All the Right Notes: Using Music to Promote Physical and Psychosocial Healing

Research shows music to have a profound effect on nearly every part of the brain – lighting up the complex networks that govern emotions, memory, pleasure, motivation and reward. For Cleveland Clinic music therapy manager Debbie Bates, PhD, LPMT, MT-BC, witnessing these universal benefits is one of her greatest professional pleasures.

“Our research and clinical work tell us that music therapy can improve the well-being of patients in a variety of significant ways,” Bates says. “But because musical experiences are so deeply rooted in emotion, their effects are difficult to measure quantitatively.”

As such, the relationship between music therapists and their patients is key.

Bates cites a favorite definition of the modality that reinforces that message: Music therapy is a reflexive process wherein the therapist helps the client optimize their own health by using various facets of music and the relationships formed through the experience as an impetus for change.¹

“I like that definition because it puts the emphasis on the relationship,” Bates explains, adding that the connection is triadic. “It’s not just the patient and the music therapist; it’s the patient, the music therapist and the music. As a result, it’s a highly individualized process that can help support patients of any age with almost any medical condition.”

Cleveland Clinic’s music therapy program was established in the 1990s; in 2008, it became part of the organization’s Arts and Medicine program, which relies on music therapy, art therapy, performing arts and research to promote healing and enhance the lives of patients, families, visitors and caregivers. Since its inception, the music therapy program has seen significant growth in the number of employees and patients it serves.

Sharing the gift of music

Any adult or child who has been admitted to a hospital on Main Campus has access to the therapy provided by Bates and her team. In addition, music therapy is available to both adult and pediatric patients receiving inpatient or outpatient oncology treatment through the Cleveland Clinic Cancer Center. Music therapy is also available to inpatients at Cleveland Clinic Children’s Hospital, Children’s Rehab Hospital, Hillcrest Hospital, Avon Hospital and Akron General Hospital, as well as Weston Hospital in Florida and the Lou Ruvo Center for Brain Health in Las Vegas, where Bates serves as a consultant. While not directly connected to Bates and her team, music therapists are also available to inpatients on behavioral health units in various Cleveland Clinic locations.

“We basically go anywhere except the OR and the ER,” Bates says. “We’re also in the cardiac, surgery, neurology, and neonatal ICUs.”

The program receives referrals from a variety of sources, she says, including physicians; nurses and patient care nursing assistants; social workers; respiratory, speech, occupational and physical therapists; chaplains; family members; and the patients themselves. The only requirement is that the referrals ultimately arrive via the Clinic’s electronic medical records system, ensuring the smooth coordination of services.

Reasons for referrals are equally varied. The music therapist begins every session by asking the patient to rate their pain, mood and level of anxiety, but Bates says that’s just the starting point. Other referral reasons may include the need for sensory stimulation or distraction, improvement of fine or gross motor skills, shortness of breath and other breathing difficulties, and end-of-life support.

“It’s wonderful for patients to access to the therapeutic benefits of music throughout their healthcare journey, but it’s important to distinguish between using music to relax or lift one’s mood and using it to achieve specific, individualized goals,” says Carol Pehotsky, DNP, RN, NEA-BC, ACNS-BC, CPAN, Associate Chief Nursing Officer, Surgical Services at Cleveland Clinic. “Our clinical staff is so fortunate to work alongside trained, experienced music therapists, who understand how to use the medium for healing and self-expression. They are great allies for our nurse caregivers, in particular, who have witnessed the powerful health benefits the treatment can provide.”

Although the duration of treatment is open-ended, therapeutic goals concentrate on five domains of health: physical, emotional/psychosocial, cognitive, spiritual and social. However, Bates notes, the specific goal for a particular patient often changes from day to day or even within a single session.

“Each music therapy session is self-contained and designed to address multiple goals,” she explains. “Maybe we initially saw the patient for pain management, but now their pain is better controlled. Regardless, the patient is still here and still dealing with an illness – sometimes for a very long time – and now they’re lonely or depressed, and they need the psychosocial support that music therapy can provide. We can’t check a box at the end of a session and declare we’ve achieved our goal. Rather, the question is: ‘What can we do today that will be helpful to the patient? What can we do in this moment to support them?’”

Tools of the trade

The music therapist’s arsenal offers plentiful options. At its heart is a three-shelf rolling cart holding a keyboard, a guitar, sheet music, an iPad and instruments for patient use. Those include a pentatonic xylophone and a specially pitched HAPI drum, both of which are designed so that even non-musicians can experience immediate success when playing with the therapist’s accompaniment. Options also include numerous rhythmic percussion instruments like rain sticks, ocean drums and “boom whackers” – pitched plastic tubes that can be safely hit against objects to make musical sounds.

“We can also loan patients ukeleles, guitars and keyboards for their own use while in the hospital,” Bates says. “Some of our patients are phenomenal musicians for whom music is an important part of their identity.”

While musical talent isn’t necessary, a patient’s relationship with music is a vital component of treatment. “We try to understand how music fits into their life at home,” Bates explains. “Do they sing along to the radio? Do they play an instrument? We ask, ‘How can we use music in the hospital setting to support you? How do you want to engage; what do you think will be most helpful? Do you want to play, listen or engage in a relaxation exercise?’ There are multiple ways to experience music, and we want to understand what’s best for them.”

Among the various music experiences the program provides are:

• Receptive: These experiences simply encourage patients to actively listen to music (live, recorded or as part of an assisted relaxation exercise) and respond in some way.
• Recreative: This approach requires the patient to learn, play, perform or sing pre-composed music, which can play a role in speech therapy and stroke recovery, for example.
• Improvisation: As a conduit for self-expression, improvisation involves spontaneously making up the music, which can be used to help patients represent their feelings in a meaningful way.
• Composition: Patients are encouraged to compose melodies or write song lyrics, perhaps for a life event like a funeral or wedding.

In the compositional category, Bates also describes the value of heartbeat recordings in end-of-life preparation. “We record the patient’s heartbeat and then – depending on the situation – ask either the patient or family member to identify a meaningful song,” she says. The heartbeat is then looped into the song as a percussive element, and the final recording is given to the patient or the family member.

“Especially when the patient can be intimately involved in the process – maybe singing the song, for instance, or holding the stethoscope – it becomes an important opportunity for them to process what they’re going through,” she adds. And beyond providing bereavement support to the family, the recording itself becomes a meaningful part of the patient’s legacy.

Although Bates acknowledges it can be tough emotional work, she says it is often immeasurably gratifying.

“Our team of 11 therapists is able to provide support across the gamut of hospital experiences – from new admissions to end-of-life care and everything in-between,” she concludes. “Every patient is different, which gives us countless opportunities to make a real difference in people’s lives.”

Reference

Bruscia, K. (2014). Defining music therapy. Barcelona Publishers.