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.

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I’m Glad Fred Phelps Died On Hospice Care

Fred Phelps

Fred Phelps

Last week, a celebrity from my home state died. Fred Phelps is about as notorious as Kansans get. As the founder of the Westboro Baptist Church in Topeka, Kansas, Phelps was at the helm of one of the most publicly, vehemently hateful groups in our country. We like to think that we’re nice people in the Midwest, so the hate and vitriol spewed by this group is both profoundly confusing and deeply embarrassing. I’ve been speculating on the source of Phelps’s hatred with fellow Kansans since my high school psychology class. The fact that our biggest national news stories have often been focused on the Phelps family? That’s something we take personally.

So it’s safe to say that Kansans weren’t terribly sad to see Fred Phelps go. I wasn’t. I hope that by losing their founder, the Westboro Baptist Church will also lose some of their steam and quit hurting so many people in our communities and across the country. And I hope the national news outlets will turn their attention from the Phelps family to something more positive, like a new universal preschool program or nation-leading innovations in the Department of Aging and Disability Services. (Are you listening, Governor?)

There is one piece of the Fred Phelps story that I really do want to highlight, though, and that is something that came to light in his estranged son Nathan’s Facebook page several days before his death. In that post, Nathan Phelps reported that his father was “now on the edge of death at Midland Hospice house in Topeka, Kansas.”

Did you catch that?

Fred Phelps died in hospice care.

That fact makes me tear up, out of great pride for my fellow hospice workers, and deep humility for the profound work we are called to do.

I believe at the deepest core of my being that everyone – EVERYONE – deserves grace and kindness and comfort and peace at the end of life. And that’s exactly what hospices provide.

I don’t know anyone who works at Midland Hospice and can’t say anything about the care they provided to Fred Phelps. But there is little doubt in my mind that Phelps was treated with all the dignity and respect and care that hospice professionals give to every patient at the end of life.

I may not have worked with Phelps, but as a hospice music therapist, I have worked with people who have done many horrible things. I’ve worked with people who had deep remorse over awful things they had done in the past, people who did not at all regret acts and beliefs that I personally didn’t agree with, and probably plenty of people who had ugly stories that remained hidden right through the very end. For every single one of them, my hospice colleagues and I did whatever we could to give them comfort and to treat them with kindness and compassion in their final days.

That is just what hospice professionals do.

Fred Phelps was a hateful man who did a lot of despicable and disgusting things, but it gives me hope to know that he was on hospice care at the end of his life. I hope that he experienced the grace and compassion that he denied to so many others and that somehow it made a difference.

Music Therapists Do It Differently: Rhythm

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 six of a ten-part series. You can find an introduction and links to all ten posts here.

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#6. Rhythm

Rhythm is perhaps the most basic building block of music.

Rhythm alone can make music, but you can’t have a melody without rhythm. You can’t add harmony to a melody without rhythm either.

Obviously, rhythm is important to every musician, whether they are performers, composers, conductors, or dancers. Music therapists do have some unique considerations when it comes to rhythm, though.

Because rhythm is such a huge concept in music, it’s helpful to talk about some of the smaller components that make up rhythm. Tempo is one that we already discussed. Two more are meter and accent.

Meter Matters.

Rhythmic meter involves the relationships between strong beats and weaker beats within a musical phrase. Those of us used to listening to Western music are probably most familiar with the difference in feeling between duple meter (2/4 or 4/4 time – like a march) and triple meter (3/4 time – like a waltz), and between simple meter (with beats having an even number of subdivisions – like “Yankee Doodle”) and compound meter (with beats divided in three – like “Hickory Dickory Dock”).

"That lullaby sound is nice! Makes me want to take a nap…"

“That lullaby sound is nice! Maybe I should take a nap…”

Music therapists choose to improvise in a particular meter or may choose a song based on its meter. For example, we know that music in triple meter tends to have a rocking feeling. (This makes sense when you think of the connection to waltz music.) So, when I want to support a husband swaying to the music with his wife, I would probably choose “Let Me Call You Sweetheart” over “You Are My Sunshine.” On the other hand, when I want to support someone in marching in time to the music or playing a drum with a steady beat, I would choose something in duple meter.

