Music therapy can be 'lifeline' for people with dementia who can no longer communicate through language

Music therapy can be crucial in reducing feelings of isolation for people with dementia, who may have got to a stage where they struggle to communicate through language. It can also boost self-esteem making them feel ‘valued and heard’.

Polly Bowler, who works with people with dementia and is a trustee for the British Association for Music Therapy, spoke to carehome.co.uk about her job as a music therapist.

What is your job title

I am an HCPC registered Music Therapist. Music therapists are Allied Healthcare Professionals (AHPs) along with occupational therapists, speech & language therapists, paramedics and radiographers.

What attracted you to music therapy

I trained as a classical musician but realised after some experiences in my personal life that my interest had shifted to wanting to work with people and to help others. Whilst at music college I took an elective called ‘Introduction to music therapy’ and had my eyes opened to a profession I’d never come across before, one that used music and all its elements as tools to facilitate therapy with people across the spectrum of mental, physical, emotional and social health needs.

I discovered it was first and foremost a therapeutic intervention and a world apart from simply playing music to people to lift their mood. The more I learnt about the psychodynamic and psychoanalytic processes and theories that were inherent in the work, and the different groups of people that it could help, the deeper my interest became.

Four years after finishing my undergraduate degree, with some life experience under my belt, I returned to education to study for the two year full time masters that is required in order to qualify and practice.

What benefits does it have

Music therapy has its roots deeply grounded in the attachment theories of Daniel Stern, Donald Winnicott and of course, John Bowlby. Mother-infant attachment is non-verbal and as such, the use of music in a therapeutic setting can easily become more understandable. By using the client’s facial expressions, body language and the manner in which they are speaking (combining the words they are using with the way in which they are delivering them; the speed, intonation and volume for example) music therapists are able to get a profound understanding or insight into the client’s inner world.

Through group work, music therapy promotes connections, inclusion and shared experiences, especially at times of isolation, such as recovery from illness, when they may be apart from friends and family. In these situations, music therapy not only helps to reduce feelings of isolation, but can encourage self-esteem, active engagement, creativity and communication. For those coming to the end of their lives, music therapy is particularly helpful for facilitating togetherness at a time when words may be difficult to access or too much, and allows for moments of creativeness and expression.

Improvisation and familiar music are used in sessions. Clients are offered instruments and need no prior musical experience or knowledge in how to play them. The way that they play, or choose not to play, offers the therapist insight.

For people with dementia who may no longer be able to find the words they seek, being able to communicate through using music in this way can be a lifeline.

Music therapy can also help

• Promote social interaction and engagement

• Encourage a sense of self through live improvised music making

• Offer opportunities for individuals to reconnect with their emotional history through the use of song and talking

• Encourage self-expression

• Enhance exploratory and creative abilities

• Facilitate gentle exercise through moving and dancing to music

• Alleviate anxiety and depression, often associated with illnesses such as dementia

• Foster self-esteem, sense of feeling valued and heard

• Reduce isolation and offers a creative medium through which to connect with others

What is a typical day for you

I work in care homes four days a week, one day in each home, and they are a mixture of residential, nursing, dementia and nursing dementia.

My hope is to see five people for individual sessions and to hold one large open group each day.

Individual sessions are a course of weekly therapy sessions for which people are referred by staff, family, health care professionals or through self-referral. Each session is tailored to the person that I am working with.

Referrals are made for people who may be struggling with symptoms of dementia such as apathy, depression, aggression, frustration or lethargy, to name a few. The focus of music therapy sessions is not to make someone feel happy, but to try to establish how a person is feeling and to be there with them with those feelings. Sometimes people are referred due to their love of music but are not in need of therapy and in this instance I encourage them to join us in the open group to make sure their love of music has an avenue. After a six session assessment period, if music therapy seems to be appropriate for a person, I establish therapeutic aims for that person.

The open groups can be busy. I think 28 people is the biggest (so far). Due to large numbers, familiar songs are my tool of choice. They offer comfort and structure which provides stability and security for residents who may find the world to be quite a daunting place at times. Residents, staff and visitors are offered small percussion instruments and invited to sing, play or listen.

Once we start to play and sing it feels as though potential barriers of ability and disability dissolve. The act of making music together stimulates minds and social interactions, and the room is often abuzz by the time we finish, whereas when we started it may have seemed muted and still.

What qualities do you need to be a music therapist

Being a music therapist requires patience and acute attention to detail. A lot of the work can be noticing the micro-expressions or movements a person makes and responding to them with the same or similar level of intensity. In my work with those who are severely impaired and perhaps are no longer verbal or mobile, these responses to the small movements that they make, or to the pace of their breathing, can offer them a sense of being heard, of being met, of not being alone. Another major quality I think is flexibility and spontaneity.

What do you find most challenging about being a music therapist

In the complex jigsaw puzzle of the care system, music therapy is one of the lesser known allied healthcare professions that helps to make up the bigger picture of care. Raising awareness about what music therapy is and how it can help can feel like having a song on repeat; gently correcting and redirecting the well-meant but often mistaken assumptions that people have.

What do you like most about your job

It has to be the people and the tools that I work with. Hearing their stories and being able to help them to express themselves when it is perhaps not such an easy thing to do any more is intensely rewarding. Music is something that we can all relate to regardless of age, and is often central to a person’s sense of identity. It provides us with ways to connect and share feelings, memories moments with others, and offers stimulation and encourages expression. I love music and the effect it has on me and on others. Working with music in clinical setting and being witness to the positive changes I can help to bring about due to it, continues to surprise and fulfil me.