Life Review and Reminiscence: Essential Tasks For Positive Aging

Reminscing with book - senior womanYou probably know from personal experience that reminiscence is something we all do. Heck, my three-year-old starts plenty of sentences by saying, “When I was a baby, I….” – it seems to be her way of making sense of where she is in the world now. The same happens on the eve of graduation for high school seniors, at wedding rehearsal dinners for brides and grooms, and for people of all ages and stations at birthday and anniversary parties, awards ceremonies, and retirement celebrations. We all have a need to review our pasts as we head into the future.

For seniors, though, life review and reminiscence are a key component of aging and ending life well. What are life review and reminiscence? And what makes them so important?

Why Does This Matter?

Although we all look back on our lives as a way of dealing with the present and looking to the future, older adults and people with life-limiting illnesses have a developmental need to look back on their lives. Psychological theorist Erik Erikson named the developmental stage for people aged 65 and older as Ego Integrity vs. Despair. In this period, people look back to determine whether they’ve led happy, successful lives. If they feel that they’ve been successful and productive, they develop feelings of contentment and “integrity,” but if they see their lives as being unsuccessful, they may feel depression and “despair” instead.

Life review and reminiscence processes can help older adults complete this important developmental task of contemplating on one’s life, and can help people to reframe and resolve past events and relationships that may be contributing to depression and despair in the present. Many researchers have examined life review and reminiscence in various contexts, and studies have indicated that these processes can decrease depression and obsessive reminiscence, and increase self-esteem, quality of life, and a sense of well-being.

Life review and reminiscence can be formal processes or informal, spontaneous or planned, and superficial or really deep in their exploration of conflicts and relationships. When thinking about these processes of looking back on one’s life, it is helpful to make some distinctions.

What’s The Difference?

Life review and reminiscence are two terms that are often used interchangeably, even by researchers and academics. There are some differences to note, however, especially if you are a clinician using these interventions with clients.

Reminiscence often refers to a more more informal, spontaneous process that can happen anytime, anywhere, and with anybody. Reminiscence often stays on a pretty superficial level, with an emphasis on recalling happy memories and simpler times – the famed “golden years” – without so much effort spent on examining and resolving past conflicts and regrets. Reminiscence is the word that comes to mind when I think about my grandfather paging through his photo albums with me and telling stories about the folks in the pictures. We weren’t really interested in learning about specific events in his past so much as enjoying time together.

Life review, on the other hand, can be more formal, structured, and comprehensive than reminiscence. Researchers have developed formal protocols for structured life review, meant to be implemented by psychotherapists and other trained professionals helping older adults dealing with clinical depression or dementia. These protocols may include step-by-step review of the major events of a person’s life, starting at the beginning, rather than focusing on the highlights, as might happen in informal reminiscence. Often, these approaches are also meant to help people uncover and work through past conflicts and regrets. Because this can be difficult work, this kind of life review process is best facilitated by a professional – someone who can support a person through this exploration of difficult issues without judgment or condemnation, and eventually enabling that person to find resolution.

If you are a clinician, you should make a distinction in your documentation regarding which processes you are using with clients. Outside of the clinic, though, it doesn’t matter much which term you use, and many researchers and academics use these terms interchangeably anyway. What matters is that those of us who love elders should be finding ways to help them share their stories and review their pasts.

How Can I Help?

If you want to help seniors with this important developmental task, what are the best ways to do it? In my next two posts, I’ll give you some concrete tips on how to facilitate reminiscence with the older adults in your life.

Until then, leave a comment below with your favorite way to spark reminiscence or a story of how reminiscence made a difference for you.

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Song Spotlight: “Yakety Sax”

Sax cartoon

  • Mood: Humorous, Farcical
  • Theme: Instrumental (no lyrics)
  • Tempo: Upbeat
  • Genre/Style: Pop-Jazz Instrumental

Here’s a purely instrumental song that goes a long a way in creating a certain energy in a group: “Yakety Sax.”

