EAPC webinar presented on 8 December 2023 by the EAPC Social Work Task Force.
Thanks Joanne and uh welcome to everyone and well good afternoon I think it’s good afternoon to everybody across Europe uh my name is Steve Marshall I’m the co-chair of the eapc social work task force with uh my colleague Audrey Rolston but unfortunately uh Audrey’s teaching today so she can’t be here so
So it’s just me chairing and I’m really pleased to say and really excited to say we’ve got three amazing speakers um speaking on the subject a subject that I don’t know that much about so I’m very keen to to hear more uh the subject is music therapy as a form of bement
Support what is the evidence so we’ve got three speakers Dr Lisa Graham Weisner Dr Tracy McConnell and Dr Noah Popin um but I will allow each of them to actually introduce themselves uh to you so first of all I’d like to hand you over to Lisa thanks Lisa thanks so much
Stephen um I’ll just share my screen here I is with me we can see that okay good afternoon everyone and firstly to just say a big thank you to the Social Work Task Force at the APC for having us sorry we can see your we can see your speak of view
So we can see your notes as well as your slides ah see if I can stop this um John would you have any advice on how to get onto normal view uh if you stop sharing yeah okay and then do exactly what you did about five minutes ago yes which is
Share the the um I yeah one second this should be it here yeah we’re still on your speak of VI oh second apologies everyone for this okay we can edit the video I’ll just see there you go perfect was that it there okay perect no idea what I did
Different but as long as we’re there apologies everyone for that um but yes as I was saying thank you so much to the eapc Social Work task force for having us um here with you this afternoon um it’s a real Delight to be in such a good
Company and for us to have the opportunity to speak on something we’re passionate about music therapy as a form of break and support was what is the evidence so I’m Lisa Grim Weisner I’m a lectur at Queens University Belfast which is in Northern Ireland my colleague Tracy McConnell is senior
Research fellow at queens and our our colleague Dr noan poin is an associate professor at Kean University in that’s over in the States and what we’re hoping to cover in this seminar is firstly a bit of an introduction to music therapy for those of you who might be might be
New to this discipline um and then we’re hoping really to make the argument as to why we think music therapy is a value as part of the overall offering really operat and support we’re then going to summarize um where the research evidence currently lies in terms of this area and
We’re going to to give some ideas in terms of where we we think we should be focusing on going forwards and we’re going to leave you with a clinical case study really to try to to illustrate the individual benefit um of music therapy as as a form of bra support and this is
Very much an emergent area so we’re we’re really Keen to get your your thoughts your ideas and hopefully there’ll be a good chance for a discussion at the end so firstly beginning to talk about music therapy um and and how this fits into bement I hope it’s not too presumptuous
To say that music is universal so many of us on this call will have a very personal relationship with music perhaps particular songs and we’ll also have used music as a way to connect to others to build community I put up a few photos here of individuals in Italy and this
Was really during the height the covid-19 pandemic they’re out in their balconies they’re singing they’re playing instruments and they’re trying to really create a connection to others at a point in time where we were all very isolated and experiencing a mass bement event I’ve put up a list of songs here
And um these are these are songs that have been um written by musical artists as a way to process their their grief now I going to have to apologize as I realiz realized that um this is very much focused on UK and US based artists
So um if anyone has any um examples of of songs that are meaningful to them that they’d like to share in the chat please please do so suffice to say music has a multifaceted impact on the brand so it helps us with emotional regulation processes with physiological processes
Um has an impact on neuroplasticity and on our cognition and it has a different impact across individuals and across context it does have a special place in terms of bement not only in terms of you know the the Arts and you know what what has been written and constructed over time um for
For people trying to process grief but also on an individual level music is something that you know often each of us connects to um when we’re trying to really derive meaning you know from from different from different losses music therapy uses the so it uses music within the context of a
Therapeutic relationship so it uses music therapy as really a vehicle to drive change so as a way for the music therapist to support individual to reach their therapeutic goals music therapists um are Allied health professionals um within the United Kingdom their hcpc registered um and they have you know various different
Professional rots um if we look internationally but that’s really the distinction between music therapy and other music Bas interventions that music therapy has that therapeutic relationship and it’s delivered by professional music therapist music therapists practice across a whole range of different settings um and they’ve been practicing
Within end of life care for around the past 40 years or so in terms of music therapy in relation to bement just to say very quickly about the the direction that that the research body really is moving in relation to brief support we know that increasingly International guidelines policy documents clinical guidelines advocate
For a public health approach to brav support so this is really around helping to support the normal grieving process it’s about early intervention enhanced um support where needed and it’s about supporting individuals across the brief and Continuum so from pre bement and right right through into longer term post
