An Interview with Susan Munro-Porchet
Bill Shugar: How did you become involved in music therapy?
Susan Munro-Porchet: In 1971, my husband was transferred by his employer to London, England. By then we had lived a year in Geneva, two and a half years in Brussels after we had left Montreal in 1967.
In London, my children began Kindergarten and school. The move to London turned out to be quite a culture shock - with a narrow mindedness, a certain sarcasm and skepticism towards foreigners surrounding us so that - even though I spoke English and had lived in several countries, I had a feeling I would turn mad if I didn’t preoccupy myself besides family and house. My diplomas for teaching were not recognized so I figured I would take the chance to study part-time to be ready to get back to some work once the kids were bigger.
I had played the piano until the age of 15 and later had bought myself a flute and had taken private lessens for years; none of this with the intent to study music formally. Now, I figured, I could probably take the time to earn a degree in order to have some training which would be useful anywhere in the world, should we be transferred again. In searching for a school which would take me as a student at the age of 33, I came across the Guildhall School of Music and Drama, with their program of music therapy. For me, this meant, that my previous training and work experience, including psychology and work at the Mackay Center in Montreal and other places, would be helpful and not lost.
I applied for the course, and despite having been told by its founder Juliette Alvin that "not just anybody could be a music therapist", I was accepted!
I have said many times that what I learned in that training was mostly that I had to do much more of my own studying and learning if I really wanted to be a good music therapist. The Guildhall program at the time was frustrating, often unprofessional, limited and gave little support for students. Fortunately, I had the chance to attend a demonstration and presentation by Paul Nordoff and Clive Robbins during that time. Otherwise I might have quit!
I graduated in 1973, subsequently worked part-time in a school for severely handicapped children and also at a Psychiatric Hospital near London.
We were transferred back to Montreal in 1974. I was hired by The Anbar Institute with "carte blanche" to set up a music therapy room with a one-way window, a good choice of instruments as well as other equipment. I could set up my own program, choose the children I could see benefiting from music therapy and develop what I saw was necessary in that setting. Working at the Royal Victoria HospitalÂ’s new Palliative Care Service was next, and the rest is history.
Photo 1: At the Anbar Institute in Montreal.
BS:How did you get involved with the Canadian Association for Music Therapy?
SM: The first Canadian music therapy conference was in St. Thomas, Ontario, in 1974. (The interviewer remembers the "banquet" being Kentucky Fried Chicken on the front lawn of the Psychiatric Institute, with Norma Sharpe playing her pedal organ.) I began looking into either a Quebec association, or, as most of us thought more important at that time, a Canadian Music Therapy Association.
I also began looking around at what was being done in the United States at that time. Because of my work at Anbar and invitations to present in nearby New York State, I learned about the American Association for Music Therapy in addition to the National Association for Music Therapy. This was the beginning of my closer connections with AAMT. For me it was always very important to link up with the others. I started very early to find out what the others did, and to see how we could work together.
With talk about an Ontario Association and our planning to form an association as well, I called Fran Herman whose name I had found somewhere to see what she knew and what she thought about a Canadian, rather than a provincial effort. Fran and I connected easily and we all began working toward the founding of CAMT, with such other notables as Norma Sharpe, Earl Charbonneau, Therese Pageau, Bill Shugar, Darlene Berringer, Nancy McMaster, Carolyn Kenny and Connie Isenberg-Grzeda. Once we officially signed CAMT on the board, we made it an official association and not just some gathering. I most certainly got involved head over heels in the field!
"I was closely involved with the founding of the Canadian Association for Music Therapy (CAMT). The struggles to arrive at clear definitions of the knowledge, attitudes and skills necessary for the qualified music therapist, of the requirements for training, of the guidelines for professional associations, early work on the Board of Directors with Carolyn Kenny, Nancy McMaster, Valerie Ivy, Fran Herman, Bill Shugar, and others, did more for my personal understanding of the music therapy process and the interrelated thinking and knowledge required than any of my training had prepared me for. To observe and at times to be part of similar developments in the American, German, French and later the Australian, New Zealand and Swiss Music Therapy Associations continually challenged me with the need to reflect on practice, on the implications of music therapy for various patient populations and on the process of careful integration of our work into existing settings. While this was often demanding, I am convinced that these circumstances helped me to stand on rather solid ground professionally, even before I entered the area of palliative care and was required to demonstrate how music therapy could work in this "very real" world." (Susan Porchet-Munro, Moments in Time. Postlude in Music Therapy at the End of Life. Dileo Ch., Leowy J. Eds. Jeffrey Books, Cherry Hill, NJ, USA, 2005, pp. 275-280).
