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Why Music Therapy in Palliative Care?

I entered my first palliative care room as a practicing music therapist in early 1990s. I was unfamiliar with the person I was about to meet – all I knew as I walked through the door was that her name was Gwen, she was wearing a colourful head scarf, and she was the same age as my mom.

Gwen asked me to learn her 12 ‘signature songs’ – songs that had special meaning in her life. She had invited her daughter and sister to her room with the intention of having a meaningful afternoon of saying goodbye — something they were all struggling to do.

As I played through each of the songs the ladies painted a canvas of flowers that would be pressed on over 150 CD labels, with one CD to be handed out to every person attending Gwen’s funeral. The afternoon affected us all, creating a goodbye experience none of us will forget. As Gwen said, “music seems like the perfect send off.”

The World Health Organization defines palliative care as “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”

The Canadian Association of Music Therapists defines music therapy as “a discipline in which credentialed professionals (MTA – Music Therapist Accredited) use music purposefully within therapeutic relationships to support development, health, and well-being. Music therapists use music safely and ethically to address human needs within cognitive, communicative, emotional, musical, physical, social, and spiritual domains.”

Together, palliative care and music therapy can create an environment that fosters a warm and soulful experience coupled with a treatment that is helpful during even the most difficult of situations.

Two decades later, I met Cindy, who was my age laying in bed with a colourful head scarf around her head. As I entered her room, her 21-year-old daughter was doing homework in the corner and Cindy’s mom read a book quietly beside her. I was quickly reminded of Gwen, orchestrating an opportunity to say goodbye to the women she loved most. Cindy looks at me with a familiar twinkle – that look that says, “I know you will understand how difficult this is – can you help me?”

I sat close to Cindy and asked her a few music-based counselling questions and was able to quickly identify her music preferences (which were lovingly mocked by her daughter). Small smiles appeared and songs began to be sung, followed by the stories that were closely hinged with each musical memory. The book and homework were quickly tossed to the side as the four of us began to feel a meaningful connection that transported us to deeper into the moment.

I have witnessed these bonding moments more times than I can say. It happens quickly.

At one time, music therapy was documented as a ‘technique’ used by many professions – but the complex nature of music coupled with the therapeutic relationship with a music therapist required music therapy to become a specialized discipline with its own standards of practice and code of ethics.

As with all allied health services, research has revealed the reasons behind many of the clinical stories being experienced. In palliative care, these include:

Pain management

  • Curtis conducted an empirical study to evaluate the effects of music on pain relief and relaxation of patients with a terminal illness. Curtis SL. The effect of music on pain relief and relaxation of the terminally ill. J Music Ther. 1986;23:10–24.

Decreasing anxiety

  • Whittall conducted an empirical pilot study documenting the effects of music therapy on anxiety among those with a terminal illness. Whittall J. Songs in palliative care: A spouse’s last gift. In: Bruscia K, editor. Case Studies in Music Therapy. Phoenixville, PA: Barcelona Publishers; 1991. pp. 603–10.

Improving mood

  • Longfield conducted a quasi-experimental study measuring the effects on mood and pain in hospice patients receiving music therapy. Longfield V. St Louis, MO: Saint Louis University; 1995. The effects of music therapy on pain and mood in hospice patients. Unpublished master’s thesis.

Kathy Kortes-Miller trained as a music therapist and is now an internationally renowned death educator and author of Talking About Death Won’t Kill You. She writes, “Music therapy is closely aligned with the philosophy and vision of hospice palliative care because it concentrates on bringing forth the personhood of the individual who is dying. Music can illicit memories, emotion and decrease anxiety and experiences of pain. Music therapy can also support a connection between the music, the memories and social supports important to a person who is dying.”

As music therapists, it is our role to listen well, show compassion in a useful way, translate what we hear into action, and create a session that is inclusive to all in attendance (family and friends are often present). Music therapy is for all persons, regardless of where they are on the passage of their first to last breath.