Bement recently there was a core outcome set developed um and that’s really what outcomes should be evaluated whenever we are evaluating brief and support interventions and by consensus they agreed the ability to cope with graef and quality of life and mental well-being were the two key um outcome
Demands um and this very much reflects that public health approach it reflects a resilience-based approach where breef is not seen as something to be extinguished but rather um a space really for for d meeting if we look at the overall research evidence base around brief for generally um it is underdeveloped now
That’s for various reasons not least of which this is a complex research area um and the funding landscape um certainly within Europe tends to be quite poor um so overall we need more evidence and we need better quality evidence of Which models of care work so we think there’s
A bit of an opportunity here for Arts based approaches generally but certainly for music therapy music therapy is a very holistic approach um it has a you know an overall um overall focus on improving many different facets of of quality of life um it often has a focus
On meaning creation or or meaning construction um there’s inherent within it a focus on developing social connection um and really in terms of supporting individuals in terms of their emotional regulation as well so we think there’s a really good fit between music therapy and a public health approach um to bement
Support as well um to note that within the research literature Briant sport interventions rarely map on to risk and protective factors for complicated grief and again this is important in terms of public health approach to brief support where we’re hoping through ear intervention individuals would experience any of the symptoms related
To complicated grief um I’ve given some examples here and these are really the risk and protective factors that are um most well established within the research literature but um through your clinical practice you there might be others that that really resonate with you um but interestingly there was work
That we conducted a few years ago um and it was with patients towards the end of life it was a feasibility randomized control trial where we offered music therapy within a hospice impatient setting and we conducted at a realist evaluation of that we were really interested to see what is it within
Music therapy that is that is influencing like comes so what are the mechanisms of change and we find that music therapy you know it very much helped people to you know resolve and develop connections with with loved ones to increase feelings of intimacy to access positive memories from before they were diagnosed
Or from before their their illness progressed it helped them for those that this was important to to engage with um you know with with their spirituality so we were seeing these key mechanisms for change which we think map on quite well actually to risk and protective factors for complicated Graves so the question
Is if um music therapy can also have a similar impact um for carers pre and post berment as as it does for for patients also to note that so music therapy as as I’ve mentioned um music therapists have been involved in end life care for for quite a few decades
Now um a few years ago we surveyed music therapists in the UK through their professional body and we find that the vast majority of Music therapists working in end of Life Care also Focus their therapeutic practice on informal cares so this is already happening in practice um as a result of perhaps
Patient and Care demand you know and also that clinicians see it is something that you know is valued and um and worthwhile so the question is then where is it the research evidence space to really underpin this um this clinically important area and this is the question that we
Set off to answer in the musicare project so i’ I’ve put up a QR code here that that you can scan that brings you to our our study website um you could Google it as well I’m sure it’ll come up quite easily um but this is a two-year
Project that was funded by the music therapy charity in the UK and essentially it was around building capacity for high quality research on the role of music therapy in supporting individuals of people um into informal cares of people um towards the end of life so um cares from pre to post bement
As part of this um we conducted a systematic literature review so we were interested in um the international evidence base existing evidence base in this area um and I’ll speak to that in a second and we also conducted an international consensus exercise and this is really R developing best a best
Practice agenda to help to to drive this research area forward so the systematic review but the systematic review um it’s as it signs you’re adopting a systematic approach to trying to identify all the research that has been published worldwide in a particular area we were interested in studies that have been published to
Evidence the efficacy of music therapy pre and post bement um so the likes of randomized control trials but also course the experiment experimental studies were requiring inclusive we were also interested in research um that would evidence the experience of music therapy um for for cares in this context as
Well we were interested in studies that were evaluating music therapy specifically for bement and also studies that were targeted towards um cares supporting someone towards the end of life so we were fairly inclusive um in that sense um we use the of life um definition as um stipulated really by
Nice um guidelines within the UK so that um people thought to be within the last 12 years or 12 months of life um and that’s really because we we thought you know in terms of anticipatory grief we wanted to capture where music therapy helps to support individuals through
Multiple losses um and not just in in the last days and weeks of life we conducted these searches we updated it last year it was the Joanna breaks Institute Mi myth’s systematic review approach and we mapped the findings to the brief and core come set um that that I mentioned earlier and