Written by James Q. “Spider” Rich and Homer “Boots” Randolph III, this song was popularized by Boots Randolph in his 1963 recording. Randolph plays the saxophone, and through the course of the song pays homage to several popular fiddle tunes.

The overall tone of the song is energetic and goofy, making it perfect for accompanying outlandishly humorous scenes in TV and film. In fact, “Yakety Sax” was used so frequently to accompany chase scenes on “The Benny Hill Show” that this song is sometimes recognized as “The Benny Hill Theme.”

How To Use This Song With Seniors

Since this song has no lyrics, it is a perfect accompaniment to movement to music experiences, because you can give verbal instruction without talking over the words in the song. Try adding some goofy movements and facial expressions along with your regular moves for some variety that fits the spirit of the song.

If ever you wondered how to use a vibraslap, slide whistle, or canary stick with a recorded song, know that this song also offers great openings for novelty instruments. Wait for the pauses and add those instruments as a humorous accent. This is a great, low-pressure way to offer solos to participants.

Finally, although there are no lyrics to discuss, you may certainly find yourself talking with participants about “The Benny Hill Show” or funny car chase scenes. For a visual element, choose several photos or movie stills of humorous adventures and invite participants to make up a story to fit the photo and music.

By the way, for some pure entertainment value, check out 15 Iconic Movie Scenes Ruined by “Yakety Sax.” It will definitely give you the sense of this song’s goofiness!

This post is part of an occasional series on special songs to share with your loved ones. For more song spotlights, click here.

What Instruments Do Music Therapists Play?

InstrumentCollage“How many instruments do you play??”

That’s a question I hear on a regular basis, usually from a shocked healthcare provider or family member after I break out my oboe or mini-marimba in a music therapy session.

The fact is, being a music therapist requires a high level of musicianship, in both breadth and depth. Music therapists have to play a lot of instruments and have to play at least one instrument extremely well.

All music therapists must sing and play guitar, piano, and percussion.

To be a board-certified music therapist, you must complete an academic program approved by the American Music Therapy Association as well as clinical training through undergraduate practica and an approved internship. Through the academic and clinical training process, prospective music therapists must demonstrate competence on multiple instruments: voice, guitar, piano and percussion. Over years of clinical practice, most music therapists eventually use some instruments more than others – I favor guitar over piano for its portability and reliability, for example – but we all have to demonstrate competency on these instruments before we can become music therapists.

All music therapists have a primary instrument, too.

On top of learning those four core instruments, music therapy students also have to have a primary instrument. Also known as our “major instrument,” this is the one we play in university ensembles, in private lessons, and ultimately for a senior recital. Some music therapy students have voice, piano, guitar or percussion as their primary instruments, but others have an instrument that you would typically find in a band or orchestra as their primary instrument – flute, trumpet, violin, cello, or bassoon, for example. My primary instrument is the oboe, and while I don’t play it in every session, it does make an appearance on a regular basis.

Many music therapists keep learning new instruments over years of practice.

The thing about music therapists is that we all really love playing music, and we just can’t stop developing as musicians. Lots of music therapists are performers as well, and many of us become much more skilled on our instruments than might be apparent in a clinical setting. Many music therapists learn new instruments, too. I joined the ukelele craze a few months ago, and learning to play the harp is on my list for the future.

What does this mean for you?

All of this means that you should expect your music therapist to be a highly skilled musician, who can sing well and play multiple instruments across different types of music. Music is the medium through which we serve clients, so you’d better expect us to play music well.

 

How Does Music Therapy Help In Hospice?

Hospices provide comprehensive palliative care to people at the end of life. At a time when comfort and quality of life become more important than curing a disease, people on hospice services receive help from from professionals across several disciplines, including medical doctors, nurses, home health aides, social workers, chaplains, and volunteers. Increasingly, music therapists are also part of this interdisciplinary team.

Music therapy is a clinical service provided by credentialed music therapists (MT-BCs in the United States). Because of their unique training and experience at the intersection of music and human health, music therapists are uniquely qualified to work with patients through music at a deep, therapeutic level.

