Virgil: Decreasing isolation
Setting: Individual music therapy in nursing home
Primary goals: Encourage positive socialization, provide emotional support
By his choice, Virgil stays in his bed for most of every day, and the activity director at his facility says Virgil chooses not to attend any group activities. Virgil does enjoy listening to country music, however, and usually has his radio on in his room. During her visits, the music therapist plays guitar and sings country songs requested by Virgil. In an early session, the music therapist also introduced Virgil to the paddle drum, and now Virgil laughs while telling about how his wife cannot believe he is a drummer. The music therapist continues to build a relationship with Virgil, and in the future, perhaps Virgil will agree to attend group music therapy sessions.
David: Bereavement and life review
Setting: Group music therapy
Primary goals: Emotional support for bereavement, life review, and exercising long term memory
David has been a regular attendee of the music therapy groups in his facility since they began. In early sessions, his wife also attended, and due to her agitation and wandering behaviors, David often was distracted in sessions by trying to keep her from bumping into things with her wheelchair. When David’s wife passed away, the music therapist provided support for David’s bereavement by creating opportunities for reminiscence and mourning within music therapy sessions. In one session celebrating Mother’s Day, David contributed a song verse about his wife’s being a good mother. David continues to share stories about his wife and children during various music therapy interventions.
Clara: Dementia care
Setting: Individual and group music therapy
Primary goals: Access and exercise long-term memory, decrease agitation and increase positive socialization
Clara is in the middle stages of dementia, with significant short-term memory limitations as well as aggressive behaviors towards staff and peers. Because of Clara’s agitation, the nursing staff sometimes hesitates to involve her in groups with other residents, but Clara immediately expresses interest when she see the music therapist with her instruments. Clara does not remember the music therapist from week to week and usually takes some convincing to participate in music-making since she remembers being told she was a monotone in grade school. Once Clara begins singing, however, she can sing all the words to many of the familiar songs of her generation, and once engaged in music, Clara will also participate in interventions that encourage story-sharing and playing instruments with the other group members, facilitating socialization. Clara is inevitably smiling at the end of music sessions and often continues singing and humming for some time afterwards.
Teresa: Decreasing agitation
Setting: Individual music therapy
Primary goals: Decrease verbal and motor agitation, provide emotional support, facilitate life review
In the late part of her life, Teresa has lost most of her eyesight and much of the time is disoriented and anxious about where she is and whether she is alone. At times, this leads to verbal agitation, yelling, and throwing objects on the floor in her room. Teresa does not attend groups because of her agitation’s effect on other residents, but she does sometimes calm down when given one-on-one attention. The music therapist uses music to draw Teresa’s attention to the present, mirroring her agitation with up-tempo songs then gradually changing to slow, gentle songs as Teresa relaxes. Teresa says she enjoys singing spiritual songs and sometimes will talk with the music therapist about her children and her younger years.
Gladys, Mary, and Bertha: Choice, leadership, and new experiences
Setting: Group music therapy
Primary goals: Facilitate socialization and leadership, exercise short- and long-term memory
These three ladies regularly attend a weekly music therapy group, which involves singing, instrument playing, trivia and name-that-tune games, as well as other music-based interventions to encourage socialization and memory stimulation. Bertha excels at trivia and name-that-tune games, raising her head to show off her bright smile each time she gets a correct answer. Mary initially shied away from playing instruments but now chooses a woodblock or drum to play in each group. Gladys often shares stories about historical events, and makes a point to address the staff and her peers by name. All three ladies have become leaders in the group, being the first to try new experiences and helping their fellow group members to participate in interventions.