Also against different predictors of complicated grief so what did we find well we identified 34 studies in this area know the vast majority were um qualitative or mixed methods um there were some C experimental studies and only two randomized control trials um in terms of the the population
Um most studies were around supporting um informal cares um of individuals with with dementia fed by Advanced cancer and other conditions in terms of the format of the music therapy interventions the majority were dietic and focus so they were targeted to both patients and carers some were targeted to the care
Only and some primarily were focused on the patient but the carer was invited in to be present during during settings and they were evaluating the the outcome really um of that on on um on cares in terms of intervention timing by and large the literature is focused in
That pre bement period um with with a smaller amount of work um post bement so in terms of the quality of evidence the the bad news is that um in terms of quantitative studies largely these were of low to to moderate quality um it is a very complex area um to to
Work within it’s that intersection of pal of end of Life Care Improvement um and and arts based approaches um you know represent various different challenges when it comes to um when it comes to evaluation key issues were um a lack of appropriate statistical analysis um quite commonly studies were under Parts
Very small sample sizes the lack of standardized come measures um so um you know commonly people used on valida measures and um interestingly it was it was quite a per reporting of the music therapy interventions themselves so um there’s a reporting guideline for music therapy interventions that we mapped um
The the findings on to and we find that there were various gaps so it meant there was a lack of clarity really in terms of the actual content and what was being delivered and for various reasons uh we were unable to perform meta analyses quality studies on the other hand um
Were incredibly Rich moderate and high quality and I’ll spend a bit longer really discussing them um but just to start in terms of the quantitative literature U most commonly interventions for targeting outcomes that related to quality of life and mental well-being outcomes I think there was one study
That focused on outcomes related to ability to cope with grief that’s other um core outcome um but but that’s largely how they clustered um findings were equiv IAL um for the effectiveness of music therapy across across all outcome domains so um inconsistent to the extent that really no firm
Conclusions um can be reached so as an example domains rela to quality of life and mental well-being um two studies CA experimental showed a um an improvement pre poost music therapy one showed a you know a reduction really a decrease in terms of outcome and and one should no
Difference so um unfortunately um it’s it it’s very difficult um to reach any any form of of conclusions really in terms of of the the quantitative um research at at present in contrast we have qualitative um findings now we performed a met agregation which is where you identify findings from all your qualitative
Studies that you’ve included in your review and you combine those into larger synthesized findings um which I present here so firstly there was one around social connectedness and social support and this is really where um individuals perceived that there was an added benefit to music therapy in a group
Context so they saw that it enabled them to have um positive opportunities for social connection and reduce loneliness it wasn’t just a great format itself but it was also music being used as a as a conduit um to create connection with others so I have a nice quote here that
Reads the music allowed you to sort of interchange with other people the group setting um was perceived as creating a safe environment for people and the presence of peers um facilitated um sharing of of difficult emotions and feelings secondly we have music as an emotional and communicative Channel and spiritual Bridge individuals perceived
That music therapy allowed them um to safely process um and and express emotions um relating to to grief but they also saw that it provided a connection to them in terms of spirituality um this was both for people um in at a pre bement um in terms of
Meeting making processes and um and acceptance and finding peace um and also for those post bement as well in terms of helping to continue on connections to the deceased it’s a quote I get uplifted by the music and I feel I can get a lot of my feelings um out into music it’s
Freedom because I hadn’t sang at home for so long we then had a finding around positive reminiscence of press identities relationships and finding balance individuals perceived that music therapy allowed them to deepen relationships and and really increase intimacy so um it was discussed that it helped to bring them back to the
Relationship dynamic they had with their with their loved one um prior to prior to their diagnosis um it also helped in terms of reconnecting with with positive um memories as well so the quote um that reflects this is the music brought love back I felt the love between us when I heard the
Music music brought us love and joy it’s so beautiful that it gets into your heart into love everything and lastly we have this finding around positive mental well-being sense of meaning and purpose in life individuals very much perceived music therapy as a tool and use the skills that they use that they learn
During the music therapy um interventions in in their everyday life um so carage used it both for their own emotional regulation but also to support the patient towards the end of life and they very much valued music therapy sessions as dedicated time that they could spend with their with their
Loved ones um and protected time so just to give an illustrative quote this has been wonderful for me because I always remember the sessions we were very happy upon arriving and even more so after we left and just to mention very briefly that hopefully it’s clear through that qualitative research that um there’s
