In her article, “Opening the Channels of Communication”, Clara Marie Costa (2009) described her music therapy work with people living with schizophrenia and how music can be the tool to help people connect with themselves and others. My main area of practice is with Alzheimer’s Disease (AD), and the parallels of music and communication between the two populations are numerous. Costa referenced an article discussing schizophrenic behavior as it pertains to communication and how non-verbal communication through behaviors can speak volumes. The same holds true for AD. There is a common phrase I have often heard in Alzheimer’s care, ‘Every behavior has meaning’. This applies to when a person is screaming, agitated, or refusing to leave his or her room. Unlike the description of people with schizophrenia who try to “not communicate”, the person with AD may have needs and thoughts that he or she wants to express, but may not have the capacity to do so in a verbal manner. Communication then comes in the form of behaviors.
Recognizing and validating where a client is in the moment is an essential component to the music therapy process. When assessing a person with AD, the music therapist evaluates the needs and strengths of the person and how music can bring meaning and reciprocation to the exhibited communication. There are times when behaviors perseverate causing the avenues of communication to be limited. For example, verbal perseveration is a person repeating the phrase, “I gotta go home. I gotta go home.” Music can interrupt the perseveration and communicate an atmosphere of familiarity and comfort, helping the person transition to a more positive state of mind. In the book Musicophilia, Dr. Sacks (2007) wrote, “Music aims to enrich and enlarge existence, to give freedom, stability, organization, and focus. Music of the right kind can serve to orient and anchor a patient when almost nothing else can” (p. 337). Despite even severe brain atrophy, a person’s musical memory can be used to provide an environment of pleasure, engagement, relaxation, and contentment. One vital component to opening the lines of communication is finding the right musical channel that clearly shows a person’s true colors and potential. Through assessment and additional time spent with a client, the music therapist learns what types of music and music therapy interventions provide the greatest level of communication. Boxill (1997) discussed having a “contact song” with a client which is the link to a strong connection and facilitates positive change. Having one or two specific songs that connect with a person provides orientation to the here-and-now and also the potential for him or her to expand connections to others within the environment.
Costa (2009) wrote about people sharing sound space and starting to become more aware of others in the group during active music making. Part of my philosophy in a group music therapy session is to make positive connections among the clients. For instance, if two clients produce the same rhythm during a drumming experience or have similar comments about the meaning of a song, I will musically or verbally acknowledge those commonalities. Fostering positive relationships is important in a long-term care environment. Costa discussed the moment in a group when patients become aware of the pleasure received from playing with another. I have seen this same outcome from clients who experience a high level of well-being while playing each other’s drum or smiling and waving to each other from across the room while singing a familiar song. Music experiences can be altered and improvised in the moment to nurture these communications.
In her article, Costa (2009) assessed levels of communication through phases of language, going from verbalizations about sensorial pleasure within a person to verbalizations about others in a group. I have observed similar levels in my AD music therapy group sessions. Some clients are able to make sensorial pleasure statements about the music, such as “That was beautiful” or “That was an oldie, but a goodie.” Others are able to make positive self-statements such as, “I’m pretty good for an old man” or “Wow, was that me?” Some positive self-awareness also can be conveyed spontaneously through music. For example, during one of my sessions, a group was singing the 1954 song “Sh-Boom”, while playing rhythm instruments. One of the clients, E. who typically experiences a high level of expressive aphasia, began to vocally improvise to the song, producing a wonderful transition of musical leadership between the two of us. She musically led the way as the group accompanied her beautiful vocal line. Her affect and posture mirrored her positive sense of self brought on by the musical experience. In the last phase of communication, a person is able to direct positive comments to another group member such as, “She has the best voice in the group” or “You have the most wonderful whistle.”
No matter what level of communication, the importance lies in making positive connections with people and providing ways for individuals to reach a higher level of well-being. Through the music therapy process, communication in the form of behaviors can be extinguished, providing an opportunity to rekindle positive relationships with the self and others. As one of my clients clearly communicated to me, “I don’t want the Alzheimer’s to rule my life, I just want to live!” Music therapy can provide an environment where a person can focus on living and channel behaviors into more meaningful, communicative ways.
References
Boxill, E. (1997). The miracle of music therapy. Gilsum, NH: Barcelona Publishers.
