When music therapy is not always the right treatment
Sarah Morgan, a music therapist at Chroma, talks about the
importance of client autonomy
Music therapy and neurologic music therapy are evidenced to provide clear benefits to speech and movement following a brain injury, but occasionally it is not the right therapeutic route for the client.
I recently met a client who had referred themselves for music therapy. Suffering a traumatic brain injury over 20 years ago, the client underwent rehab including physiotherapy and speech and language therapy and was later deemed to have the capacity to live independently.
During the assessment process, it was clear the client had cognitive deficits such as poor short-term memory, difficulty understanding some of what was being discussed, planning and organising and slurred speech.
After some research and having exhausted other therapies, the client hoped music therapy would further improve movement and speech.
During the first session, we discussed expectations, and shared insight into how music therapy works, timeframes and realistic goals.
A three-way combination of Patterned Sensory Enhancement (PSE) exercises, where music supports the client’s range of movements, basic speech therapy exercises with different sounds and phonemes and Melodic Intonation Therapy (MIT) to encourage singing a phrase as opposed to saying it was used during the sessions. Such exercises bypass the damaged part of the brain that processes speech and moves towards the unaffected part of the brain that processes singing.
While the engagement was high, the client clearly felt self-conscious, and the initial results were not what the client expected. This is understandable as although these exercises are effective immediately after a brain injury, the client, who was an older adult, felt the tasks were a bit childish.
After discussing the sessions and arming the client with all the facts, the client chose to end therapy. Importantly, the client had the mental capacity to make that decision.
The client chose to begin music therapy and stop it, demonstrating just how important it is for people to be empowered to make their own decisions.
Music therapy works. We know it does, but it is not for everybody, and part of our role is not only to deliver it to the highest standards of therapeutic input, but to know when it’s not right for that client.
Unfortunately, in this case, it was not right, but the client chose to try it, realised it was not for them and stopped the sessions.
All I could do at that point was offer alternative recommendations and wish the client well.
A client-centred approach is about establishing trust and a partnership between practitioners and clients, focusing care on the needs of the individual and ensuring that people's preferences, needs and values guide clinical decisions and sometimes that means being honest about the right support clients’ needs, even if means finishing a piece of work earlier than planned.
Benefits of music therapy for older people
The pandemic, and the realisation of its significant impact on people’s mental wellbeing, has seen creative arts therapies come to the forefront as a cost-effective and effective way to support mental health.
The extent to which the pandemic negatively impacted the mental wellbeing of older people – especially those who live alone and those who live in residential care homes, is now widely documented and recognised.
Lockdowns saw incidences of social isolation and loneliness increase dramatically, which researchers have suggested can lead to, or worsen, anxiety and depression as well as increase the risk of developing conditions such as Dementia.
This has not dissipated in the intervening years and so support for the mental health and wellbeing of the elderly is vital to maintain their quality of life.
Creative Arts Therapies, especially music therapy, has been proven to be an effective tool and is being increasingly used to help older people with communication, social engagement and memory; memories associated with music are not lost in the progress of dementia; therefore, nostalgia is a powerful therapeutic tool.
Bringing a group of older people together to listen to music from their youth is a simple, yet highly effective way to connect with others – to share and reminisce.
Playing music together as a group has also been found to support quality of life, promote mental wellbeing, increase social interaction and reduce depressive symptoms.
Music is a universal language that automatically connects with the brain and in doing so, releases hormones such as dopamine, endorphins and oxytocin, which help to elevate and improve mood.
This is what makes music so powerful and allows people to feel and release emotions, promoting a positive mental state.
For older people, group music therapy sessions provide a great way to support social interaction boost self-confidence and morale and develop trust and positive relationships with others.
Most importantly, by allowing the group to choose the music they listen to, it gives them ownership of the group as well as allows them to choose the music that they themselves, relate to.
Studies show we tend to go back to the music of our youth, so this generation will share numerous songs they can all connect with and this connection helps make music therapy effective.
Mood elevates with each positive memory and the coherence of a group improves socialisation – gives them something to look forward to and develops new friendships and bonds, tackling loneliness and isolation directly.
But music therapy is more than just listening to music.
Music therapists guide people through the process of listening to music, playing music and improvising with instruments to help unburden feelings and emotions – again, promoting good mental health.
Group music therapy sessions can be easily integrated into residential care homes and those living in assisted living accommodation by providing them as regular weekly activities among residents.
Those living in their own home should be able to join group sessions that are provided within their area.
Group music therapy can be adapted to meet the needs of each individual in the group and prides itself on its inclusivity.
Chroma recently began delivering music therapy sessions within a residential care home.
Through this, residents have been able to develop connections with one another allowing them to interact with each other in a meaningful way.
Sessions are a mixture of singing and instrumental activities, with each session bringing a smile to residents’ faces.
They talk, sing and play as one, which gives them a connected sense of happiness.
Playing together is providing them with a greater sense of solidarity and community within the home.
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