Really a wealth of data there that evidences the wide range of different impacts that music therapy is perceived to have upon different Health outcomes and the various different mechanisms of changed that that result in those outcomes we marked the findings on to risk and protective factors of
Complicated grief and they seem to align very well um so this is certainly um very reassuring going forwards um in terms of really trying to evidence that the value of of music therapy as a as a public health intervention um in relation to brav support in terms of recommendations
Overall um there is a need for more music therapy interventions which are specifically developed for for bement so quite quite a um well a majority really of the interventions that were included um in our review were very much focused on patient care towards the end of life
But wasid an explicit bement Focus um so that’s that’s a gap um and interventions that align to um outcomes as as identified within that core com set for bement support qualitative research in this area is very rich and it’s really about just trying to translate that um into
Into evidence you know with with um with high quality trials um and this is where I hand over to to Tracy who’s going to talk a bit more about um how we can make that happen thanks Lisa that’s great so this second phase of the project we held a World Cafe event with
International stakeholders and what we mean by stakeholders mean so people who have had experience of gement music therapists and other Health Care Professionals supporting th so we H that event to identify what we should be doing you know so looking for additional recommendations and priority questions
For future research and how we should do the research to help uh build the evidence based for music therapy as a form of BR support So as his name suggests the event was conducted in a calfe style approach with several rounds of convers STS and small groups of four to five
People but instead of doing this around a table we had online breakout rooms so each round involved discussing what attendees raised as an important area of research that was um decided in a pre-event survey and then brought for discussion so notes of the conversation were made by facilitators of each table
Made up with the research team and then the discussions were summarized um and given to the next group who joined that table so over time the groups built on each other’s conversations leading to a better understanding of what the key issues are so Lisa can you move on next slide
Please so you can see here we had a mix of clinicians academics early career researchers with experience in this area and that experience ranged from five to 15 years and then next we had 16 researchers and music therapists so that was from four different continents across seven countries and eight different time zones
So as you can imagine it was a bit of a nightmare trying to find a time for the workshop that would suit everybody from all these different countries and time zones but we managed to do it and it was great to have 16 experts um from so many
Different areas across the world Lisa thank you next one and you can see here at a glance what the top priorities were for uh best practice research agenda so don’t worry about trying to absorb those all right now I’m going to go into those a little
Bit more detail and this is recorded so you can reflect back on them so next slide Lisa you can see here that the the top priority overall unsurprisingly was that we really need to evidence the impact and the benefit of music therapy across the Brean opinion and that really
Reinforces the key message from the systematic review of the literature that we need more high quality um and we say trials because that is still seen as the the how you say the marker for accidents in terms of research but having said that we also need to do mixed methods
Research because Noah saw in the chat there had me really good in point that a lot of the time trials will gather a lot of different um folk together and It all becomes very muddled so the good thing about the the World Cafe event was that
We looked at okay how can we do it and if we do do a trial how’s the best way to do it that we get the best outcomes so to do that mixed methods and what we mean by that is we can look at the effectiveness stuff so we can look
At the figures but we also need to understand why how and in what circumstances music therapy is more likely to Benefit Service users some of the other things that our expert you know mentioned that was really important is looking at a core gement outcome set because again we can
Only evidence benefit if we are evaluating the right outcomes that music therapy is designed to improve we also looked at the important time points to consider for evidencing both the immediate and longer term benefits and our experts believe those to be immediately after the music therapy intervention has completed and
Then again three months later and then finally we also need to measure cost Effectiveness and this is what commissioners of services who hold the P strings that’s what they’re really interested in so they want to know whether or not they should invest in music therapy to save Health Service um
Resources in terms of improving care outcomes okay Lisa next slide please and theory was something that was brought up as integral in informing the various parts of clinical practice so that’s in for in terms of including assessment looking at how inter interventions are designed for um different individuals evaluating
Treatment outcomes and then just all other forms of clinical decision making that music therapist have to do as part of the treatment so the choice of theory should be guided by individual need so again it’s not one siiz fits all it’s very important there needs to be flexibility matched to the person’s
