Music Therapy in Hospice Care

Add guitars and other musical instruments to the tools caregivers can use to help patients in hospice care. That’s what University of Alabama senior Sarah Pitts found when she brought her music therapy skills to patients in Hospice of West Alabama.

“We’ve gotten a lot of encouraging comments from families,” says Pitts, a music therapy major from Memphis, Tenn. “Sometimes families who hear us say, ‘Can you come and play a song or two?’ Even one session with a music therapist can reduce pain and anxiety in this setting.”

Pitts’ experiences in hospice care inspired her to research how students doing clinical practice in hospices react to the experience. She won the E. Thayer Gaston Award for outstanding student paper, and she continues her survey research with her mentor, Dr. Andrea Cevasco, assistant professor of music at UA. The resulting article is titled “A Survey of Music Therapy Students’ Practical Experiences in Hospice and Palliative Care.” Part of Pitts’ motivation for pursuing this research was the lack of resources she could draw on when working with hospice patients.

“In this particular area, there’s not a lot of research to go to as a student,” Pitts says. “The emotional component and goals are a little bit different from other clinical settings. You’re improving the quality of life or helping with the changing needs of the patient, and you’re also helping to provide closure and support for families. For students, it’s a very difficult thing to handle.”

Music therapy, taught in a four-year program with a six-month internship following coursework, combines work in music, psychology and other disciplines. It has many applications in a wide variety of environments and a broad range of clients, from premature babies to people needing physical or psychological therapy. The key is to get a patient moving or involved with the music, perhaps singing along or playing an instrument as the therapist plays on the guitar.

It might be that we have kids playing drums,” Cevasco says. “They reach and extend their arms out, which might help a child who has cerebral palsy whose muscles may be tense. Reaching out and playing the drum is fun and enjoyable, but the therapy also is important, because the child is using specific muscles that might normally be painful to use during physical therapy and daily exercises.”

The music therapy program has had a relationship with Hospice of West Alabama since 2007. Cevasco says one of her students came to her asking if she could work in hospice for her clinical experience, so Cevasco set it up. She notes that it takes a student with a particular interest in working with patients at the end of life to follow this path.

“I don’t force the students, but if they’re interested in it, we move in that direction,” Cevasco says. “As an undergrad myself, I never pictured myself doing any kind of hospice work. Personally, I wasn’t ready to deal with death and dying as an 18 to 22-year-old.”

Pitts chose to work with hospice patients because of a personal experience that brought her face to face with mortality.

“I’ve also faced death in someone my own age,” she says. “Last year, my brother dealt with a potentially fatal health condition. I understand you need someone to support you at that time. As a therapist, I can be there for people when they face very difficult times in their lives.”

Her work with the hospice patients varied; two clients became well enough that they could leave hospice. In one case, Pitts, at the request of a family who had heard her play did perform music while a patient died.

“The family requested a few songs, and I played straight through,” Pitts says. “I added a couple of songs of my own that I felt were appropriate. I felt like what she (the patient) needed was slowing-down music as her breathing slowed. I got to be there as she was dying, and we all got a chance to be a part of that.”

Patients in hospice care, depending on their illnesses, may or may not be able to participate in the playing of music for therapy, Pitts says. But music still matters. In her clinical experience, Pitts says she found a wide range of music to be helpful in working with hospice patients and families. Hymns, including “Amazing Grace,” are often requested, but patients frequently want to hear other styles of music as well.

“Typically, when we go in, I have a list of songs I know,” she says. “I prepare songs from different genres – hymns, show tunes, or sometimes songs from the ’30s, ’40s and ’50s, which may be from the patients’ young adult years. If the patient isn’t responsive and awake, I find out what the family wants me to play. If I’m in a situation where the patient is actively dying, I just play a few songs, and I’ll be a very passive member of the room. The family is just there saying goodbye, and I’m providing an atmosphere for that.”

The working with hospice patients – that element of saying goodbye – troubles young music therapists, Cevasco says.

“For all the students, they’re wondering how they’re going to deal with this relationship and this attachment that has developed with this patient and having the patient pass away -- how they’re going to cope with this aspect of the job,” Cevasco says.

In the survey Pitts and Cevasco collaborated on, they note that students feared how they would cope when working with dying patients, particularly in how they handled “emotional attachments or relationships with clients, talking about the death and dying process and how previous experiences would affect current clinical work.”

The survey also asked students some open-ended questions about their own beliefs about the end of life. Finding out what those fears and beliefs are, Pitts says, may help instructors better train the students who plan to work with hospice patients.

“The students said it was a very difficult and emotional thing to do,” Pitts says. “Some people had done palliative care with children, but others didn’t realize that was what it was – that the patients died. They didn’t realize what the unit did.”

For Pitts, this kind of therapy represents a way she can use her deep background in music to help people. She ended up choosing to pursue music therapy in college, particularly once she became involved in the clinical part of the degree program.

“I grew up in a very musical family,” she says. “I had piano lessons, and I started singing in middle school and high school choir. . . . I found music therapy to be a nice mix of psychology and music.”

Cevasco says she admires the work Pitts has done, both with the research article and the therapy she provided the hospice clients.

“I was really surprised when she chose hospice,” Cevasco says. “I realized, and she realized, how great she was working with patients with mental-health needs in the previous semesters of her clinical work. I was very surprised, and I was so pleased with her and her work that she did with those hospice patients. It was beautiful the way she was able to work with the hospice families. And the beauty of her being able to play the guitar and sing and provide these families with what they needed and the patients what they needed at this critical moment of their life.”