It is the depth and breadth of clinical music therapy practice that distinguishes it from other applications of music in hospice care. While an approach like harp therapy is limited musically (to harp music), a music therapist can provide a wide variety of music on several different instruments. A music therapist is also knowledgeable and experienced in manipulating the various elements of music to address the various clinical needs that emerge in the shared music experience. (I wrote much more on that topic here.)

Old young holding hands seatedMusic therapists help in many ways, and exactly what we do and why changes from session to session, depending on the patient’s needs and desires on any given day.

Here are three big ways that music therapy helps people in hospice care:

1. Music therapy helps loved ones connect.

Several disease processes and symptoms that occur frequently for people in hospice care can make it difficult for loved ones to connect with each other, just when those loving relationships are most important. Whether the cause is dementia, confusion due to end stage cancer, or disorientation or lethargy related to high levels of pain medications, this disconnection can be very painful for the person on hospice care and for their loved ones. Music can be a bridge for people, because of its central place in human experience and because of how music is processed in the brain. Music therapists know how to introduce and facilitate music experiences that help loved ones connect and communicate their love, despite dementia, confusion, or disorientation getting in the way.

2. Music therapy provides relief from pain and anxiety.

Music can help people relax on a physical level and on an emotional level. Music therapists are uniquely skilled in helping people find the right music for the moment as well as the techniques or images that work for them. For people who need another approach to pain management in addition to the medical interventions offered by the hospice team, music therapy can be just the right answer.

3. Music therapy can help people say the un-sayable.

Just as the symptoms attending the dying process can make communication difficult, so can the emotional burden of facing life and death. For people approaching the end of life, coming to terms with regrets, fears, and other intense feelings can at the same time be incredibly important and tremendously challenging. Music can provide a container for difficult emotions, allowing people to feel those intense feelings that are impossible to put into words. Music can also be a vehicle for sharing messages that are too difficult to say.

Why choose a music therapist for hospice care?

Two huge advantages to having board-certified music therapists working in hospice care are that

  1. They can be flexible in adapting their approaches to meet patients’ needs on any given day
  2. They have a depth of clinical knowledge that allows them to work effectively with people who are dealing with serious physical, emotional, social, and spiritual needs.

But still, you might be asking this question:

Are music therapists the only people who use music in hospice care?

No, we certainly aren’t! Other hospice professionals can use music within their own scope of practice, and musician volunteers are called upon frequently to visit patients to provide entertainment and companionship. Ideally, hospice organizations will call upon music therapists to provide direct clinical services to those patients who are most in need, and to train and consult with other team members and volunteers on how best to use music in their own work. In this way, people receiving hospice care will have music touching and healing them through the very end of life.

5 Songs for Springtime

TulipsIn honor of this season, I have five songs to recommend adding to your bag of tricks if they aren’t already there. Add these songs to your “Springtime” playlist, use them to spark conversations with individuals or small groups, or integrate them into large group activities:

1. When It’s Springtime in the Rockies
This song is especially perfect for those of you in the upper Midwest who still have snow on the ground. It’s written from the perspective of a guy in a cozy apartment in the city, thinking about when he’ll be able to travel again to see his sweetheart in the mountains.

2. It Might As Well Be Spring
Listen closely to the lyrics of this Oscar-winning song for a description of spring fever, and use this to start a discussion about signs of springtime. Add pictures of babies in swings, crocuses or rosebuds to add a visual element to your discussion. Sharing the video from the film State Fair is also a great idea.

3. When the Red, Red Robin Come Bob, Bob, Bobbin’ Along
The red robin might be the most recognizable sign of springtime, so this song fits perfectly with the season. Be ready with this song when you can watch robins out the window.

4. When You Wore a Tulip
Tulips and roses are among the first flowers to bloom in the springtime, so this song also fits with the season. Again, have photos on hand or live flowers indoors or outside the window. (You can read a longer post on this song here.)

5. The Birds and the Bees
Along with a discussion about the birds and bees coming out again in the warmer weather, this song might spark discussions about young love, too – that “spring fever” mentioned above.