Needs but the person centered theories were the most commonly chosen approach and that’s perhaps because they position treatment in the therapeutic relationship so rather than focusing on predetermined outcomes which can be complex and multi-dimensional when supporting informal cares through reement and then next next l and then most importantly a vital aspect
Of any future research in this area is involving service users throughout that’s inal care because you cannot evidence or benefit of an intervention without knowing what the users of that service need and then in the next slide um this shows that that’s exactly what
We plan to do in the next feas of this project so we will work with individuals with left experience of brement we will work with music therapists and professional supporting carers and that will be focused on uh developing a music therapy intervention that is adapted to the needs of par of
Patients at the end of life and that is practical for use within health care services and they will use the learning from the phase one that GLA has spoken about and this phase to word Cafe and to submit an application for a feasibility trial so visibility trial is basically
Like running a a mini experiment if you like to see is what we proposed to do is it possible to do in practice and that will be looking at a music therapy intervention again to improve outcomes for informal carees of individuals at the end of
Life so I’m going to hand over to Noah now he is our music therapy expert to share uh case study with you and give you bit more insight into what we’ve been chatting about so far thank you okay hi all um yeah so my part in today
Is going to share this case vignette that comes from my clinical experience working in hospice um as Lisa mentioned I live in the states and some of my clinical perspective is going to be um um somewhat rooted or or colored from from that origin but um I do believe
That part of a big part of what we’re going to be talking or what I’ll be talking about with this spinette will have some transferability uh with my dissertation I looked at pre- bement or careers who who were pre-bed and were sharing a music therapy sessions with their loved
Ones prior to um their loved one dying and something that was really profound that came up was this idea around how music helps people to identify in different ways that within a Music Experience they were no longer locked in to just being a caregiver and their loved one was no longer locked
Into just being a patient and they were able to re-engage with what uh we came to code as a pre-illness identity where who was I and what was our relationship before this diagnosis hit was I mother was I father was I spouse was I partner child was I
Neighbor and then what was our relationship how did we Define the connection between us and Among Us and music therapy helped those individuals those diads to recapture what it wasn’t lost it just wasn’t being activated it was still sitting under underneath the surface it just be accessed and for some of those
Caregivers it was about reframing it where a loving act had turned into an act of service so that I wasn’t having dinner with my spouse I was feeding dinner to my spouse and for sure there were some uh pragmatics and mechanics which they were you know literally
Putting food onto a utensil and putting into the loved one’s mouth that led them to thinking of it as feeding them but it was through music therapy that they were able to take a step back and recognize right this is why I’m doing this this is
My why in this situation that this isn’t just a random person that I am allocating these resources towards and assuming this burden for this is somebody who I share this really profound connection with and even though it might physically exhaust me there is a spiritual fulfillment there’s an
Emotional fulfillment that can come from it and so it was through the connection in music therapy was through the shared experience that they were able to um rekindle that connection and what was also really important and that and that’s what will be the tie in for uh sharing this case
Vignette was it also helped for the dying experience and ultimately the death experience to not necessarily be one that was harmful it allowed them to feel connected in the ways that they wanted to be connected up until that connection was um inalterably changed so with this particular case um
Fred was a 55-year old male receiving hospice care for ALS and um one of the paradoxes of music therapy and end of Life Care is that were often referred out for work with the patient and then we get out there and we find you know what the patient is doing well
They are resolved they are ready their resilience is activated um they’re not necessarily um what we would call happy but they’re moving through it in a way that was healthy and it’s the people around them the caregivers their loved ones friends family who actually needed the most
Support um and this ultimately was the case so I was referred out for Fred but I get there and it’s really his son Jake who was 15 years old who was really um having a difficult time so Jake knew his father as this incredibly vibrant person the soccer coach the journalist the guy
Who would take him out for trips and just was um was able to infuse a lot of energy into his space and what we know about ALS is it leads to a wasting way the body physically deteriorates um Fred was still able to sit upright but he weighed probably
Between 90 to 100 pounds by the time we started working together he was unable to speak he had um ability thankfully to be able to use his right fingers enough that he was able to type out messages on an iPad that was streaming to a TV so he
Was able to communicate in that way but for Jake it didn’t feel like communication like this wasn’t his father this was like a a physical uh like a a mirror like a like a like a fun house mirror like a distorted video vision of how he knew his dad to be and
So um what I my assessment was that Jake was able to be around his dad but he wasn’t able to be around his dad as his son he was able to be around him as like the guy who like visits the person who happens to be living upstairs in his parents’
