Almost daily, I have experiences in my clinical hospice work that cause me to reflect back on all my education and training. This is fabulous because it means I am continuing to stretch myself and grow as a clinician, and my patients and their families deserve nothing less from me.
I had one such experience recently. I made two routine hospice music therapy visits back to back and I found myself singing the exact same song during both clinical encounters. That, by itself, is not unusual or noteworthy. Many of my patients share similar demographics that play a significant role in determining their music preferences, and by nature of having a life-limiting illness, many of my patients will present with similar clinical needs to be addressed in music therapy.
What really stuck out to me was how very different the experience was of using this song with each patient and family. Again, there is nothing too shocking here. Responses to music are highly individualized and depend on a massive variety of factors and variables. The same song that brings me comfort and peace of mind might be reminiscent of nails on a chalkboard to you. As a board-certified music therapist, this knowledge was part of my training and it is part of my job to continually assess my patient's responses to music via their own self-report and my clinical observations.
So, if it's not unusual for me to use the same music with multiple people, and I am fully prepared for each person to respond uniquely to the same song, what exactly about my day was significant enough to stop me in my tracks and prompt me to blog about it?
It was the degree of absolute contrast between those two home visits that got my attention. The same three minutes of organized sound functioned in two polar opposite ways for each patient-family group.
In one home, my patient needed distraction and refocus from physiological discomfort. The song in this context functioned as an upbeat, external focal point to divert attention from pain and discomfort. Here, this song is associated with happy memories and current happy experiences. In this home, the song elicited smiling, laughing, toe-tapping, and intentional optimism as a coping skill. As a music therapist, I expected to see those responses and that is why that song was used over any of the other hundreds of thousands of songs out there.
In the other home, my patient and their family needed a safe place to openly grieve a deceased loved one. This song was a favorite of their loved one, and here, the same song elicited tears, naming of grief feelings, emotional catharsis and active grief processing. Bittersweet memories of this song came rushing to the surface and the lasting connections with their departed family member were strengthened. Here, too, I was expecting and prepared for this reaction and had a good sense of the appropriate bottle to take off the shelf and open.
The experience of using one song to remember joy, and less than an hour later, the same song to appropriately channel sorrow was surreal to me. Opening that musical bottle in each home revealed something very different inside.
This experience has sharpened my awareness of the way the same bottle can hold dramatically different things for two people. It has pushed me to dig deeper in my clinical work, to always strive to observe more closely, listen more intently, and keep building my musical skills and repertoire so that I am always prepared to offer the best clinical experience to the people I serve.
