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The Fine Art of Music Therapy


Monica Horn, RN, CCRN-K, CCTC
Mhorn@chla.usc.edu

Leah Cruz, MT-BC
Lecruz@chla.usc.edu
Children's Hospital Los Angeles
Los Angeles, CA, USA



It has been said that music may be thought of as a universal language for expressing thoughts or feelings. As an escape, to perhaps "lose yourself in the music" there's a lift above the clouds to seize it all. Many of us find solace in listening to our favorite selections while going to and from work to help inspire anticipated management of daily interactions or to cope with stress accumulated by the end of the day. Of course, when we arrive to work or home from work, gravity "snaps us back to reality."

What if we could help sick children and their families cope with illness and hospitalization through music? Historically, therapeutic use of music has been documented for rehabilitative purposes back to Orpheus and the Ancient Greeks over 2500 years ago. . Patients with medical conditions including pain syndromes, neurological disorders, childhood illness-related developmental delays, psychiatric conditions or anxiety states, memory problems and communication deficits have benefited greatly from music therapy. Children who have severe heart failure awaiting heart transplantation in a hospital setting are particularly vulnerable to having acquired these conditions as well.

What is Music Therapy?

According to the American Music Therapy Association (www.musictherapy.org), "Music Therapy 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. Music Therapy is an established health profession in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individuals. After assessing the strengths and needs of each client, the qualified music therapist provides the indicated treatment including creating, singing, moving to, and/or listening to music. Through musical involvement in the therapeutic context, clients' abilities are strengthened and transferred to other areas of their lives. Music therapy also provides avenues for communication that can be helpful to those who find it difficult to express themselves in words. Research in music therapy supports its effectiveness in many areas such as: overall physical rehabilitation and facilitating movement, increasing people's motivation to become engaged in their treatment, providing emotional support for clients and their families, and providing an outlet for expression of feelings."

Hospital Program Example

Children's Hospital Los Angeles has the Mark Taper and Johnny Mercer Artists Program which offers Expressive Arts Therapies. The team consists of trained and certified Art Therapists, a Dance/Movement Therapist, and Music Therapists. Music Therapy, Art Therapy, and Dance/Movement Therapy can be offered to all patients at Children's Hospital Los Angeles. Medical professionals who have access to the patient's chart can place a referral to request any of these therapies for their patients just as they would order medications. The Expressive Arts Therapies team does their best to assess the patient within 72 hours of receiving the referral. The department is also under the Family Centered Care Support Services umbrella, which means we not only support the patient but we also provide services for the whole family.

Along with providing benefits to a wide variety of diagnoses, as stated above, music therapy can also be used with patients of all ages. Specially trained NICCU Music Therapists see premature babies as young as 24 weeks gestational period to assist with decrease in agitation, appropriate sensory stimulation, and teaching families how best to interact with their babies at this stage. The team provides services to all ages from infant to toddler, school age, teen and even young adults in their early 20s who have been coming to Children's Hospital Los Angeles for ongoing treatment.

Real Life Cases

MMusic therapy has seemed to greatly benefit children of all ages. Infants and toddlers who have severe heart failure awaiting heart transplant are often agitated, irritable, and alone at times due to the often long term hospitalization. For these patients, our music therapy sessions focus on helping decrease their agitation, promote appropriate socialization, and introduce developmentally appropriate stimuli through the use of musical interventions.

Through live vocal and rhythmic cues, sleep is promoted after dressing changes and other common bedside procedures, which can be difficult for very young patients. Though it may look like we are just singing to these patients there is so much more. Music Therapists pay attention to facial affect and body language, vital signs, the current environment and how it may affect the baby as a whole. Music Therapists are trained to understand the appropriate tempo and volume that is best for their developmental stage. In these moments music therapists are able to build rapport with the patient to help normalize the hospital environment and decrease the patients' fear of staff, which is common in the pediatric setting.

Pre-school/school age patients tend to be more active and more physically engaged than the infants and toddlers. This music therapy focus would be on providing autonomy and socialization, encouraging emotion identification and emotional self-expression, as well as reaching developmental milestones and encouraging family bonding if family is present. These patients should engage through music therapy interventions involving musical stories and musical play to encourage expression of thoughts and feelings about hospitalization. For example, one patient's favorite song was Disney's Tangled song "When Will My Life Begin." The song is sung by Rapunzel who is trapped in a castle and is singing about all the things she does in a day while stuck in her castle. This patient connected her hospitalization to being like Rapunzel in this castle through connecting with the metaphor. She was able to use music to help externalize her thoughts and feelings regarding hospitalization even when not directly asked. Continued music therapy sessions with this patient led to the patient creating songs about her own hospitalization, waiting for her heart, and her future hopes for after her discharge from the hospital.

Sometimes we have the pleasure of working with the family who are present with the patient. It is beneficial to encourage positive family engagement with the patient to help promote family cohesion, open communication amongst family members, and an opportunity to bond with each other in a new and different way. Families can write songs to one another, or write a song together about what they are going through or what their hopes are for the rest of their hospitalization. Families may engage in music making which can involve playing instruments or singing together. This promotes open communication through listening to each other musically and reflecting upon the music together, decreases stress for the patient and families through active music making as a release, and encourages family bonding as a whole.

Perhaps one of the most memorable experiences recalled was with a patient who was with a teenager who was awaiting a heart transplant. The music therapist met her the week after she got her VAD. During the initial meeting and assessment session she was able to talk about her hospital journey so far and put it into a song. This music therapy intervention helped encourage externalization of her feelings and provided a safe space for processing her feelings about her past experiences in the hospital, her new VAD, and the unknown road ahead. She was able to share her knowledge of the VAD and the process of awaiting a heart transplant which reinforced her acceptance of her situation and helped validate any feelings she had.

Another music therapy intervention used with her involved asking her what song would describe how she is felt that particular day. On one of her tougher days in the hospital she was able to share a pop song that described how she felt about the medical staff. She was not able to say how she felt before the song, but after listening to the song she was more open to sharing what she thought and felt. Music provided her with an emotional outlet and gateway to help externalize her feelings.

At the end of her hospitalization and after she got her heart and recovered, she met the therapist with a smile and was excited to share songs she had written on her own time about what she was feeling. Music therapy sessions introduced her to a healthy coping mechanism she could continue to use during and after her hospitalization.

Reflections

Every December for the last six years, the ISHLT Links Newsletter has exposed us to some Great Master Composers: Dvorak, Beethoven, Mozart, Berlioz, Tchaikovsky and Mahler - to broaden our armamentarium for our patients and ourselves with our expanded horizon of classical music. It was Hans Christian Andersen who penned, "Where words fail, music speaks." Henry Wadsworth Longfellow asserted, "Music is the universal language of mankind." Whether comfort, consolation, expression or just plain entertainment: life without music really would B♭!

Disclosure Statement: The authors have no conflicts of interest to disclose.




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