Bedroom um so he wasn’t rude he wasn’t mean um but there wasn’t a there wasn’t an affection and so my goals were to enhance the quality family engagement to increase expressivity related to this pre-b process and to help them to actively engage with processes of closure so Frank uh or Fred
Was Mo he was as I mentioned a journalist and so he had actually started doing his own life review work at that point he was cataloging um And archiving all these pictures that had been scanned into his computer so we started working on a slideshow he would select he would create categories for
The pictures we would work together to decide on what song or songs he felt were accurate reflections of that period in his life and then he typed out paragraph long narratives telling stories about it so did Fred need me for this probably not he was doing a pretty
Good job with it already um so my buyin for uh for coming or visiting at the house was to get Jake involved it’s like here is something your dad is doing that you can be a part of and Fred asked um they were from Alabama and so um at
Least in the states a very popular song about Alabama is Sweet Home Alabama by Leonard skinnard um and Fred really wanted Jake to play the guitar line for it like he wanted Jake to make a recording of swee Home Alabama to use in the slideshow and Jake wouldn’t come
Outright and say no but he would hem and he would ha and he would like sort of like dance around the topic and find reasons or or ways to not directly engage and so as I’m watching this play out I’m recognizing that um this was going to lead to an intimacy a
Vulnerability that Jake had been working really hard for the past year or two to uh divest himself from that that was too scary a place um and so he wanted to engage so his way of he would be with us in music but it would be through lots of
Humor so like he he shared the story about um how his dad dressed up as Superman and he dressed up as Superman um when um that’s a father son Duo and he found this like ridiculous song about called Superman’s Daddy on iTunes and it was funny and we had to laugh about it
But this was Jake’s way of putting up a protective space around him so I’m working uh for the next uh six weeks I’m working with Jake and saying hey this is something that your dad is talking about and wondering your thoughts and we’re getting there um we’re getting deeper
Into the conversation but Jake would always find a way to move away from it and so we would uh uh we would shift Focus onto something else and then Fred moved into that imminent death phase um it’s that 24 to 72 hour window where there’s a number of different symptoms
That we’re observing that let us know that death is probably going to be coming sooner rather than later so I give a call into the house and and I’m checking in I I speak to Fred’s wife and uh his wife says Jake would really like
You to come out and make a visit this evening which that’s a first that’s never happened before um and I had a sense of what was coming I walked in I looked at Jake I said are we doing this and Jake said we’re doing this so we
Went down into the basement and I asked him do you want to sing and that was a step too far for him in that moment um singing perhaps more than any other type of musicing it uh it leads to an elicits a vulnerability because it comes from us
We feel it on this very sensorial level physically physiologically orally it is such an intense representation of Who We Are so in that moment his ego strength wasn’t such that he could come right out and use his voice in that way because he was doing so much processing um but what he
Was okay with doing is he knew how to do that riff so if you hear s Home Alabama it’s a rockus song um the guitar is celebratory it’s actually a bit of a protest song in its own way it was written in response to um Neil Young’s Southern Man which
Was a calling out of racism in the South and Leonard skinnard said well this is in everything that the south is and so the song has an an intensity to it but the way that Jake played the song it wasn’t um celebratory it was Heavy it was lots of really intense
Downstrokes and then there’d be like a great you could almost hear the pick grading against the strings as he would play so I played rhythm guitar behind it and I sang and my voice adjusted accommodated the Sonic features that he was introducing the aesthetic features he was
Introducing um and so it was almost um it was almost like a lament we I was singing in in a very low voice and using almost more of an air quality because there was um because of all the complex and complicated emotions this musical encounter was looking to capture so we
Played through it and I asked Jake what would you you know what would you like to do next um and he said I’d like to um I’d like to record it so we played through it again and we recorded it I checked in with him again we listened
Then we listened to the recording I checked and I said what would you like to do with with the recording at um right now he goes I’m not really sure he said well here’s the thought is your dad is upstairs um this was something that he’s wanted you to hear I wonder your
Thoughts about um playing the recording for him and he goes he he gave it a moment’s pause and he thought about it and he said yes so we go upstairs and his family there and um at this point Fred is um he’s in bed and Fred’s presenting with apnic breathing and his
G his gaze is very fixed and clouded over he’s in that space where we’re not really sure just how aware um he is because his ability to respond was compromised but we played the song um or Jacob played the song and his dad was there and listened to it um his mom was
There and and gathered family and friends were there as well um and we did a little bit of processing about it afterwards um and then I left and Fred passed away overnight and then um I spoke to the wife the next morning I actually I sto back at the house at
Her request and she said you know Jake crawled into bed with his dad and held his dad’s hand um for about I don’t know 45 minutes to an hour sometime soon after that session and for me it was like yes this is what we were looking
