“I’m Here With You”
By Maya Benattar
Abstract
Through my work as a music therapist with people who have dementia, I’ve learned a lot about the power of connecting on a simple, yet profound level. When I was a new therapist I was eager to always “do” and found it hard to just “be”. This is a story about Elizabeth, a nursing home resident and one of my first individual clients. My experiences of working with Elizabeth helped me learn how to be fully present, connect in a space of deep intimacy, and develop my personal identity as a therapist.
It is sometimes easier to work with a verbal client, or a client who makes eye contact, or who sings a lot. For me, as a new therapist, when all those aspects were not present, it was challenging to connect in a deep, meaningful way. I did not know- or really understand- the power of silence and simplicity. This story will share my experiences over a two year period of working with Elizabeth1, a nursing home resident. In the end, I believe I equally learned from and gave to Elizabeth in a relationship that proved pivotal to my development as a therapist.
I first met Elizabeth in September 2007. A handsome woman in her 80's, Elizabeth had late-stage dementia, and was confined to a gerichair. The activity staff described her as a vibrant, active woman who loved animals, photography, and music. As her dementia had progressed she was unable to engage in group activities.
I first met Elizabeth in the unit dayroom, where she was seated behind a table. Her eyes were unfocused, and she was gripping the table tightly, her entire body tensed. She constantly leaned to the left, and gripped anything she could reach in an effort to feel stable - a table, gerichair arms, or bedclothes. During our first session, it took a few minutes of me singing alone before she made eye contact, and sang a few phrases of “You are My Sunshine” with me.
As our sessions continued, Elizabeth showed an ability to relax her body to my singing. She would often release her grip without prompting, though it took several minutes. This act of being so patient and present was hard for me, as I worked on the process of not looking for immediate results. I was touched when she began to hold my hand, it seemed that she was reaching out and looking for connection.
We continued in this vein for a few months. Each week, I would gently bring Elizabeth to a quiet corner of the unit, and sing familiar songs to her, such as "You Are My Sunshine" and "Take Me Out to the Ballgame". After a few minutes, she usually made eye contact, deepened her breathing, and sometimes sang a phrase or two with me. Sometimes I assisted Elizabeth in playing a triangle or other small percussion instrument, but most of our sessions focused on the use of voice and song to help her connect with me and release body tension.
As the months went on, Elizabeth continued to decline. In January 2008, Elizabeth stopped singing and by March 2008 she stopped being able to play instruments, even with assistance. This was a turning point in my process, as I realized that in order to really connect with Elizabeth I had to tune into her body, her spirit, and her energy.
While she did not sing anymore, Elizabeth's body and breathing continued to respond to my voice. I stopped searching for eye contact, and found that she sought me out on her own. It was astounding to realize that an isolated person who has very little speech still wants to connect. Her awareness was still there, and came out at the most unexpected moments, like when I sneezed in the middle of a song (despite my best efforts not to!) and she said "God bless you!" in a loud, clear voice. At that point, she had not spoken or sung in several months.
I realized that I was spending most of the session singing "You Are My Sunshine" to Elizabeth, and although I varied the tempo and volume, I was not truly being present with her. With some trepidation, I began to improvise vocally, singing lines like "Elizabeth, I see you" and "I'm here with you". I sang her name, stretching out the syllables or playing with the melodic contour. I began to feel a deeper connection with Elizabeth. I learned to remain grounded as she held my hand, to provide for her the comfort and stability she often sought from inanimate objects. Through the use of my voice, I tried to communicate myself as a constant, nurturing source of energy. I visualized my voice as creating a therapeutic space for us. In essence, it is the thread that connected us as two individual people.
When Elizabeth was especially tense or breathing heavily, I chose to tone, placing my hand gently on her, trying to impart a sense of peace and stability. I imagined us as two vibrating beings, and tried to honor that connection, while offering my energy to her. At those times, I felt it important maintain a "home tone", which was grounding for both of us. Wherever my melodies traveled, I returned to the "home tone", which I believe symbolizes a return to the inner core of the body. The home tone also allowed me to keep my own energy, and not feel sapped. Toning often led us to a quiet moment of looking at each other, which seemed so intimate and true.
It is important to note that although I stopped reaching and yearning for results, they continued to come. Looking back over my notes, I remember such deep, intimate moments of connection. The expressive raising of her eyebrows, the "mmm" she made under her breath as if experiencing a moment of great pleasure, and her spontaneous chuckles are just a few. Sometimes, mid-way through a session, she released her body tension with a big "whoosh" of air, and began to breath in a more relaxed manner. Often her body remained relaxed and her hands did not re-clench for several minutes after a session. I valued these moments, not only because they justified my work and this new approach, but for the opportunity they provided for connection, humor, and exploration. It seemed that Elizabeth's spontaneous, whole self came out when she was given the time and space for such expression.
It was a deep, spiritual experience to work with Elizabeth. Through the spontaneity of voice, breath, and body, we connected. I feel that this connection honors the vibrant person she was.
Elizabeth passed away in June of 2009. I miss her still.
References
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Cadesky, N. (2002). Dynamic engagement in a Jewish facility’s dementia unit- voice, improvisation, and process. Proceedings of the 10th World Congress of Music Therapy, Oxford, England, 264-280. Retrieved January 25, 2009 from http://www.wfmt.info/WFMT/2011_World_Congress_files/Proceedings%20Oxford_2002.pdf
Hatfield, K., & McClune, N. (2002). Principles of person-centered care in music therapy. In A. Innes & K. Hatfield (Eds.), Healing arts therapies and person-centered dementia care. (pp.79-112) London: Jessica Kingsley.
Hayes, J., & Povey, S. (2011) The creative arts in dementia care. London: Jessica Kingsley.
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Kitwood, T. (1997). Dementia reconsidered: the person comes first. Bristol, PA: Open University Press.