BS:You introduced what was to become the logo of CAMT, adopted by the Board of Directors in May, 1976. What is its symbolism?
Photo 2: The CAMT logo as it is currently used.
SM: I described the logo in the June 1981 issue of the CAMT Newsletter:
The logo was designed by two Swiss friends, Margit Stutz and Freddi Jaggi of Design Link in Montreal. It symbolizes the ear channel through which music reaches us and the heart where our emotions and feelings are reflected. Within the "ear" is a symbolized shape of the human brain, the centre of human thinking and function, which is susceptible to musical stimulation. The shape of the ear alludes to the shape of a guitar, symbolizing musical instruments.
The overall design of shapes and lines reflects composition, form, rhythm, and movement; as a whole, the logo represents the essence of the uniqueness of music therapy and the multi-dimensional qualities of music in relation to humans.
Although the logo was designed in the 1970's, it has a timeless quality that projects into the future and suggests that music and medicine will once more complement each other.
"Susan Munro is a passionate advocate of all of the healing arts, most particularly for her pioneering work in the field of music therapy in palliative care. She presented music therapy as a completely legitimate approach that could stand on its own. I was incredibly impressed with her powerful presentations - and that was before Powerpoint !! (ed.) As a clinician and a teacher, Susan helped put music therapy on the map." Deborah Salmon, M.A., MTA, CMT Music Therapist McGill University Health Centre Palliative Care Services
BS: You were the first in Canada to formally use music therapy in Palliative Care?
SM: I was the first one around the world. At the time there was a woman in the States, who knew and did some work with Elisabeth Kübler-Ross. I wanted to go and see this person and did. A presentation of hers was very emotionally laden, focusing mainly on herself. I tried to talk to her subsequently to find out more about her approach to patients, but she was basically only interested in selling her cassette tape. This meant that I had to find my own way to use music therapy in palliative care.
In 1977 The Royal Vic Palliative Care Unit had only been open for about a year. It was a model. It was the first setup like that in a university teaching hospital anywhere in the world. People from Europe and the U.S. came to visit the unit and did internships. Many programs that started in the U.S. would call on us to come and do workshops. I was asked to talk about music therapy and how it could work. I presented on music therapy twice at the international symposiums, held in Montreal every two years.
Photo 3: Music therapy during a lumbar puncture procedure.
Photo 4: At the Royal Victoria Hospital Palliative Care Unit in Montreal.
Photo 5: A tender moment in the RVC Palliative Care Unit.
You were always alone in this business. There was no one to ask. So when we heard of someone we would contact each other and gradually there were more people and it became more known.
"The goal of the Royal Victoria Hospital Palliative Care Service was to deliver "whole person care" - physical, psychosocial, spiritual and existential - with the focus of our concern being the patient and his or her significant others as the 'unit of care'. Given the demonstrated potency of music as a determinant of quality of life I was interested in determining its efficacy in end-of-life care. I was already familiar with the work of Susan Munro in other arenas of need and had great respect for her insight and her mastery of her craft. I watched with delight as her diagnostic and therapeutic skills became a central part of our program of inpatient and home-based care. Our collaboration led to a variety of foundational contributions to both palliative care and music therapy - the integration of music therapy in an acute care medical interdisciplinary team; the development of a range of effective music therapy interventions in the end-of-life setting; teaching programs; articles in the medical literature; Susan's acclaimed book on music therapy in palliative care. It has been an honour to have Susan Munro as a colleague, mentor and role model." Balfour M. Mount, MD, Emeritus Professor of Medicine, McGill University.
Photo 6: The RVH PCU team singing - Dr. Balfour Mount, 4th from the left, Susan playing guitar on the far right.
BS: Do you get emotionally involved with your patients? How do you deal with that?
SM: ThereÂ’s a little bit of a difference in palliative care in that thereÂ’s always an end in sight to any relationship you establish. You cannot totally stay out of it emotionally. You have to keep an eye on limits, on being too or not enough involved, or not enough involved. This awareness has to be quite astute.
You can feel the loss of a patient greatly in some cases, of patients you get closely involved with. I was alert to that issue.
Over time, with so many deaths in a short period, you absorb some of that sadness. One day, while I was going to breakfast, all of a sudden I felt like crying for no reason. Thinking about this, I realized there had been eight deaths in the previous two weeks. Often, you absorb much sadness and it stays with you. You have to be mindful to have chances to let this go.
If you work in a palliative care setup, you work with one difficult situation after another and you really do absorb quite a lot. Occasionally I would walk around outside the buildings to look at the flowers, to stay in touch with life before going into another session.
You also become involved with the families. They are often there and the patients tell them what music therapy is all about or you tell them what itÂ’s all about. Occasionally, they become involved in the music. There were a few times when I stayed in contact with a family for some time after the death, for instance when children were involved, but the main work is certainly with the patient.
