Workshop : Music Therapy in Dementia Care

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Workshop Music Therapy in Dementia Care

• Psychosocial Interventions in Dementia
  Conference10 September 2009
• Adrienne Freeman Music Therapist

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Aims Of Workshop

• To demonstrate the differing functions of music
  therapy as applied to early, mid and late-stage
  dementia.
• To explore appropriate approaches
• To further discuss and learn together

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Tears and Rain

• How I wish I could surrender my soul
• Shed the clothes that become my skin
• See the liar that burns within my needing.
• How I wish Id chosen darkness from cold.
• How I wish I had screamed out loud,
• Instead Ive found no meaning.
• Blunt, J. (2004) Back to Bedlam. New York
  Atlantic

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Tears and Rain

• I guess its time I run far, far away find
  comfort in pain,
• All pleasures the same it just keeps me from
  trouble.
• Hides my true shape, like Dorian Gray.
• Ive heard what they say, but Im not here for
  trouble.
• Its more than just words its just tears and
  rain.
• Blunt, J. (2004) Back to Bedlam. New York
  Atlantic

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Tears and Rain

• How I wish I could walk through the doors of my
  mind
• Hold memory close at hand,
• Help me understand the years.
• How I wish I could choose between Heaven and
  Hell.
• How I wish I would save my soul.
• Im so cold from fear.
• Blunt, J. (2004) Back to Bedlam. New York
  Atlantic

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Tears and Rain

• I guess its time I run far, far away find
  comfort in pain,
• All pleasures the same it just keeps me from
  trouble.
• Hides my true shape, like Dorian Gray.
• Ive heard what they say, but Im not here for
  trouble.
• Far, far away find comfort in pain.
• All pleasures the same it just keeps me from
  trouble.
• Its more than just words its just tears and
  rain.
• Blunt, J. (2004) Back to Bedlam. New York
  Atlantic

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What is Music Therapy?

• Music Therapy involves interactive, live
  music-making as a basis for developing a
  therapeutic relationship between client and
  therapist.
• According to the current clinical needs of the
  client, the Music Therapist may set clear
  non-musical goals and work towards these through
  the specific application and use of music as
  appropriate. How the therapist responds and works
  musically is key to the process of therapy
• Music Therapy offers a means of self-expression
  and interaction to those whose illness impairs
  such abilities.

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Points to note

• The British model of Music Therapy relies heavily
  on the use of improvised music.
• Clients use easily accessible percussion plus
  voice therapist uses own study instruments/
  voice/ percussion as appropriate.
• Artistic creativity is often unimpaired by
  disability and can be a dynamic force for change.
• Music Therapy offers a safe, secure space for the
  release of feelings via non-verbal means.

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MUSIC THERAPY IS NOT

• Teaching someone to play an instrument
• A music lesson
• Music appreciation
• Performing pieces of music

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The Music Therapist

• Training
• Undergo HPC validated post-graduate Music Therapy
  training courses are 2 years full-time/ 3 years
  part-time at MA/MSc level.

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The Music Therapist

• Post-training
• Required to
• be registered with Health Professions Council
  (HPC). Not otherwise allowed to practise
• adhere to professional Code of Ethics
• maintain high standard of musicianship
• receive regular clinical supervision. Association
  of Professional Music Therapists (APMT) holds
  register of approved supervisors.
• Maintain ongoing CPD log, to be audited by the HPC

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Early Dementia ProjectIssues brought to the
group

• Sharing of personal histories
• Childhood freedom, security, wartime
• Journeys, people leaving, home
• Happiness and independence
• Excitement, creativity and gladness
• Frustration and disappointment at no longer being
  able to do the things one used to
• Problems of memory loss, things threatened by
  illness
• Loss of precision and discipline
• Loss of function, role and lifestyle
• Grief anger, denial, bewiderment
• Anger and exhaustion (with Drs?)
• Arguments/ storms/ nightmares
• Endings, including death

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Six phases of change experienced by people with
dementia

• recognition and concern
• denial
• anger, guilt and/or sadness
• coping
• maturation
• separation from self
• Cohen, D. and Eisdorfer.(1986) The Loss of Self
  A Family Resource for the Care of Alzheimers
  Disease and Related Disorders. New York Norton

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Allow time...

