lives, the concept of “attention” in music is addressed and explored. The paper will investigate:

a) What is the difference between the quality of attention that is available to ourselves and our patients “in” music, as opposed to other ways of being together?;

b) What does musical experience, particularly when achieved through improvisation, enable us and our patients to be that we cannot achieve in other ways?;

c) Can “being in music” with another person fulfil a sense of longing that is evident in people at the end of their lives? In her book Waiting For God, Simone Weil suggests, ‘Those who are unhappy have no need for anything else in this world other than people capable of giving them their attention…” (1). Can the improvisation of music offer a unique and uncomplicated medium for being close?

This paper proposes a theoretical framework for understanding how music therapy elicits and supports depth experiences in palliative care. The author explores music therapy as a containing or sacred space in which ventures into the realm of psychospiritual awareness may safely occur. The ultimate goal is to facilitate the process of connecting to that which is psychologically and spiritually significant for the patient, thereby transforming experiences of suffering into those of meaning.

The purpose of this paper is to describe the music therapy program at the Harry R. Horvitz Center for Palliative Medicine, to present different music therapy interventions that are used with individuals who have terminal illnesses, and to introduce initial findings from a pilot study of the effects of music therapy on an inpatient palliative medicine unit. For the first time, a computerized database has been designed to evaluate clinical practice by tracking music therapy intervention effectiveness on common symptoms. Measurement techniques included visual analogue scales and behavioural observation. Music therapy was shown to have a significant effect on common symptoms in advanced cancer patients, suggesting that it should be included in palliative medicine programs as an adjunct to symptom treatment.

A music therapy research study aimed at understanding patients’, visitors’ and staff members’ experiences of a music therapy program in a cancer hospital over a three-month period is described. Respondents’ answers to brief open-ended questions, as well as the music therapist researcher's interpretations of the program's relevance, were examined using thematic analysis based on grounded theory. ATLAS.ti software supported data management and analysis. Themes encapsulating 128 patients’ reflections about music therapy were delineated and substantiate how music therapy can support palliative care aims throughout the cancer illness trajectory.

This article presents four case studies which demonstrate the use of music therapy in assisting palliative care patients and families cope with grief and loss, pain and anxiety, disorientation and dementia, lack of meaning, and hopelessness. Music therapy techniques are illustrated and patient-related goals are defined within the case studies. A review of the literature supports the use of music therapy in palliative care, and a variety of qualitative and quantitative studies are reported in the article.

Pain associated with advanced cancer is multifaceted and complex, and is influenced by Physiological, psychological, social, and spiritual Phenomena. Suffering may be identified in patients when pain is associated with impending loss, increased dependency, and an altered understanding of one's existential purpose. Comprehensive pain management aims to address problematic symptoms in order to improve comfort, peace of mind, and quality of life. Music therapy is a treatment modality of great diversity that can offer a range of benefits to patients with advanced cancer pain and symptoms of suffering. Music therapists perform comprehensive assessments that include reviews of social, cultural, and medical history; current medical status; and the ways in which emotions are affecting the pain. A variety of music therapy techniques may be used, including vocal techniques, listening, and instrumental techniques. These techniques provide opportunities for exploration of the feelings and issues compounding the pain experience. Case examples are presented to demonstrate the “lifting”, “transporting”, and “bringing of peace” qualities of music that offer patients moments of release, reflection, and renewal.

This article examines the imagery and music components of the relaxation program at the Vancouver Centre of the British Columbia Cancer Agency. An outline of the objectives and design of the experiential portion of the sessions is accompanied by a detailed description of the musical elements and influences. Some participant evaluation is also included.

This paper explores how music therapy can assist patients and relatives in the processes of making friendship and love audible in a child cancer ward. Four short patient histories are presented to illustrate a health-oriented, ecological music therapy practice. Two histories describe how texts, made by patients, become songs, and how the songs are performed and used. Another two histories deal with musical communication with dying children and their parents. The paper indicates that these interventions may involve more than palliation (making a disease less severe and unpleasant without removing its cause). Not least, such activities can make it possible for the sick child to expand from being “just a patient” into playing, if only for a moment, a more active social role. The processes of artistic interplay, in- and outside the sickroom, influence various relationships in the child's social environment.

This paper addresses the music therapy process specific to one subgroup of the general population identified as having terminal illness. This subgroup includes individuals who are impoverished, homeless, and do not have someone to provide them with care at the end of life. Based upon her clinical work at Malachi House, the author identified three distinct phases of the music therapy process with these individuals: engagement, relationship building, and actively dying. The progress of 50 residents through the therapy process was documented over a three-year period, as was the musical and nonmusical content of music therapy sessions. This paper reviews the results of the documentation recorded and offers case examples to represent each phase.

Work with people who are dying is painful and no palliative caregiver is exempt from this. The emotional pain associated with being a palliative care music therapist is related to professional training, the experience of being a professional minority and newcomer in the workplace, and the intensity and intimacy of the musical workspace. Questions are posed to facilitate music therapist self-reflection. Therapist self-acceptance includes tolerance for imperfection, which, in turn, affects the music's capacity for containment.