Accent Matters, Too.

You can say that the strong beats in a particular meter are accented (i.e. beat one in 3/4 time, or beats 1 and 3 in 4/4 time). When the accents do not match up with the naturally-expected strong beats in a particular meter, you get syncopation.

Syncopation was the defining feature of jazz and other popular styles to emerge in the 20th century. Although it has been around long enough to be very familiar to our Western ears, adding syncopation in melodies and accompaniment can still sound contemporary and fresh. In fact, one study suggested that syncopated patterns were more enjoyed and viewed as happier and more complex than unsyncopated patterns. So, music therapists may add syncopation to make a musical experience more emotionally rewarding and attention-grabbing.

On the other hand, from a neurological perspective, it is easier for us to find and match the strong beats in a meter than to track syncopated rhythms. Simpler, more predictable accents work better for clients who are trying to match a movement to rhythm, whether that is playing a drum on the beat or walking in time to the music. In helping clients with gait training using rhythmic auditory stimulation (RAS) following a stroke, for example, music therapists prioritize simpler rhythms that encourage rhythmic entrainment over the enjoyment or emotional reward of the music. So, music therapists choose simpler or more complex syncopation based on the needs and goals of their clients.

What do these choices look like in a music therapy session?

Imagine Lynn working with an 77-year-old resident, Larry, who is in the early stage of Parkinson’s Disease and is recovering from a hip fracture in a nursing home. Larry is working with a physical therapist to rebuild his strength and endurance for walking, and Lynn is providing music therapy co-treatment. To support Larry’s gait training, Lynn sings and plays “Yankee Doodle.” While this isn’t Larry’s favorite song at all, it does give the strong beat to help him march down the hallway. The priority is regaining the functional skill of walking.

Contrast that with Lynn’s session with Rhonda, a 69-year-old woman on hospice care for end-stage breast cancer. Rhonda loves classic Motown hits, especially Martha and the Vandellas singing “Dancing in the Street.” Lynn often offers to play this song, and on “a good day,” Rhonda invariably shimmies and shakes to Lynn’s version of the song. Lynn uses syncopation and other musical surprises heavily, to add interest to the song and encourage Rhonda’s musical engagement. It doesn’t matter whether or not Rhonda is dancing in rhythm, as the goal isn’t to regain functional movement. A positive emotional experience is the priority.   

Rhythmic choices – tempo, meter, and accent/syncopation – matter for all musicians, but for music therapists, these choices are made with the clients’ goals in mind.

That’s how music therapists do rhythm differently.

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Music Therapists Do It Differently: Texture

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 five of a ten-part series. You can find an introduction and links to all ten posts here.

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#5. Texture

Musical texture refers to the way that melody, harmony, and rhythm are combined to create a particular musical sound. There are formal terms for musical texture (including monophonic, homophonic, polyphonic), but for our purposes, we can think in terms of how thick or thin the musical sound is.

What is thick or thin texture in music?

For a thin or light texture, think about the solo violinist playing on a stage, before the full orchestra comes in. Or imagine an open mic night, with one guy singing while strumming his guitar. The sound is simpler, with fewer musical lines crossing over each other. You could hear every single note if you wanted.

By contrast, for a thick texture, imagine the moment the full orchestra swells behind that solo violinist, carrying the concerto through to the finale. Or imagine a rock band pumping out a power ballad, with guitars and drums and backup singers. Now you’re hearing a bigger sound, something closer to a wall of sound. Many musical lines are happening at once, and it might be difficult to hear individual parts.

In terms of musical entertainment, composers, arrangers, and producers are generally the folks who determine the texture of the music, by deciding which instruments or voices to include in the composition, or how many layers to add to a recording or live performance. Performers have some control, too, by adjusting the complexity of their arrangements or adding more instrumentalists or singers to their performance. (Of course, the latter often becomes a matter of logistics, too – how many performers will fit in the venue? How many can we afford to pay?)