In her article, “Opening the Channels of Communication”, Clara Marie Costa (2009) described her music therapy work with people living with schizophrenia and how music can be the tool to help people connect with themselves and others. My main area of practice is with Alzheimer’s Disease (AD), and the parallels of music and communication between the two populations are numerous. Costa referenced an article discussing schizophrenic behavior as it pertains to communication and how non-verbal communication through behaviors can speak volumes. The same holds true for AD. There is a common phrase I have often heard in Alzheimer’s care, ‘Every behavior has meaning’. This applies to when a person is screaming, agitated, or refusing to leave his or her room. Unlike the description of people with schizophrenia who try to “not communicate”, the person with AD may have needs and thoughts that he or she wants to express, but may not have the capacity to do so in a verbal manner. Communication then comes in the form of behaviors.
Recognizing and validating where a client is in the moment is an essential component to the music therapy process. When assessing a person with AD, the music therapist evaluates the needs and strengths of the person and how music can bring meaning and reciprocation to the exhibited communication. There are times when behaviors perseverate causing the avenues of communication to be limited. For example, verbal perseveration is a person repeating the phrase, “I gotta go home. I gotta go home.” Music can interrupt the perseveration and communicate an atmosphere of familiarity and comfort, helping the person transition to a more positive state of mind. In the book Musicophilia, Dr. Sacks (2007) wrote, “Music aims to enrich and enlarge existence, to give freedom, stability, organization, and focus. Music of the right kind can serve to orient and anchor a patient when almost nothing else can” (p. 337). Despite even severe brain atrophy, a person’s musical memory can be used to provide an environment of pleasure, engagement, relaxation, and contentment. One vital component to opening the lines of communication is finding the right musical channel that clearly shows a person’s true colors and potential. Through assessment and additional time spent with a client, the music therapist learns what types of music and music therapy interventions provide the greatest level of communication. Boxill (1997) discussed having a “contact song” with a client which is the link to a strong connection and facilitates positive change. Having one or two specific songs that connect with a person provides orientation to the here-and-now and also the potential for him or her to expand connections to others within the environment.
Costa (2009) wrote about people sharing sound space and starting to become more aware of others in the group during active music making. Part of my philosophy in a group music therapy session is to make positive connections among the clients. For instance, if two clients produce the same rhythm during a drumming experience or have similar comments about the meaning of a song, I will musically or verbally acknowledge those commonalities. Fostering positive relationships is important in a long-term care environment. Costa discussed the moment in a group when patients become aware of the pleasure received from playing with another. I have seen this same outcome from clients who experience a high level of well-being while playing each other’s drum or smiling and waving to each other from across the room while singing a familiar song. Music experiences can be altered and improvised in the moment to nurture these communications.
In her article, Costa (2009) assessed levels of communication through phases of language, going from verbalizations about sensorial pleasure within a person to verbalizations about others in a group. I have observed similar levels in my AD music therapy group sessions. Some clients are able to make sensorial pleasure statements about the music, such as “That was beautiful” or “That was an oldie, but a goodie.” Others are able to make positive self-statements such as, “I’m pretty good for an old man” or “Wow, was that me?” Some positive self-awareness also can be conveyed spontaneously through music. For example, during one of my sessions, a group was singing the 1954 song “Sh-Boom”, while playing rhythm instruments. One of the clients, E. who typically experiences a high level of expressive aphasia, began to vocally improvise to the song, producing a wonderful transition of musical leadership between the two of us. She musically led the way as the group accompanied her beautiful vocal line. Her affect and posture mirrored her positive sense of self brought on by the musical experience. In the last phase of communication, a person is able to direct positive comments to another group member such as, “She has the best voice in the group” or “You have the most wonderful whistle.”
No matter what level of communication, the importance lies in making positive connections with people and providing ways for individuals to reach a higher level of well-being. Through the music therapy process, communication in the form of behaviors can be extinguished, providing an opportunity to rekindle positive relationships with the self and others. As one of my clients clearly communicated to me, “I don’t want the Alzheimer’s to rule my life, I just want to live!” Music therapy can provide an environment where a person can focus on living and channel behaviors into more meaningful, communicative ways.
References
Boxill, E. (1997). The miracle of music therapy. Gilsum, NH: Barcelona Publishers.
Costa, C. M. (2009). Opening channels of communication. Voices: A World Forum for Music Therapy. Retrieved from https://normt.uib.no/index.php/voices/article/view/361/284
Sacks, O. (2007). Musicophilia: Tales of music and the brain. New York: Alfred A. Knoff.