For for Jake to have this moment of connecting with his dad through this fatherson pre-illness identity connection before he passed so that Jake wouldn’t be on the other side of that death experience wishing that he had had been able to facilitate or not facilitate but had been able to connect
With his his dad um in that way he was able to actually um be able to have that so these are the sorts of psychotherapy um depth-based work that we’re looking to support music therapists to be able to understand how to approach it through an uh an assessment and clinical decision-making
Process because historically music therapy has struggled to explain processes Beyond looking at music as a means like there’s a x problem here’s a y music therapy intervention and here’s a z solution this is not that sort of situation it very rarely is when it comes to pre-bereavement and so the
Challenge here is to construct and design a clinical decision-making model developing a methodology through which music therapists can can be thinking about this constellation of factors this holistic way of being in space with clients and within the music so that these whole person outcomes can uh can be
Approached thank you you finished oh no sorry I wasn’t sure thank you very much thank you and and thank you to all of our speakers that’s really been Food For Thought for me and I like the way that the three talks complement each other we get the research from from Tracy and
Lisa and then and then actually having a case study from Noah really really helped kind of bring the issue alive so thank you so much for that guys I really appreciate it um we’ve got some questions um I’m going to start with my myself actually because I’m the chair I
Can ask a question first um I I’ve been in Pala of care for many many years myself and I know music therapy is quite well embedded in hospices um I now work in an acute hospital is there access to music therapy for bereaved relatives that are
Not known to to to hospice or paliative care anyone Tracy I will be honest I am not really sure Lisa Noah I’m not sure if you will be better aware this is where my understanding of um Health Care outside of the states is limited um within the states uh Medicare or our
Hospice happens to be only one of two types of socialized Healthcare that we have the other being uh for veterans um how it works with us is it’s through a program called Medicare and after somebody passes away then a hospice is required to follow for 13 months through bereavement um and as
Long as the hospice employs a music therapist then they have uh the uh they have the music therapist at disposal I’m just thinking sorry I’m just reflecting back to survey the B and I did a few years back can’t remember exactly the was maybe you might remember
The but a few years back anyway and we looked at music therapy provision across the UK specifically and we found that music therapists you know did provide um care to the family I me may not have been classified as specific we spoke bement support but in essence that
Is exactly what the re Lea would that be your sense of the results of that survey as well yeah I think so but um I mean it it is what we find even even like to specialist Poli care and impatient settings not you know the sort of accessibility of music therapy generally
Is so Hatchy and inconsistent and inequitable um that’s yeah I I’m really not sure if it you know for for connecting into individuals who aren’t aren’t known to specialist Poli of care I don’t imagine the provisions I don’t imagine the provisions really there and I think to
The need for the research is to to build this evidence Bas um to show that this is a valuable contribution to Brean support yeah absolutely I suppose I come from a we I work in in South London we have uh you know patients and families from a
From a wide geographical area and it’s very much a postcode Lottery about who can access different types of bement support and I must admit I have never heard of being able to to refer someone from for music therapy in that even outside of of those known to to our local
Hospit so but thank you for that um I’m going to take there’s there’s some questions in the chat so um I think the first one is actually probably more for Lisa and Tracy is there a music therapy course or program in Northern Ireland that you could recommend there isn’t we
We quite often get contacted about this um but but there isn’t um I’m a psychologist by par so I have to declare you know I um you know have no involvement but um no there’s a if you go on to the um bamp so it’s do you know
I’ll I’ll try to get the link and put it um in the chat they’ll give you um all the music therapy courses across you okay um Tracy are you aware of um Irish courses there is there is a course lick perhaps but again it would
Be good to go on to it’s the British Association of music therapy that Lisa is referring to and Lisa if um I put it in the in the chat you’ll see but there are talks to try and get a music therapy course set up in Northern Ireland and
We’re not sure as yet whether that’s going to be through Queens University or oler university but those talks are h there is a need for it h because a lot of folk end up going overseas because there is nothing here so we are hoping that within the next few years there
Will be an offering within Northern Ireland okay thank you guys that was a I should have said that was a question from Justin mcer um we’ve got a question from Elizabeth Fair who says um and this this really resonates for me as well because I know certainly in the hospital
I work in when people are d we will often have music playing for them you know music of their choice um so this this question from Elizabeth is what would you say are the differences between music therapy and people using music therapeutically in paliative care I think this is one for Noah yeah
Certainly that’s a great question um and you know it’s one in which we under at least for me I understand where there’s confusion for non-music therapists because music therapists have historically uh struggle to create what I feel are accessible distinctions between those two what I’ll say straight up is that no