For me as a music therapist, though, musical texture is on my mind frequently for clinical reasons.

Musical texture plays an important role in clinical music-making.

Music therapists do a lot of in-the-moment arranging of music to meet the demands of a given clinical situation, in both group and one-on-one sessions.

How do music therapists use musical texture in groups?

"How does she choose what strum patterns to use?"

“How does she choose what strum patterns to use?”

Take the example of Janet leading a group in “Singing in the Rain.” In the scenario described here, Janet was facilitating music with a very thick texture, with every group member playing an instrument. The aim was to have everyone in the group making music together at once. But what if the sound of Edith playing the rain stick was getting lost in this thick musical sound? Janet could have everyone stop playing except for Edith, highlighting the rain stick solo.

This change could facilitate a few goals for group members – shifting attention to one instrument, encouraging the group to support Edith and allowing Edith to feel that group support, bringing down the volume level to decrease the potential for agitation due to noise or discomfort for those with hearing aids, or bringing attention back to the session theme of weather, providing a natural shift back to a group discussion. The music therapist facilitated shift from a thicker texture to a thinner texture to meet a clinical purpose.

Music therapists pay attention to texture in one-on-one sessions as well.

When facilitating music for entrainment with a hospice patient, for example, a music therapist might start with a strummed guitar accompaniment, then taper down to a finger-style pattern, before ending with a cappella singing. Here, the shift from a thicker texture to a thinner texture is meant to facilitate relaxation. Or, a music therapist might shift from finger-style playing to a thicker, strummed guitar accompaniment to support someone in playing an instrument. Here, the shift to a thicker texture provides a stronger musical support for someone trying out an instrument.

In any case, just as music therapists pay attention to tempo, key, range, and session structure, they consider musical texture for the purpose of meeting clinical needs.

This is yet another way that music therapists do live music differently.

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Music Therapists Do It Differently: Tempo

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 four of a ten-part series. You can find an introduction and links to all ten posts here.

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#4. Tempo

One incredible advantage that live musicians have over recorded music is the ability to adjust tempo. That is, we can play slower or faster depending on what is happening in the room. Any skilled musician may make some of these choices:

  • Bumping up the tempo to raise the energy level, or slowing it down a bit so people can keep up dancing
  • Matching the tempo of a famous recording or the composer’s specifications, or choosing to play much faster or slower for an intended musical effect
  • Adjusting tempo for our fellow musicians (e.g. slowing down to the new drummer’s pace.)

Musical decisions about tempo have to do with sounding great as performers with mindfulness towards the audience we’re trying to reach.

Music therapists take this a step further, choosing and modifying tempo to address clinical concerns.

Let’s start with an example from a group session. Using the same scenario as in an earlier post, imagine music therapist Janet leading a group playing rhythm instruments along with the song “Singing in the Rain.” A common goal for this kind of experience involves bringing everyone into the music-making experience at their own level, to promote environmental awareness, group cohesion, and socialization.

"How did she get Robert to play in time with everyone else? He's usually just making noise, not music!"

“How did she get that Robert to play in time with everyone else? He’s usually just making noise, not music!”

Janet might have one tempo in mind when she starts singing, but she notices one resident – Robert – playing his drum with a steady beat slightly ahead of her tempo. Janet could try to get Robert to match her beat. In fact, she would have to do this if she were using recorded music. Instead, she just speeds up a bit to match Robert and help the group meet at one tempo.

The result is more musically pleasing, increasing everyone’s satisfaction with the music they’ve created together, and Janet has helped someone be in the music with others who might have struggled otherwise.

Tempo choices are also important in one-to-one sessions. In fact, one technique I use often in hospice care is all about tempo. We call it entrainment or using the iso principle, and it involves starting music at a higher tempo, matching the client’s energy, anxiety, or pain level, then gradually decreasing the tempo. Because our bodies want to match the dominant rhythm in the environment, this helps the client to relax, in body and mind. (Read more about using the principle of entrainment for yourself here.)

