by Joy Berger, DMA, FT, BCC, MT-BC
“If there’s a time, person, or place you’d like to visit, what music will take you there?”1
Many of you may know me as a hospice educator, but you may not know that I am also a board-certified music therapist. Through COVID’s isolation, we’ve all experienced moments of support through creative music via the Internet, TV, and more. Take this further. These are times to increase the use of your professional hospice music therapists (yes, use Zoom), or to consider hiring one.
Music “therapy,” as defined by the American Music Therapy Association, is “the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.”2
Music therapists use music within the therapeutic relationship to address the person’s changing needs: physical, emotional, cognitive, relational, and spiritual. Relevant to COVID-19, music therapists are especially adept at adapting caring interventions to challenging settings and needs.
How Music Therapy Can Improve the Hospice Patient’s Experience
Based on the patient’s clinical Plan of Care, we assess what music interventions can be most effective.
Musically, we might listen, sing, play instruments, write new lyrics or music, or something else. Therapeutically, we address person-centered goals, such as these few examples.
- Physically: Music can energize or calm. It needs to be a style the person enjoys. Music can help ease pain. I call this the “3 D’s: Distract. Divert. Direct.”3
- Emotionally: Music can express and validate one’s emotions. To help the person gently shift an emotion, I call this “Match It and Move It.”4
- Mentally: Music easily taps into one’s memories. When walled off in dementia, music can open window-moments of awareness and connection. Through my research and clinical practice of music and memories, I’ve named these “5 R’s for Relating With Memories: Respond. Recognize. Recall. Reflect. Re-Vision.”5
- Relationally: Music can be a rich, meaningful way to involve one’s family in supporting their loved one, through all phases of illness and dying. Is a TV mindlessly blaring from the dying person’s room? Or, do gentle sounds of music foster the family’s presence? I describe this vigil time as “The Final Cadence.”6
- Spiritually: Music needs to express this person’sfaith. It should never be imposed onto the person’s beliefs and values. My CORE Principles are Care, Ownership, Respect, and Empowerment.7
A Music Therapy Relationship from the Past, for Today
COVID’s isolation and the approach of Autumn 2020 have stirred my memories of Judy, her isolation, and our music therapy, together.
Judy was an outspoken advocate and professor of social justice, who could barely speak due to her throat cancer. Through my weekly visits as her hospice music therapist, I helped her voice her day-to-day physical changes with “highs” and “lows” on a small, portable piano keyboard. Together, we created a “Music Menu”8 for her different emotions, placing her favorite music within her reach. Through her dying weeks, a deeper life-healing emerged.
She described to me a hole within. Deep. Long. Sad. Judy was drawn to an old, worn-out collection of music recordings she had inherited.
Judy was born in New York City. When she was a toddler-learning-to-speak-English, Judy’s parents had left her for several years to be raised by her German-only-speaking grandparents. They were stoic. Private. Stern. Cut-off. Hearing their music at this time filled Judy with memories of those voice-less, confusing, formative years. These familiar sounds stirred both a longing and a connection. Experiencing their music now—as an adult—she painstakingly described her grandparents’ fears and sorrows in fleeing Nazi Germany, and in tightly hiding their Jewish heritage through many decades later.
Judy chose music for her funeral: “Autumn,” from Haydn’s Seasons. As I began to play this with her—from her grandparents’ music—she slowly whispered, “I realize the people I love most will be together at my funeral. But, I won’t be there. I will never see most of them, again.”
Hear Judy’s fresh realization. Her grandparents’ losses of “never seeing most of them again” (their German/Jewish family and communities) profoundly affected her. From the past, she grasped hidden emotions she had absorbed from her stoic grandparents. For the present, I invited Judy to close her eyes and imagine her loved ones in this room with her, now, in this present moment as we experienced this music. For the future, I offered to take her words of love to them at her funeral.
In Judy’s final hours, I played her music at her bedside. I spoke to Judy as we do with the dying—using words, tones, and prayers that give voice to what she had shared with us, believed, and hoped. At Judy’s funeral, I described and re-created our “Autumn”/Seasons music moment with Judy’s family and friends. I invited them to close their eyes and imagine Judy’s love for them, through memories past and moments ahead. Hearing her music, a transcendent moment broke through. We felt Judy’s absence and her presence; her essence of advocacy for social justice; her life-purpose of giving voice to the voiceless. Her life-meanings inspire me, today.
Back to my favorite question: “If there’s a time, person, or place you’d like to visit, what music will take you there?”
I would love to hear your music, your stories. Freely tell me more, firstname.lastname@example.org.
1, 3-8 From Joy Berger’s book, Music of the Soul – Composing Life Out of Loss, (2006), in Routledge’s Series in Death, Dying, and Bereavement, Series Editor Robert A. Neimeyer.
2 For more information about music therapy, visit www.musictherapy.org for the American Music Therapy Association.
About Joy Berger
Joy Berger, DMA, FT, BCC, MT-BC is the Founder and CEO of Composing Life Out of Loss, www.composinglife.com, equipping end-of-life care organizations with empathic, 24/7 resources to improve quality, increase access, and cut costs. Dr. Berger brings 25+ years of expertise to end-of-life care as an education leader; Fellow in Thanatology: Death, Dying and Bereavement; Board Certified Chaplain, and Music Therapist – Board Certified. She was honored with the National Heart of Hospice Psychosocial/Spiritual Care Award by the National Council of Hospice & Palliative Professionals.