Music therapist um would ever feel like they own music that it’s not like our soul prance that nobody else should be able to uh be able to engage with it in the same way that um I wouldn’t think that only a chaplain are allowed to engage spiritually or religiously uh
With patients if that’s the sort of comfort or support that they’re looking for um the uh the theu that I use for myself is uh Ken aan introduced in a book about or it’s been almost 20 years at this point um music as a means versus
Music as a medium I think I just referenced it a second ago so music as a means that music is a tool essentially we have a problem we’re going to introduce music we’re going to get a solution um music as a medium in contrast to that focuses more on the
Experience of Music it emphasizes the idea that to be musical is such an innate part of being Being Human that to be musical is a state of health unto itself that while we engage musically when we’re engaging musically we’re engaging cognitively emotionally interpersonally socially in all the ways
That that we don’t need those secondary benefits to validate just the innate value of being in a creative aesthetic space all into itself and so when I think about how do I make the distinction between music therapy and using music therapeutically I think about that in contrast the chaplain so I
Think that from a chaplain we’ll use music as a means in order to get into a spiritual medium because that’s where they exist they they look at change and transformation within this transpersonal realm but they’ll use music as a way as an Avenue for moving into that transpersonal realm with the people that
They’re working with and for us it’s the opposite we’ll use spirituality as a means to get into music as an um as a medium we will engage spiritually and relig religiously to get into the site of transformation or change which is the music experience and I feel like that’s
Where music therapists are distinct is that we know how to be in space within a music environment with people and be able to adjust and accommodate the aesthetic features of that experience in ways that can accommodate emotional responses uh the potential for harm traumatic triggering um expressions of
Joy whatever it might be so that it often times music therapeutically I’m using music therapeutically means that here’s a music product that’s going to be sort of immutable and finite like there’s lots of structure around it but within music therapy the Music Experience is constantly in a state of flow and truly
The Paradox of music therapy is that at the end of the day it’s not even about my music it’s about the patient’s music and what they’re bringing forth um so I know it’s a long-winded way of answering but those are often that’s often the language and the the constructs that I
Use to help make create those distinctions for myself thank you and I I think you’ve answered we had a question from Andreas which I I think you’ve answered this he’s saying should music therapy just be provided by music therapists or can it be provided by anyone yeah it’s a great question um and
Something important to think one way of thinking about that can be helpful is that music therapy isn’t often times we talk we’ll hear people say like I do music therapy the music therapy isn’t a singular intervention music therapy is a field that’s filled with a whole array of interventions informed by a whole
Array of philosophies and methodologies and approaches and techniques um and so yes music therapists their training is explicitly focused on um on what we call functional or clinical musicianship where so like I can give you an example of I once worked with a patient um who had a really
Intense response to Summertime from porge and best starts tearing at his hospital gown he’s hitting the guitar he’s wailing I want my mama because this was a song about it’s it’s a bit of a it’s a lots of melancholy attached to it and so for the non-music therapist in
That moment it’s like let’s stop the music let’s get a PRM medication because right now there’s something potentially harmful happening in terms of self-injurious behaviors and he’s moving into an agitated state but as a music therapist I was able to adjust and accommodate the Music Experience so that
We were able to cycle down the agitation and then he was able to move through the experience and not be cut off from his emotion but allowed to reshape his emotion in a way where he could feel the grief but without it becom um too intense um at that time so those
That’s and you know the um and then the example I always give too is that like I have an 11-year-old my 11-year-old falls down um and she needs an aspirin not aspirin don’t give CH as like a Tylenol I’ll give her Tylenol because I can read
The side of a label and say this is how much Tylenol I give an 11-year-old that doesn’t make me a nurse nurses might do something similar to it but they’re bringing a whole host of knowledge about medication and side effects and application and how to assess for um
What’s happening on the other side of administering that medication that I will never have um and it’s the same way for music therapist in terms of engaging in music experiences with patients yeah I mean that really resonates with me in terms of like the support that we provide emotionally to
Patients and families is when does that become therapeutic do we have to be counselors to be able to provide emotional support and I think a lot of the support is provided for people in paliative care is not by people who would necessarily say that that was a
Therapeutic support so so thank you for that um I’m just conscious of time I think we’ve only got about four minutes left so um certainly for me I think that’s really opened up some thinking for me around how I support people in their bere which is something I do a lot
Of work and and I think music therapy is not really in the Forefront of my mind so I think I need to go away and think about that maybe just just see what there is um locally for for our patients um