As you can see from these examples, playing music live allows for tempo adjustments much more easily than using recorded music. Add to that music therapists’ extensive training and practice in making tempo and other musical choices according to clinical needs, and you can see why music therapists can make such a difference.

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Music Therapists Do It Differently: In-The-Moment Adaptations

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 two 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.)

#2. In-The-Moment Adaptations

No matter what kind of musical interaction a music therapist is facilitating, we always starts by considering the client’s needs and goals on a given day. Sometimes the session plan is highly structured and well-thought out in advance, but sometimes the plan has to change to meet the needs of the group or individual on that particular day. In fact, sometimes the plan has to be pretty flexible from the outset, ready for the adaptations that will surely be required. I have found this to be especially true in my hospice work.

Imagine this one-on-one scenario:

Joe is doing a one-on-one music therapy session with Gina, a 96-year-old hospice patient living in a nursing home, who has end stage cardiac disease and moderate dementia. You hear Joe sing “You Are My Sunshine” and “Singing in the Rain” while strumming his guitar, and you think Gina might have chimed in with a word or two. When you peek around the corner, you see Gina looking intently at Joe and smiling. When you walk back down the hall again, you hear Gina and Joe laughing at something. How nice for Gina to have this music man come to visit!

What’s going on?

From the outside, it may appear that Joe simply thought of a few songs off the top of his head to sing with Gina. It’s true – Joe may or may not have written down a formal plan for this session, spelling out which song to sing when.

Or, on the other hand, it may look like Joe has some kind of “set list” of songs that he performs for ladies of a certain age. It’s true – you’ll hear music therapists singing “You Are My Sunshine” a lot more frequently with folks in their 90s than people in their 60s.

The bigger picture, however, is that Joe was choosing music based on the client’s goals and needs on that particular day.

Music therapists are ready to adapt. 

As discussed in the last post, Joe isn’t playing “You Are My Sunshine” just because he really likes that song. Rather, he has some kind of goal or purpose in mind. He might be singing “You Are My Sunshine” in an early session with Gina to assess whether she will sing a familiar song. His purpose is assessment. Or, he might choose that song to support a conversation about the warm weather outside while they watch the birds at the feeder outside Gina’s window. The goal is reality orientation and helping Gina find joy in the moment.

But what if Joe arrived one day, planning to talk about the lovely weather, but Gina was curled up in bed, crying like Joe had never seen before?

Music therapists prioritize client goals over session plans.

"Gina's having a bad day. I wonder what that music man will do?"

“Gina’s having a bad day. I wonder what that music man will do?”

In this case, Joe ditches his plan to talk about the weather and focuses on what support Gina needs in the moment. Perhaps Gina has become tearful from remembering that her eldest son has died. Knowing that Gina used to sing “You Are My Sunshine” when her children were young, Joe might offer this song as support for her grieving. Rather than using this song as an assessment tool or a vehicle for a pleasant social interaction, Joe offers it as a validation for Gina’s emotions and as a way to honor her history as a mother and her love for her son. Either way, Joe does not force Gina into a cheery conversation. Today is not the day.

This flexibility is central to the effectiveness of a music therapist.

We make plans for our sessions. Really good plans, based on clients’ goals. This lays the groundwork for music therapy.

By themselves, though, these plans would be limiting. They’d only work for the person and the circumstances originally conceived, not what might be happening on a different kind of day.

That’s why music therapists can’t really provide a protocol for which songs to play on which day to help Margie stay calm. Music therapists’ ability to make sometimes subtle adjustments in our musical interactions makes all the difference in the effectiveness of music therapy.

Music therapists adjust and adapt the music in the moment, based on clients’ needs right then and there. That’s how we do it differently.

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Aesthetic Experiences at the End of Life

What is the value of aesthetic experience near the end of life?

This question has been on my mind as I’ve been thinking about a character from Toni Morrison’s novel Beloved. This is the story of ex-slave Sethe trying to live a new, free life while haunted by the ugliness of the past, not the least of which was her murdering her own daughter to save her from returning to slavery.

