At the end of life, music’s natural calming effect can help hospice patients express and experience a wide array of emotions at a time when self-expression and coping matter more than ever.
“Music therapy is really a unique tool in the hospice experience,” says Ecumen Hospice Music Therapist Theresa Bulger. “People are different. All of our patients are different. We’re working to meet people where they are, so music therapy is different depending on the patient and their individual goals.”
In hospice music therapy is used to meet emotional, cognitive, spiritual, social and physical goals. “The really great thing about it is that it is so versatile,” Theresa says. “I can work in all those different domains with different patients given their individual needs. I get excited about working with patients in all of those areas.”
Part of a music therapist’s training is to evaluate a patient’s needs and adapt the therapy accordingly. “If people are having a hard time coping, I’ll often use songwriting as a means of expression and processing,” Theresa says. “Other times, a patient who is not verbal anymore will sing a line or two of a familiar song, and that gives them a way to communicate with family members and with me. Hymns are often a great source of comfort. Music is so diverse and so versatile, it can reach us all.”
Music can calm agitation and anxiety, Theresa explains. The rhythms can help lower heart or breathing rates that have accelerated. “At the end of life,” she says, “hearing is one of the last sense to go, and music can be really powerful that way.”
Music therapy is now fairly common in hospice, she says. It’s offered at admission to all patients and families, and those who want it receive an assessment of needs that guides the therapy throughout hospice. Also, sometimes nurses or chaplains will call Theresa to work with patients who are actively dying and experiencing agitation and anxiety. “For most people, it can be really effective,” she says.
Generally, Theresa plays her guitar or keyboard in therapy sessions and sometimes she will encourage patients to participate with instruments like hand drums, bells or tambourines. “And I have my voice, which is my first instrument,” she says. “It’s portable and I always have it on me.”
She tells the story of a patient with Parkinson’s disease, who was having trouble coping with her condition. “I brought in a drum and said: this is Parkinson’s. What would you like to say to it?” She beat the drum until she was physically exhausted. That was a way for her to express these heavy emotions that were inside her but she wasn’t able to articulate.”
Another patient had been a musician all his life — until he had a series of strokes and could not hold his guitar anymore. She played guitar for him for a few weeks, then started encouraging him to play. “That’s not part of my life anymore,” he said. Yet slowly he warmed up to the idea and eventually made the choice to pick up the guitar. He struggled to relearn some of the fingering positions and then began to play again.
“It was amazing to see the transformation he underwent,” Theresa recalls. “Being able to do something that he loved gave him a renewed sense of his identity. On my last visit with him, he said: I feel like myself again when I am playing guitar. He died later that week. To give someone that experience is an incredible honor.”
Typically, in therapy sessions people will make requests if they are able. If not, Theresa will look around the room for clues about what someone might like. “I will start somewhere I think is safe and see how they respond, and I improvise and assess as I go along.”
She knows many songs and carries an iPad with her music stored on it. “I have the standards from every generation at my fingertips,” she says. But she jokes that most every music therapist wishes for a larger repertoire of songs.
Theresa says “You Are My Sunshine” is probably the most requested song. “Almost everyone knows and loves it. I see fun responses and people will sing who have never sung with me before.” Another big favorite with older patients is “Sentimental Journey.”
She explains that music therapist are trained in the “iso principle,” which essentially means matching the mood of the patient to the music being played – meeting people exactly where they are emotionally. Sometimes that means upbeat and sometime somber.
When Theresa was in high school, she was thinking about becoming a nurse but she also was deeply committed to music. Music therapy turned out to be “a perfect combination of my passions and the things I want to do with my life.” She has a degree in music therapy and is board certified. She also works for a school district providing music therapy to school children with disabilities and special needs in addition to working with hospice patients.
“I never fail to be in awe of the role I get to play in people's lives at these pivotal moments,” Theresa says. “It is a deep honor to share a part of this journey with patients and families. Music empowers us, awakens something in us, and evokes a very personal response, drawing out our identity. I love being a part of that.”