Wonderful and moving accounts of how music therapy can make a difference for those living with dementia. Thank you to James for giving his permission for this article and video to be shared and thanks also to Morag. If you would like to contact Pemma Spencer Chapman (music therapist) about her work please email pemma.sc@gmail Watch James find his voice at: mediafire/watch/96q1y2rddqafg83/Jon-edit_2008.wmv ‘Where words fail, music speaks.’ Hans Christian Anderson A music therapist reflects on her work with people living with dementia Pemma Spencer Chapman 2013 ‘I’m playing this the way I am. I can’t use the word ‘magic’ but it (the music) has a moving tone that is like part of me and talking to me.’ James (not his real name) was diagnosed with Alzheimer’s disease in his mid-fifties and soon had to give up the work he loved. Now in his late fifties he would lie in bed at home after his wife had gone to work until a carer or support worker came to help him. He didn’t have insight into his illness. When James was first brought into the music therapy room, I pointed out the range of tuned and untuned percussion instruments in the room and asked if he felt drawn to try any of them. He dismissed the drum and cymbal saying he would never play anything loud as he was a gentle person who didn’t get upset by things in life. He then picked up the small lyre and stood gently sounding the strings. After listening for a while I played a gentle, low repeating pattern on the guitar to support and give a musical ‘container’ to his sounds. As he played James reflected on what he was experiencing. He said the music made him think of his grandmother and mother. It made him feel alive. He spoke the words quoted above, that the music seemed to be part of him and talking to him. He brushed away tears. He kept repeating that he was a gentle person, never angry, accepting life as it came, and then he spoke of the hole he felt where his work used to be. For James the music was putting him in touch with his feelings of distress (even while he denied them verbally), and with his need for comfort. The sound of the lyre held close to his heart, the low, supporting guitar music and my presence as listener, brought up memories of strong early attachment figures, his grandmother and mother. He couldn’t acknowledge the anger and pain he found the courage to explore in later sessions, but in this first session, he found comfort. One role of the music in music therapy is to help people get in touch with their feelings. Music can by-pass our defences. Music also offers huge scope for expressing emotions. Humans are innately musical beings. A music therapist finds the musical potential that people have and harnesses it to the task of addressing their difficulties. Where one person may have a strong sense of rhythm, another may have a great sense of melody; where one has good motor skills useful for playing instruments another may love to use their voice. The music used might be well known, (one client’s needs were met through using songs from musicals), or it may be improvised, as with James. Musical improvisation in response to a client is core to the role of the therapist and is one of the main skills a student music therapist must develop. The relationship between client and therapist often includes a point where the therapist improvises in response to the client. To take one extreme, if a client was in a coma, the therapist would take the only musical element the person was exhibiting, the tempo of the rise and fall of their chest as they breathed. The therapist would improvise music using that tempo in the hope that at some level the person would become aware of something outside themselves that was tuning in to them. In contrast, a client may pick up a drum stick and beat a drum, to which the therapist responds musically. In James’s case it was the lyre. But music, while being an emotional experience, is also a language with ‘grammatical’ components. Beats, patterns, phrases, harmonies, all can be analysed and cognitively known. And this structured, language element can help shape and organise the sounds a client makes into music. The language of music continues to makes sense to most people who have serious cognitive impairment and they can engage and interact with it; it isn’t just noise. ……………………………………………………………………………. ‘I wanted to do more!’ Introduction Morag (not her real name) was in her early sixties and like James, her illness had started in her early fifties (‘early onset’ dementia). She now lived in a care home for people with advanced dementia. Despite suffering abuse in her early life from her father and later from her first husband, Morag had raised a family and finally made a happy marriage in her middle age. Her daughters were devoted to her and visited regularly as did her husband. Morag was dependent for all care. She only had movement in one arm, and the ability to turn her head a little. She couldn’t feed herself or direct any purposeful movements. Her speech was limited to occasional short words like yes or no. She hardly ever made eye contact. Staff had a problem because for part of each day Morag emitted loud cries and didn’t respond to their efforts to calm her. These were so distressing to other residents that they were forced to put her in an empty room away from others at these times. When I first heard the cries my instinctive thought was that I must go and pick up the baby. The music therapy sessions In sessions I improvised on the piano using the same pitch and length of phrase that Morag used for her cries. I was trying to let her know she was being heard and also offering a musical shape and form to embrace and partner her sounds. After a few sessions I thought that Morag was responding to my music. She seemed to anticipate where the pitch was leading and her next cry would start on that note. The quality of the cry was becoming slightly more song-like. It made me think of the early twentieth century German term ‘sprechstimme’, describing an experimental way of half singing, half speaking. Was Morag aware of the musical relationship or were her increasingly interactive and song-like sounds purely evoked by the music itself, like foot tapping often is? In the next session, (session nine), Morag’s music was even more interactive. We went on beyond the half-hour allotted to the session and eventually I decided I should bring the session to an end. Turning to Morag I put a hand on her rug covered knee and told her it had been wonderful. After a moment she gave a choked little cry and then, in a strange speech-song voice I heard the clear words, ‘I wanted to do more!’ I was so surprised and moved that I immediately said we could continue and the minute my hands sounded the keys she launched back into the music. Reflections Morag’s words of protest probably referred as much to her life as a whole as to the music making but perhaps it did make her feel alive and so was symbolic of her life. But I had my answer. She was aware! Music had provided Morag with a language that made sense to her and through which her cries, her only source of self-expression could find ‘stability, organisation and focus’ (Sachs, 2007) in a creative partnership. Conclusion Music speaks for us, to us and through us. It puts us in touch with our emotions, gives us a means of self-expression through both improvised and previously known music, and offers a language our brains, even when damaged, can in most cases make sense of and use to interact with another person. Music fires the connections in our brains. Many clients are more articulate verbally after making music. The reasons may be complex, but referring back to the Hans Christian Anderson quote, ‘When words fail, music speaks,’ it is encouraging to think that the reverse may be true –‘after music has spoken, words flow’. This article was originally published in the Oxford Psychotherapy Society Bulletin 2013. …………………………………………………………………….. References Nordoff P, Robbins C (1971) Therapy in Music for Handicapped Children: Gollancz Stern D. (1977) The First Relationship: London, Open Books Schore A. (1994) Affect Regulation and the Origin of the Self: The Neuro-Biology of Emotional Development: Laurence Erlbaum Assoc. Inc. Sachs O. (2007) Musicophilia: Knopf Publishing Group
Posted on: Mon, 19 May 2014 18:33:51 +0000
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