One memorable character is Baby Suggs, the protagonist’s mother-in-law and the matriarch of Sethe’s new home in Ohio. At the beginning of the novel, Baby Suggs is dying, and she is craving color:

Suspended between the nastiness of life and the meanness of the dead, she couldn’t get interested in leaving life or living it…Her past had been like her present – intolerable – and since she knew death was anything but forgetfulness, she used the little energy left her for pondering color.

“Bring a little lavender in, if you got any. Pink, if you don’t.”

And Sethe would oblige her with anything from fabric to her own tongue. (p. 4)

Why would a person spend her final days craving color? By the end of the novel, Sethe thinks she knows:

Now I know why Baby Suggs pondered color her last years. She never had time to see, let alone enjoy it before. Took her a long time to finish with blue, then yellow, then green. She was well into pink when she died. (p. 237)

Besides the fact that Beloved is a masterpiece worth reading for many reasons, I think this novel also makes a powerful statement about experiencing beauty amid the ugliness of life. There is no doubt that the characters in this novel saw a lot of ugliness, without the time to consider beauty – to “stop and smell the roses,” as we might say.

By the end of her life, though, Baby Suggs desired little but to ponder color. On some level, she needed to see and absorb the beauty of the world that had given her a lifetime of ugliness, and she used the remaining energy she had to do so.

We need beauty, too.

Most of us probably haven’t experienced ugliness on the level of slavery, but each of us does go through excruciatingly difficult times, whether that is the pain of cancer, the slow decline of Alzheimer’s disease, the grief that follows the death of a spouse or child, the shame of physical or sexual abuse, or the myriad other hurts that come with life on this planet. And, eventually, all of us have to face the uncertainty and fear that comes with the end of life.

In hospice care, a significant amount of attention is given to decreasing and preventing physical pain. In fact, hospice and palliative care physicians and nurses are experts in using medicine to help people stay comfortable. Hospice professionals do not stop at preventing physical pain, however. The hospice team includes social workers, chaplains, volunteers, home health aides, and (increasingly) music therapists to help people end life well. One recent study showed that these teams, working together with the patient and their family, provide a lot of non-pharmacological care in the very last days of life, including “creating an aesthetic, safe, and pleasing environment.”

The researchers expressed some surprise that so much time was spent on creating an aesthetically-pleasing environment in a person’s final days, but I’m not surprised. Sometimes I have the privilege of providing some beauty through music during a person’s final days. It makes a difference. So can a bouquet of flowers or a homemade quilt or a nice view out the window.

Appreciating beauty in the world is part of what makes us human, so it’s no surprise that aesthetic experiences can help us end life well.

A Meditation on the Rhythms of Life

Life is rhythm.

Any music therapist worth her salt will tell you this.

Once you start looking for the rhythms in life, you begin to see how many overlapping rhythms we all share.

We have rhythm in our bodies as we breathe and move.

We have rhythm in our day, as the sun rises and sets, as we move from bed to work to family time and back to bed again.

We have rhythm in our weeks, as we get busy on Monday and relax on Saturday.

We have rhythm in our seasons, as swimsuits and ice cream turn to pumpkin and sweaters and then again to multicolored lights and holiday cheer.

We come to rely on the regularity of these rhythms, this structure that helps us to know where we stand in time and space, what we’re meant to do and maybe how we’re meant to feel.

Staring at roadBut then those rhythms get disrupted.

Yesterday morning, I heard that my 92-year-old grandfather had died. We knew he was nearing the end of his life, and we had all had plenty of time to hear his stories, sing a few more songs, and say goodbye. It was a predictable rhythm, the natural end to a long life, but still, it was jarring to know that his life had come to an end, with the rhythms of his breath and heartbeat falling to silence and the rhythms of our family forever changed.

Then we all learned that many more children and adults had their lives end, too, this time in a more violent, abrupt, horrific way that I had ever imagined, in a school in Connecticut. More life rhythms ended – silenced – with no warning, no hint that the song was coming to end. Rather than the gentle end of a lullaby or the triumphant coda to a symphony, it was having the radio unplugged and a tornado siren blown directly in our ears.