BS: Have you been with patients at the moment of death?
SM: Sometimes. Occasionally, when music had been important for the person or had to do with the family. As well, when patients had no close relations or were semi comatose or comatose for a long period of time.
The time when somebody dies is a very intimate moment for the loved ones. If it was important to have music, then of course I played. But the moment of dying, as far as I am concerned, belongs to the loved ones.
Certainly in Switzerland, you wouldnÂ’t walk in with a guitar in hand and strum away.
BS: Is your approach different with patients who are comatose?
SM: You read about the fact that people can hear even when they are comatose. I looked into the possibility of music on tape which would then be available even if I was not working. At first, I would sit with someone who was comatose and play taped music. Or I would play the flute or I would quietly sing songs that were dear to them. From that, I started to tape pieces I thought appropriate for such moments.
I used to sit and watch patients closely when this music played I observed that occasionally there would be a certain change of expression or a tiny movement when keys or tempi changed, which led to the idea of repeating one piece many times to initiate relaxation
Generally with a comatose patient, I was very mindful not to use any kind of music, unless I had a notion of what was dear to that person. Man has no defense against the influence of music, therefore I felt it to be invading if I just went in and - for instance - played a hymn that I thought appropriate.
BS: Would you want to have a music therapist if you yourself were in palliative care?
SM: I probably would not. I think I would use music myself when I would need it. You never know until you are there yourself. I would listen to music. I donÂ’t think I would want someone to play to me. The "person" would probably feel in the way. ThatÂ’s why I often used recorded music, and why, occasionally I would encourage close ones to use music.
BS: What kind of music might it be?
SM: I am very much a "classical" person: Mozart, Beethoven, but mainly I "need" melody.
BS: Your pioneering work at the McGill Palliative Care Centre revolved around the concept of "whole person care". You have used another phrase in your work that reflects the need for proper education.
SM: I guess part of me is and always has been that of an educator. The issue of how caregivers reflect on their attitudes which favour competent and compassionate caring besides simply relying on cognitive knowledge, has long preoccupied me. From having to give workshops about my work with patients frequently, I learned that music therapy techniques, more than conventional teaching methods, offer the scope to explore emotional and intangible issues in a non-threatening way. Hence my interest in healthcare teaching to address the theme "care of the caregiver" and my intense involvement in interdisciplinary palliative care teaching in these last years.
BS: How would you define music therapy?
SM: "The multifaceted nature of music itself differentiates music therapy from all other therapies! This, together with the diverse skills and a profound respect for human endeavor of the therapist, are the powerful ingredients for the therapeutic work."
BS: What is your personal philosophy of music therapy?
SM: Music has the potential and power to reach, move, disturb, comfort or relax persons beyond their cognitive control and to reach innermost depth. A music therapist therefore needs to tread mindfully, with much respect and an astute awareness of boundaries.
"The answers in this work often are not up to us, but depend on given moments in time. Moments in time where we may be more than we thought we could be, where we see needs clearly and sense just how and when music can accompany, comfort or be a source of strength to persons nearing the end of their life." Susan Porchet-Munro. Moments in Time. Postlude in Music Therapy at the End of Life. Dileo Ch., Leowy J. Eds. Jeffrey Books, Cherry Hill, NJ, USA, 2005, pp. 275-280.
Photo 7. Susan with music therapists from Montreal in 2009 - Debbie Carroll and Claire Lefebvre.
Photo 8. Skiing in the winter of 2008.
Writings Supportive of This Interview
Porchet-Munro S. (1984) Music Therapy in Palliative/Hospice Care. Magna Music Baton, Inc., Saint Louis, MO, USA. (translation into German - Musiktherpie mit Sterbenden, 1986).
Porchet-Munro S. (1993) Music Therapy Perspectives in Palliative Care Education. Journal of Palliative Care 9(4):39-42
Porchet-Munro S. (1995) Music Therapy Perspectives in Palliative Care Education. In "Lonely Waters" Proceedings of the International Conference, Music Therapy in Palliative Care, Oxford, Sobell Publications, Oxford
Porchet-Munro S. (2005) Moments in Time. Postlude in Music Therapy at the End of Life. In Ch. Dileo , J. Leowy (Eds.), Jeffrey Books, Cherry Hill, NJ, USA.
Porchet-Munro S., Stolba V., Waldman E. (2005) Den letzten Mantel mache ich selbst. Über Möglichkeiten und Grenzen von Palliative Care [I Make My Last Coat Myself: About possibilities and limitations of palliative care]. Schwabe Publishers, Switzerland.
