A Brief Introduction to Music Therapy in the Hospice Setting

C. Gourgey Ph.D., MT-BC, LCAT

Music therapy is much more than simply entertaining people with music. The specific practice of music therapy depends on what sort of population the music therapist is working with. I work with terminally ill people (the majority have cancer in a hospice setting. Therefore I have certain specific goals in mind:

1. Use music to lift the person's spirits. Usually I try to find the kind of music that corresponds best to the individual. Contrary to the popular saying, music is no more a "universal language" than any other, purely verbal language. There are many different musical "languages" corresponding to different cultural backgrounds. This means I must speak several musical "languages" (and for me, speaking Spanish is also very essential in a city like New York). Music that is familiar, bringing pleasant memories or associations, helps decrease the patient's sense of isolation, which can be a strong affliction among those who are seriously ill and hospitalized. Music that expresses faith and reassurance can also help many patients maintain a sense of hope.
    
2. Use music to maintain a connection between the patient and the outside world. As I've said, patients in hospital often feel a deep sense of isolation. Also, since they are so sick, many of them cannot speak or communicate in "normal" ways. Therefore others, including family members, may easily give up hope and write them off as "vegetables," hopelessly out of reach, which only increases their isolation and depression. So through music I can communicate nonverbally with patients who cannot use words. This is a great challenge for me and forces me to develop my intuitive skills, since I have no verbal cues telling me what the person is feeling.
    
3. Use music to bring patients and family members together. Often when a patient is very ill, family members and visitors don't know what to do. They just sit there, reading their newspapers or staring out the window instead of interacting with the patient. So I might have a family member hold the patient's hand while I sing a song familiar to both of them, and often the family member will feel a response from the loved one. If the entire family is present, I may make it a group experience. This way the family maintains hope of preserving a meaningful relationship even until the very last moments of life.

Recently I was working with a woman who could not speak at all, but was crying incessantly. She was inconsolable, but couldn't tell anyone why she was crying. Her crying stopped only when I sang spirituals to her (no other type of song had any effect). And I was told this woman wasn't even religious! But this example shows that the performance of the music itself is actually the easy part. The tricky part of music therapy is assessing just what the person needs and finding a way to meet that need.

Once I worked with a woman, a stroke patient, who couldn't speak and hardly moved. Her kids would visit and yell at her, which only made her withdraw. But when I played my flute for her she would suddenly light up and hold my hands and sway back and forth in bed as if she were dancing.

Many patients who can no longer communicate verbally still need to be held and reached on a "preverbal" level. Music, especially the comforting sound of the soft human voice, can communicate on this level when words fail completely. Very often through music patients can still feel that they are loved, at a time when love can seem most elusive.