And in yet another corner of the world, one of my friends gave birth to her first child. A new heartbeart, a new breath. An entirely new rhythm for my friend and her family. Sure, she had time to plan and prepare, but how does one get completely ready for the arrival of a new person?

What do we do when life’s rhythms change so abruptly?

How do we cope?

Do we try to get ourselves back in step as quickly as possible, pretending we never missed a beat?

(Can you even do that when you’ve lost a child to a gunman, or you’re no longer with the husband you’ve loved for 61 years or the father you’ve known your whole life?)

Or can we change the rhythm enough to integrate the changes that have already happened?

(How do you figure that one out? It can’t be easy…)

I don’t have an answer. All I know is that life will keep moving on, and the rhythms will keep going.

Somehow, we’re all still part of the song.

Song Spotlight: “Mama Tried”

Migrant Mother, Nipomo, California – Dorothea Lange

  • Mood: Regretful, Defiant, Wistful
  • Theme: Regret, Motherhood/Parenting
  • Tempo: Moderately Fast
  • Genre/style: Classic Country

Mother’s Day is coming up in a few days, and in honor of the holiday, I’ve been sharing many songs about motherly advice and love with clients in music therapy. In fact, a few that I’ve spotlighted before work well for this holiday, including Que Sera Sera, Shoo Fly Pie and Apple Pan Dowdy, Cuddle Up a Little Closer and Button Up Your Overcoat (although it’s a bit warm for that last one. Maybe it would work in the southern hemisphere?)

The fact is, though, that Mother’s Day isn’t always the happiest day, for the children or for the mothers. My heart goes out to mothers who have lost their children and children who have lost their mothers, as I know they are grieving at this time. My heart also goes out to the women who desperately want to be mothers but who have struggled with infertility or miscarriages. These losses leave holes in our lives that cannot be papered over.

And, I’m also thinking about the mothers who have been disappointed by their children. Parenting always involves ups and downs as children grow and life happens. Sometimes things don’t work out for the best, and sometimes children make serious and lasting mistakes, no matter how hard their parents tried to raise them well. This causes a different kind of pain, especially when you think that you are the reason why your child turned out this way. I’ve known mothers of adult children who have experienced this kind of pain. I’ve also heard the regret of folks who disappointed their mothers, who made those lasting mistakes and now can’t repair the damage. That’s the topic of this song spotlight: Mama Tried.” Continue reading

A Musical Response for When a Senior Says, “I Just Want to Die”

I just read an article on how a caregiver can respond to a senior who is saying, “I just want to die.” I appreciate the advice given by Margaret Sherlock, M.A., Clinical Director of the Behavioral Health Program & Assessment Program Services at the Visiting Nurse Service of New York, which includes not ignoring the statements and being realistic about a senior’s need to talk about death and dying, while still setting limits on such heavy discussions and monitoring for signs of clinical depression in both the senior and in yourself. You can read all of her advice here.

This is sound advice, but I do think there is one important piece missing: you must think about how to deal with all of the emotions you and your loved one are both feeling. In fact, this kind of conversation can be so emotional for both the senior and the caregiver that it can be difficult to tell who is feeling what. You might think, is this person feeling depressed? Or is he just ready to die? Or is this person saying she wants to die because she wants to make me upset or get more attention from me? Or am I interpreting all of this wrong because I am the one who is feeling sad, or tired, or frustrated? Or maybe it’s a mixture of all of the above feelings, and I’m not really sure how to put words to it?

Even just trying to identify these feelings is difficult. No wonder these emotional conversations can wear you out! As Ms. Sherlock advised, though, you can’t just sweep the difficult feelings under the rug: they’ll just build up and create bigger problems for you and the senior later on. That’s why I’m usually not a fan of just changing the topic or putting on happy music to avoid the conversation.

When someone says, “I just want to die,” you need to acknowledge their emotional expression and honor your own. Continue reading