These are just a few of the songs that might say “springtime” to your older adults. What other songs are on your springtime list?

What Song Was #1 On This Day 50 Years Ago?

50yrsagoBeatles

Answer:

I Wanna Hold Your Hand by The Beatles

This song was a hit at the very beginning of Beatlemania in the U.S.

People of all ages will remember this song, but keep in mind that folks in their 60s were teens when this came out, while people in their 80s were probably the parents of those Beatles-loving teens.

You can see The Beatles performance of “I Wanna Hold Your Hand” on The Ed Sullivan Show below:

Want more songs to share with your clients and loved ones?

Be sure to check out the song spotlights series.

5 Ways Music Makes Your Life Better

Woman with music notesYou can probably identify with the idea that music can make you feel better.

It’s pretty natural for us as human beings to seek out music for joy and pleasure and beauty. But why exactly does music feel so good?

Music connects us to others.

Not only is music a uniquely human experience, but it is also a communal experience. For generations upon generations, before iPods and TVs and even electricity, people gathered to make music together, to celebrate, to mourn, to commemorate, and to pray. Even now, when you’re listening to a song through your very own headphones, you’re connected to the people who created the music and others who experience the same recordings you do. People crave connection to others, and music helps us to connect.

Music can be a catalyst for emotions.

If you’ve ever put on a carefully-selected playlist to rev up your energy to tackle household chores or to set the mood for a romantic evening, you know what this one means. We’ve always known on a human level that music and emotions are closely connected, and now we even have neurological research to show us exactly that. By intentionally choosing music to match where you want to be, you can help yourself get to that desired mood.

Music can be a container for emotions.

Even as music can help us to get to a desired mood state, it can also go a long way in helping us to honor and cope with difficult feelings. All of us experience fear and anger and grief and confusion at one time or another, and sometimes it can seem almost impossible to get through those difficult feelings. At the same time, ignoring or stuffing those feelings away can lead to much bigger problems. Instead, you can choose a song that expresses the full depth of your feelings, listen with intention, and allow that song to hold all that you are feeling. Your music then becomes a container for your emotions, honoring all that you feel while allowing you to do what you need to do in your day-to-day life.

Music helps us relax.

Besides using music to relax on an emotional level, by getting you to a happier or calmer frame of mind, you can use music to help your body to relax on a physical level. Through the process of entrainment, your body’s rhythms will want to match the dominant rhythms in your environment. So, choosing steady music around 60 beats per minute will help you slow your heartbeat to a resting rate, deepen your breath, and turn on the “rest and digest” part of your nervous system. Using slow and steady music will help your body relax. (You can read more about that process here.)

Music gets us moving.

Finally, just as music can help your body to slow down, it can help you ramp up, too. The same process of entrainment that helps you relax to slow and steady music makes you want to move your body to upbeat, rhythmic music. Believe it or not, this actually make exercise seem easier. And while we adults often have to frame our intentional body moving as “exercise,” with music, you can really explore your playful side, too. Okay, let’s just call it what it is: Music helps you dance. And dancing feels awesome. (Read more about choosing music to support movement here.)

How does music make a difference in your life? What songs help you to relax or get moving or to deal with difficult emotions? Leave your comments below!

Song Spotlight: “Don’t It Make My Brown Eyes Blue”

I work in eldercare settings, but that doesn’t mean all of my clients love Frank Sinatra and Hank Williams. In fact recently, I’ve been learning a bunch of of songs from the 1970s, so I can have new ways to connect musically with people in their 50s and 60s, who might be caring for loved ones in their 80s and 90s or on hospice or long-term care services themselves.

One tool I’m using is The Grammy Awards Song of The Year 1970-1979. As the title suggests, this songbook includes all of the songs nominated for the Song of the Year during the 1970s. Does that mean these are the best songs to use in music therapy for people who were young in the 1970s? No. But it’s an excellent place to start an exploration.

