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March 12, 2008
Therapeutic Music and Patient Care by Andrea Kielpinski Sadler, PhD
What is Therapeutic Music?
Music is therapeutic in a variety of ways. Most people have experienced feeling cheered up by listening to music when in emotional distress. The everyday experience of listening to music in order to relax, cheer up, etc., can be likened to use of an over-the-counter analgesic. It is self-administered and very effective for many situations. Therapeutic music in a medical setting is analogous to a prescription drug; the therapeutic musician chooses music “prescriptively” in order to effect a deeper level of care for more serious conditions.
The field of therapeutic music is an emerging modality of whole-patient care. While the term “therapeutic musician” is general, my own training is that of Certified Music Practitioner (CMP); other titles, such as Harp Therapist, are conferred by other training programs.1
In the work of a CMP and other trained therapeutic musicians, therapeutic music is defined as live, individualized music provided at a patient’s bedside to create an environment wherein healing can occur. “Healing” is an open-ended term to describe a move toward balance; it is distinguished from “curing,” i.e., the cessation of disease symptoms. In practical terms, the healing offered by a therapeutic music session can occur on one or more of the following levels:
Physiological (pain is lessened or monitors show a quantifiable metabolic normalization);
* Emotional (anxiety is lessened, a patient’s spirits seem lifted, or an emotional release takes place); Physiological (pain is lessened or monitors show a quantifiable metabolic normalization);
* Emotional (anxiety is lessened, a patient’s spirits seem lifted, or an emotional release takes place);
* Spiritual (a patient responds in religious or spiritual terms);
* Social (the music seems to connect the patient and family), or
* Integrative (a patient appears to shift into a deeper state of relaxation in which self-healing forces can be marshaled).
CMP’s play for patients in many settings: ICU, CCU, Oncology, Alzheimer’s units, outpatient dialysis, and others. Different types of music are appropriate for different categories of patients; familiar music can be comforting at times, while unfamiliar music can move the patient out of his or her habitual responses. Critically ill patients need music that assists in stabilizing body rhythms. Moreover, the CMP responds to patients’ needs dynamically with changes in tempo, pitch range, rhythm, and other musical parameters. In a sense the CMP is “listening” to the patient, with a similar therapeutic effect that listening to patients’ stories has, yet verbal communication is in the main bypassed.
The music itself is a kind of witness of the patient’s condition and this witnessing is the agent of change. In addition, there are physiological effects from the musical tones themselves; some of these effects are only now beginning to be understood. All of these considerations depend on the music being live, not recorded, and one-on-one, not in a group. People do benefit from recorded music and music played for a group; one might say that live, individualized sessions are the most “potent” application of music-as-medicine.
In contrast to music therapy, which is oriented toward the patient’s own music-making as a psychological therapy, therapeutic music is a receptive modality. The music is simply received by the patient for healing on one or more of the levels outlined above. As such, it is an especially useful intervention for patients who do not have the life-force to engage actively with music.
While a variety of instruments have been used in this work, I use harp and voice in my sessions with patients. Both have a seemingly innate power to soothe. The physical effect of the resonance and sustain of harp strings, as well as the psychological effects of the human voice (even recalling the mother’s voice in infancy), are surely factors in patient response. In the sterile environment of the hospital, the mere presence of a beautiful wooden object with graceful lines has a therapeutic effect, and many hospital visitors comment with admiration and awe when riding an elevator with me and my harp.
Therapeutic Music: An Oasis of Sound
He is not yet 30 years old, and he has had cancer for several years. The nurses tell me he’s non-compliant, jacks his bed up high, refuses medication, and throws them out of the room with colorful language. Surprisingly, he agrees to let the therapeutic harpist (that’s me) into the room to play. He’s a combination of virile young manhood and the bone-crushing weariness that cancer and its treatment bring. His guard is maybe half down.
I’m a Certified Music Practitioner (CMP) and provide therapeutic music through a grant from the UAMS Auxiliary. I’m trained to provide live, individualized sessions of music to patients at their bedside. Unlike music therapy, which seeks to engage patients in music-making, in a therapeutic music session the patient need only receive the music. Pain reduction, relaxation, and emotional release are just some of the possible effects of a session.
As a CMP, I assess a patient as soon as I walk in the room. Unfamiliar music usually helps patients let go better than familiar music, but to establish rapport I often begin with a piece that will be familiar to my patient. In a typical day I may play Gregorian chant, Willie Nelson, Celtic music, and Baptist hymns—all depending on the patients I see.
Most patients I see are older, and I realize with a sinking feeling that I probably don’t know even one song my young patient likes to listen to. Rap is a genre I haven’t yet figured out how to do on the harp. I start with “Unchained Melody”—I learned it the first time it was popular, but maybe he’s seen the movie “Ghost.” He listens attentively, comments politely on the harp. I find out he plays drums. He hasn’t thrown me out yet. I keep playing and notice how tired he is, his eyes close and I softly segue into an old lullaby as he allows himself a few moments of rest. He’s been fighting his condition and the constraints of the hospital so long, but he can’t stay asleep, he’s got to keep fighting. His eyes open and I play the old Motown hit “Jimmy Mack,” rhythmically but at the same time delicately, mirroring what’s in front of me. Again his eyes droop and I switch to another lullaby. He’s so tired. I’m alternate lullabies and Motown right along with him as he struggles to keep his defiance up in the face of this weariness. When he naps I see just how weak he is, how much he needs this respite. Finally he very politely asks me to stop because he “has some things to do.” We both know perfectly well he’s stuck in this bed and he can’t bear it. I’m glad he was able to let it all go for a little while.
My job as a CMP is to create an environment for each patient where healing (literally, to make whole) can occur. While I can’t make this young man’s cancer go away, or even make him accept its reality, I can perform the powerful act of witnessing his journey through the unique medium of music. I can lead a patient gently toward a state of wholeness and balance. It’s a mysterious process and success is often measured by the subtlest signs an alert look at the end of a neurological patient’s session, a more relaxed facial expression of a patient in pain, or simply being accepted by a young man acting out his anguish.
When I tell the resident chaplain about the session and how it ended she laughs and says, “Honey, you should hear how he tells the nurses to leave.” As a therapeutic musician, I’m honored that this young man let me accompany him for a few steps of his long journey. Providing an oasis of sound serves patients in a different way than chemotherapy treatment. Perhaps true healing encompasses both.
-Andrea Sadler, Ph.D., Certified Music Practitioner
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Andrea Kielpinski Sadler is a singer, harpist, and therapeutic musician. She holds a bachelor’s degree in music from University of Illinois-Chicago, with conservatory training in voice and piano from DePaul University School of Music and the American Conservatory of Music. She studied voice with Anne Perillo and piano with Julian Leviton at DePaul, and she studied voice with Eileen Deneen at the American Conservatory of Music. Andrea’s harp studies were with Sile Harriss, an award-winning harpist in the Scottish tradition, and Jane Taylor. Andrea is particularly interested in the therapeutic aspects of music and studied music thanatology with Therese Schroeder-Sheker. Andrea is trained and certified to provide therapeutic music in medical settings as a Certified Music Practitioner. She co-founded Healing Hands of Missoula, an innovative collaboration of harpists and body workers providing therapeutic sessions in nursing homes in Montana. Andrea now uses harp and voice therapeutically at the bedside for patients at the University of Arkansas Medical Sciences Center in Little Rock. She also performs as a free-lance harpist and leads workshops in Gregorian chant. Andrea holds a Ph.D. in chemical engineering and conducted research in nuclear safety for ten years.
Posted by Perry Miller, Editor at March 12, 2008 8:43 AM