Post on 20-Jun-2020
How Music Therapy can affect, heal, and transform oncology experiences
Panelist: SarahRose Black, MA, MMTMusic Therapist, University Health Network and Kensington Health
Wednesday March 12th, 2014: A Room 217 Webinar Presentation
Overview and Learning Objectives
Attendees will learn about:
The role of music therapy in: hospice palliative care
Acute/palliative inpatient oncology
outpatient oncology
The four facets of music therapy used in clinical practice at the University Health Network & Kensington Health
How music therapy can affect the experience of inpatient/outpatient oncology and end of life care
Origins of Music Therapy in Oncology
Deforia Lane
Deborah Salmon
Amy Clements-Cortes
Clare O’Callaghan
Susan Munro
Lucanne Magill
What is Music Therapy? The Canadian Association for Music Therapy defines
music therapy as:“The skillful use of music and musical elements by an accredited music therapist to promote, maintain, and restore mental, physical, emotional, and spiritual health. Music has nonverbal, creative, structural, and emotional qualities. These are used in the therapeutic relationship to facilitate contact, interaction, self-awareness, learning, self-expression, communication, and personal development.”
Canadian Association for Music Therapy / Association de Musicothérapie du Canada Annual General Meeting, Vancouver, British Columbia, May 6, 1994
What is Oncology?
Oncology (a branch of medicine that deals with cancer) may involve diagnosis, treatment plans, ongoing assessments, palliative care, symptom management, and early detection/screening
The experience of oncology for the patient, family/friends of the patient, and the health care team is varied, multi-faceted, complex, and often full of unknowns, not to mention frightening and difficult at times (Grassi & Riba, 2012)
What is Music Therapy in oncology? Music therapy in cancer care is the creative and
professionally informed use of music in a therapeutic relationship with people identified as needing physical, psychosocial, or spiritual help, or with people aspiring to experience further self-awareness, enabling increased life satisfaction and quality. (O’Callaghan, 2004)
Clinical Goals in MT Oncology
Music therapy can support goals that the health care team has established (e.g. pain/symptom management)
Music therapy can create NEW goals e.g. creating a living legacy for patient’s families, or supporting a deeper exploration of the existential questions that arise during treatment and/or palliative care
An Overview of MT Clinical Goals Collaborative triad process of goal setting:
Patient ~ Therapist ~ Health Care Team
• Clinical goals are a defining feature of music therapy
• Goals may focus on physical, emotional, psychosocial, or spiritual well being, depending on several factors (patient’s requests/needs, health care team’s needs, family’s needs etc.)
Examples of MT Clinical Goals: Evidence – Based Work Pain/symptom management (Magill, 1993, O’Callaghan, 2012)
Anxiety relief (Hilliard, 2001; O‟Callaghan, 2001)
Creating legacies for family and friends (Clements-Cortes, 2009)
Relaxation (Hilliard, 2003)
Support for families (Hogan, 1999)
Support (physical- breathing, emotional-comforting) at end of life (Salmon, 2003)
Providing a positive distraction from treatment/symptoms
Providing a non-verbal space for communication
The Four Facets Clinical Improvisation
Client and therapist improvise together
Inter-Active Listening Therapist plays and client listens to music
Song-writing Client and therapist write music together
Active Playing Client and therapist play music (often pre-composed) together
Clinical Improvisation
Defined as: the spontaneous creation of music between therapist and client using instruments and/or voice (Lee, 2003)
Clinical example: Mazi and the ukulele
Inter-Active Listening Defined as: A music therapy methodology that
involves the therapist playing, singing, or providing music in some form while the client listens; therapist and client may interact non-verbally or verbally; further interventions may be based on potential client response. (Black, 2013).
Clinical example: Anna and the Singing Bowl
Song-writing Defined as: the creation of a song (either with or
without lyrics) by therapist and client that may reflect the client’s experiences. Song-writing is often done as legacy work for a client’s family.
Clinical example: Angela’s Song
Active Playing Defined as: client and therapist playing (generally
pre-composed music) either together or separately
Clinical example: Teresa and the Beatles
The Referral Process: who and why A standard referral form has been created and
implemented at UHN
Referrals are made for a variety of reasons e.g.: Patient requests/enjoys music/plays an instrument/sings
Patient is experiencing distress and needs psychosocial support
Patient is anxious/depressed/struggling with symptoms/treatments
Patient is actively dying and family requests support at bedside
Referrals come from a broad spectrum of health care professionals including: Physicians, nurses, occupational & physiotherapists
Psychiatrists, social workers, psychologists
Patients and family members can self-refer
Inpatient Oncology Common goals:
Supporting the patient (and family/friends) through treatment and related psychosocial issues
Providing a non-verbal outlet for patients to express themselves
Supporting symptom management
Common interventions: Patient listens to live music
Patient sings meaningful songs
Patient plays an instrument which provides distraction/enjoyment/sonic vibro-acoustic experience
Inpatient Palliative Care Common goals:
Supporting symptom management at end of life
Supporting team discussions and expressions of relationship completion (Clements-Cortes, 2009)
Supporting families through anticipatory grief
Common interventions:
Inter-Active listening for pain management, relaxation
Breathing entrainment (breath matching through music)
Song-writing with patients/families
Outpatient Sessions Aims and objectives:
Helping patients transition (reintegrate back into their activities of daily life OR integrate a palliative care plan)
Reasons for referral:
Difficulty coping with treatment and symptoms
Legacy work for family members and loved ones
Examples of interventions
Connecting meaningful pre-and-post cancer moments through improvisation, song-writing
Joint sessions with psychiatry
Evolution and Expansion at UHN Origins of the program (CAMT Internship and
academic connection with Kensington Hospice)
Liaising with Psychosocial Oncology and Palliative Care, Dr. Gary Rodin, Interdisciplinary Health Care Team
Pilot project at Toronto General Hospital
Qualitative study at Princess Margaret
Blending research and clinical practice
Music Therapy and Hospice Care
What is Hospice?
Primary diagnoses are cancer
Goals of Care: comfort measures, psychosocial support
Role of Music Therapy in grief and bereavement
Kensington Hospice
Music Therapy with Staff Joint sessions
Collaborations in Care/Joint Sessions Occupational therapy
Psychiatry
Nursing
Pharmacy
Spiritual Care
Staff wellness Physicians and nurses
Pharmacists
CONCERTS!
The Stories The Bells of Ward 14B- song-writing
Shawn’s Legacy- active playing
Jason’s Saxophone- active playing
Diana’s Voice- inter-active listening
“The Bells of Ward 14B” Creating meaning during a
difficult time
Engaging in activity
Engaging in singing
Having an emotional outlet
Sharing the experience with the staff
Shawn’s Legacy Creating a living legacy for his
family
Engaging his health care community in a musical experience
Expressing gratitude to his health care team
Encouraging his community to experience song together as a celebration of life and hospice care
Jason’s Saxophone Creating meaning in the
moment
Embracing a defining part of his life
“I want to go out with a squawk”
Diana’s Voice
“This is my mom’s voice, she’ll always be alive in it”
Grief and bereavement support through the meaningful musical moments
MT & Oncology: A Summary How can music therapy affect the experience of
oncology?
Creating meaningful moments through a musical relationship incorporating clinical goals
Creating legacies & providing emotional outlets
Engaging staff
Supporting grief
Possibilities are endless…!