The song that has struck me recently was a 1977 hit for Crystal Gayle: Don’t It Make My Brown Eyes Blue. Written by Richard Leigh, this song has a jazzy piano line that probably helped it to become Gayle’s first and biggest crossover hit. This song reached #1 on the country charts and #2 on the Billboard Hot 100, and it won Gayle a 1978 Grammy Award for Best Female Country Vocal Performance.

Uneasy senior woman praying for sick manThere are a few things about this song that work really well for clinical and caregiving situations:

Sing-ability. Another fun fact? This song was recognized by ASCAP in 1999 as being one of the ten most-performed songs of the twentieth century. That means a lot of people are doing live cover versions of this song, and I bet that’s because its narrow range makes this song pretty easy to sing.

Honest feelings and unanswered questions. This song is about someone leaving and the person being left not quite understanding why. One thing is clear: the singer is sad and lonely and trying to cope with it all. Beyond that, though, there is plenty of room for interpretation about the details of what happened. The listener can put a lot of their own feelings and experiences into this song.

Simple, repetitive lyrics. When you’re dealing with difficult feelings, sometimes all you can do is say how bad it feels. The repetition of the line “don’t it make my brown eyes blue” underscores the sadness and loneliness, while making the song more singable, too.

That crossover appeal. Because this song was popular with country and pop music audiences, chances are a lot of people will be familiar with this song. That makes it a good one for opening a discussion about love and loss, or starting a deeper musical exploration.

Try This: Songwriting Experience

This song also works quite nicely for a simple fill-in-the-blank songwriting experience.

Especially for family caregivers, this song could be a great container for some of the difficulties you’re experiencing in your caregiving work. Try adding your own words to this framework:

I don’t know when I’ve been so blue

Don’t know what’s come over you

You’ve __________________

And don’t it make my brown eyes blue

I’ll be _______________ when you’re gone

I’ll just ____________ all night long

Say it isn’t true

And don’t it make my brown eyes blue

Tell me ________________ and tell me ___________

Give me ________________, give me _____________

Tell me you love me and don’t let me cry

Say _____________ but don’t say ________________

I didn’t mean ____________________

I didn’t know ____________________

But honey ______________________

And don’t it make my brown eyes

Don’t it make my brown eyes

Don’t it make my brown eyes blue

Some of those phrases sound just like what I’ve heard from people who are caring for loved ones with Alzheimer’s Disease or other forms of dementia:

I don’t know what’s come over you.

Tell me…

… you love me.

… you know my name.

… I’m doing the right thing.

I didn’t mean…

… to make you upset.

… to leave you alone.

… to get so angry.

I didn’t know…

…it would be this hard.

…it would end like this.

…how scared I’d feel.

I think there is comfort in having our deepest thoughts and feelings expressed through music. Perhaps using the framework of this song can give you some comfort in expressing your own experience.

What do you think of this song? What lyrics would you fill in the blanks? Leave a comment below, and let us all know.

This post is part of an occasional series on special songs to share with your clients and loved ones. For more song spotlights, click here.

Music Therapists Do It Differently: Supporting Movement

In this series, we are exploring how music therapists do live music differently than other musicians, even though it may not be easy to see. This is part ten of a ten-part series. You can find an introduction and links to all ten posts here.

(P.S. Are you loving this series? There’s more where that came from! Jump on our email list for specialized, exclusive content, just for subscribers. Click here to subscribe.)

Our bodies have a natural tendency to move with music. In fact, classical music concerts are kind of weird for the expectation that people are to sit quietly in assigned seats. The truth is music and dance have almost always gone hand in hand, in cultures around the world. It just feels natural – and really darned good – to move in time with music. You could even say that moving to music is musical all by itself.

"Methinks it's time for a conga line."

“Methinks it’s time for a conga line.”

Still, dancing and moving to music are not that common in the live music situations you might encounter in an eldercare community. Most often, I see folks listening quietly to entertainers, applauding quietly at the end of each song. When it gets a little jazzy, you might spy a few people tapping their toes, or clapping to the music if the performer tells them to. If you’re lucky, some brave soul may stand up and start dancing to the music, and for a brief but brilliant second, you think maybe a dance party is going to get going. On the other hand, if the poor entertainer is performing during a party while people are being served refreshments, her audience will be too busy with conversations and snacking to get into dancing.