• Remember that even with moderate dementia it can
  take five times longer to process information
  than it takes for an elderly person without the
  illness...
• Do not be afraid of long pauses, and...do not
  assume that they do not understand just because
  they have not responded straight away.
• Goldsmith, M. (2002) Hearing the Voice of People
  with Dementia Opportunities and Obstacles.
  London Jessica Kingsley
• Itallics added

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Continuing personhood personal history

• A person who is the ex-matron of a nursing home
  is likely to want to sit in the office and check
  through the medical notes or duty roster and will
  not take kindly to being told that she may not do
  so by someone she considers her junior staff.
• A person who has spent time in an orphanage or a
  prison at an earlier time of their life may
  interpret particular staff actions in ways that
  were not intended by those staff members.
• Brooker, D.(2007) Person-Centred Dementia Care
  Making Services Better . London Jessica Kingsley

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The Palliative Ethos

• Why is this work different from other music
  therapy work?
• So-called norms have to be reconsidered the
  quiet undisturbed space, the time-boundaried
  session, the notion of beginnings and endings
  that are prepared for, the regular weekly
  sessions happening at the same time and in the
  same place.
• Lings, J. (2005) The Tonic dilemma focussing on
  adult palliative care.
• Leading Note the Quarterly Newsletter of the
  Association of Professional Music Therapists
• 4 (Winter) 14-15

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The Palliative Ethos

• There is no future as such, aims are
  considered
• differentlyyour job as a music therapist is to
• accompany each patient on their journey. Each
• person will perhaps call on something different
• from you and need you to sense how to
• accompany in different ways and at different
• levels. you will always need to improvise to
  find
• ways of meeting your client where they are.
• Lings, J. (2005) The Tonic dilemma focussing on
  adult palliative care.
• Leading Note the Quarterly Newsletter of the
  Association of Professional Music Therapists
• 4 (Winter) 14-15

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The kaleidoscope effect
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Mr Rs song

• Saint Thomas, Trinity Ville, was not very quiet
  on a Sunday,
• When Ronald and Ted played reggae,
• When Ronald and Ted played reggae.
• But Teds voice was bad, and he couldnt sing,
  but he drives a car, drives it very well, goes to
  the betting shop
• And right into work and all over the place.

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Mr Rs song

• Violet is a good sport, and she is a big woman
  now.
• Shes bigger than Ronald but smaller than Ted,
  bigger than Ronald but smaller than Ted.
• She talks all the time, to Ronald or Joanne, but
  she lives in Kingston, back in Jamaica. She
  bought a record with some tunes on it, for
  listening and dancing to.

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Mr Rs song

• Susan is very flashy and she can sing a lot!
• She is a hairdresser in Trinity Ville
• And also in Kingston.
• Ronald danced with Susan in Kingston in Jamaica,
• Ronald left her there, to receive her customers.
• She was about 31 when she left Trinity Ville
• But she looked about 23!

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Toms Song

• I dont like it when its noisy.
• Let me go, let me go, let me go!
• Oh, I dont like her in there.
• Go away you nasty person!
• Oh please stay out of my room.
• Dont come back, dont come back, dont come
  back!
• Do you have to keep looking at me?
• Leave me alone, leave me alone, leave me alone!
• Freeman, A. (2003) Following the path how two
  cases finally ended, in
• Community, Relationship and Spirit
  Continuing the dialogue and debate.
• Papers from the BSMT/APMT Annual
  Conference BSMT Publications

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Spectrum of music for dementia

• opening greetings song - closing good-bye song
• pre-composed song
• improvised song running commentary
• wordless songs
• Tonality, rarely atonality
• structured improvisation
• free improvisation can connect with movement,
  breathing
• accessible and appropriate instruments
• relevant and personally significant music

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Making connections.

• However devastating and depersonalizing the
• effects of a dementing illness, however
• convincingly a person seems to drift away into
  the
• realms of unbeing, there is yet something
  inside
• that remains intact, a spirit that constitutes
  the vital
• essence of personhood. Music, the Quickening
• Art, as Kant described it (Ansdell 1995, p.81),
• stands perhaps unique in its capacity to make
• contact with, and give life to, this spirit.
• Simpson, F.(1999) Creative Music Therapy A Last
  Resort? In Aldridge, D. ed. Music Therapy in
  Dementia Care. London Jessica Kingsley

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For Further Information

• Contact
• The Association of Professional Music Therapists
• Website www.apmt.org