I’m not sure why this is. Do we expect our elders to be polite and sedate? Are they just tired or hurting to the point that moving doesn’t feel good? Or are our seniors embarrassed to be seen moving the way they do now, rather than how they did decades ago?

In any case, I know two things to be true:

  1. Most people should be moving more. Research has demonstrated that regular physical activity can lead to improved mobility and strength,  better sleep, preserved cognitive functioning, decreased depression, and stronger feelings of self-efficacy and personal control. Yet adults over the age of sixty-five are the most sedentary age group.
  2. Moving your body as a form of musical expression feels great. People have always known this on a human level, but now neurological research is starting to show us why movement and music go together so well, too.

This is why I deliberately encourage movement to music when I am doing live music with older adults. Rather than just hoping for people to “get into the music” and move spontaneously, as you might do in an entertainment-oriented program, I view movement as an important form of musical communication and consciously facilitate movement to music. This is one more way that music therapists do live music differently.

#10. Supporting Movement

Sometimes music therapists are very direct in facilitating movement to music with verbal, visual, or tactile cues; and sometimes music therapists focus on reflecting and amplifying the movement that arises spontaneously for people that are doing music with us.

Let me share some examples of how this works.

Directing Movement

Imagine Janet’s music therapy group in a memory care community. One song fitting into her “weather” theme is “Over the Rainbow.” Knowing that the wide range of this song makes it difficult for many of her clients to sing, Janet plans to integrate movement with this song. She demonstrates expressive arm movements to match specific lyrics (e.g. reaching one arm over the head to draw a rainbow shape for “somewhere over the rainbow”), then leads the group by singing a cappella and demonstrating the movements visually. When participants have the arm movements learned well, Janet adds a guitar accompaniment, for an even more layered musical creation.

Planned movement experiences could work in a one-on-one session, too. For example, maybe Jennifer knows that her hospice patient Maude craves touch. Rather than playing guitar, Jennifer often holds Maude’s hands and sings a cappella. When Maude seems to have the energy, Jennifer says, “will you dance with me?” and sways Maude’s hands gently while singing, “My Bonnie Lies Over The Ocean.” If Maude resists this movement or feels tense, Jennifer stops dancing with her, but on some days, Maude seems to take over moving to the beat. Jennifer notices that Maude is more likely to make eye contact and smile on these occasions.

Reflecting and Amplifying Spontaneous Movement

Of course, those planned experiences aren’t the only ones that get participants moving to the music. Perhaps Janet is playing “Singin’ in the Rain” as several residents sing along, and she notices that Glenda, who is usually pretty withdrawn, looking up in her direction and kind of waving her fingers to the beat. Janet says, “you’ve got the beat, Glenda!” and taps her guitar in imitation of Glenda’s movement. In this case, Janet is supporting movement in a different way: reflecting and amplifying Glenda’s movement.

Again, the same thing can happen in one-on-one sessions, too. Perhaps Jennifer notices Joe nodding his head slightly to her rendition of “Hound Dog.” Jennifer mirrors his rhythm, swaying to the beat while continuing to sing and play guitar. Seeing Joe’s movements get even bigger and more deliberate, Jennifer abruptly mutes her guitar on the line “you never caught a rabbit,” then points at Joe and sings, “and you ain’t no friend of mine.” He smiles broadly and points back at her, while Jennifer strums an appropriately rock-n-roll beat to end the song. Here, Jennifer was amplifying Joe’s movement and showing him where to add an accented movement, too. Now Jennifer and Joe are collaborating in the music on a new, deeper level.

Helping music therapy clients move to music means that they can shift from passive listening to more active engagement in the music-making. What’s more, music therapists see participants’ movement as being an essential part of the music itself.

Facilitating movement to music is one more way that music therapists do live music differently.

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