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Receptive Music Therapy In Palliative Care E-Book

Cordula Dietrich

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Herausgeber: Books on Demand
Kategorie: Geisteswissenschaft
Sprache: Englisch

Beschreibung

We are currently facing very challenging times. Through the COVID-19 pandemic, death and dying came very close to everybody, regardless of age or cultural background. Many people had to face the sudden, often unexpected passing of a dear person. Death breaks into people´s lives, not asking, if they are prepared for it or if it is the right time. Many questions arise with this fact, and one of them often is the concern of how to die with dignity when the end of life is nearing. Dying in dignity is a concern of palliative care, which aims to care and not to cure, focusing on the life quality of a patient who is facing the last days of their life. Sound and music can play an important role in this process. This book is meant to encourage all those working in a palliative care team to consider music as a powerful tool in dealing with the challenges surrounding the end of life. The book will inspire the reader to examine the healing power of sound and music more deeply and serves as a useful support for students in palliative care approaches.

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Seitenzahl: 169

Veröffentlichungsjahr: 2023

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Leseprobe

Dr. Cordula Dietrich, a medical doctor, psychiatrist, and psychotherapist has had her own successful private practice for psychotherapy in Berlin, Germany, since 2005. She is trained in receptive music therapy, is a GIM-fellow (Guided Imagery in Music), and MI therapist (Music Imagery), and holds a PG-Diploma in Indian Music Therapy. She completed a two-year further training qualification in palliative care. Since 2019, Dr. Dietrich has been teaching music therapy in palliative care at Yenepoya University in Mangalore, South India as a guest professor of music therapy. Dr. Dietrich wrote her dissertation on the introduction of Siddha medicine, a holistic art of healing in South India. She is also a trained classical singer.

Since my early childhood, music was always my constant companion and, throughout my life, music is a constant and reliable source of joy, happiness, consolation, peace, and love, especially in difficult times. It helps me to overcome challenges, to find motivation in times of loss, and encourages me to go on.

There is a wonderful classical song composed by the great German musician Franz Schubert (Op.88 Nr4) with the title “an die Musik” (“to the music”). The lyrics of this song perfectly express my relationship with music:

You lovely art, in how many gray hours,

where I was stricken by life

you ignited my heart for warm love,

you brought me to a better world,

brought me to a better world!

Often a sigh, that left your harp,

a sweet, holy chord from you,

has shown me the existence of a better time

you lovely art, I thank you for it,

you lovely art, I thank you!

For a long time, I was wondering how to integrate the two main pillars of my education, namely medicine and music. After finishing my specialization as a psychiatrist and psychotherapist, a completely new space opened up for me when I discovered the field of music therapy. And, during further training in music therapy, I came into contact with the sound of the Body Tambura for the first time. Back then, in 2002, the Body Tambura was a brand new string instrument in the field of receptive music therapy, which was invented in Berlin by the instrumental designer B. Deutz. Through different training approaches in receptive music therapy, I slowly became aware of how to use sound/music for the treatment of people suffering from psychological problems and started to integrate sound/music into my psychotherapeutic sessions with surprising outcomes. I also became very actively involved in two research studies regarding the effect of the sound of the Body Tambura on patients in the field of palliative care. One study was conducted in a hospice in Berlin, and the other in a hospice in South India. Both studies confirmed my observations that the sound of the Body Tambura has countless qualities, making this instrument an incredibly precious tool for dealing with human issues in different contexts based on different cultural backgrounds. At present, there are more than 1 000 Body Tambura instruments in use in different parts of Germany alone while at the same time, an increasing interest in this particular instrument is becoming evident abroad. In Germany, the Body Tambura in various ways now is part of the everyday life of teachers, nurses, therapists, doctors, counselors, psychologists, volunteers in hospices, and also in ordinary people’s lives.

The beauty of this instrument is that no musical education is needed to be able to produce its wonderful sound. It is comparatively easy to learn how to play the Body Tambura, provided that a person is seriously interested in doing so. The biggest challenge in this context is to be disciplined and committed enough to properly learn the tuning of the Body Tambura. By regularly practicing playing the Body Tambura, a good level of progress can be anticipated for most students. In 2005, I started to conduct seminars on the handling and use of the Body Tambura. These were initially held in Germany together with B. Deutz, the inventor of the instrument. Since 2014, I have given lectures and moderated workshops (mainly in South India and Germany) on the therapeutic use of the Body Tambura sound. Since I finished my training in palliative care in 2016, I am highly involved in the development of the approach to palliative care worldwide. I am convinced that receptive music therapy with the Body Tambura and also with other types of music could make an extremely helpful contribution, especially to the field of palliative care.

In this book, I would like to shed some light on the usefulness of the sound of the Body Tambura in the field of palliative care regarding the issues of patient care, self-care, grieving processes, and simply how to make use of the instrument at home to reduce the stress level of everyday life. Along with a good number of case reports from Germany and abroad, I try to illustrate the effect of the Body Tambura from my experience of more than 15 years in various contexts, mainly in psychotherapy, palliative care, and everyday life. A further aim of this book is to share some insights on receptive music therapy based on the technique of guided imagery in music by using recorded classical music for the treatment of patients. This book is meant as a source of support and knowledge for all who are undergoing receptive music therapeutic training in palliative care. It can also be of interest to any person who would like to know more about Body Tambura in particular. Additionally, the book may inspire the reader to explore the wide field of receptive music therapy in general and to also become inspired to commence training in receptive music therapy.

2. Introduction

There is so much to say concerning the question of how I encountered the sound of the Body Tambura, which inspired me so deeply. What motivates me to share my experiences and knowledge about the effects of the Body Tambura’s sound is the fact that the sound has already touched so many people. Over the past 17 years, I could witness the effect of the sound of the Body Tambura – not only in my work as a psychotherapist and music therapist – but also while I was conducting various seminars. In therapy sessions, deep changes were taking place and some of these experiences are shared in this work. It was in 2002 during my music therapy studies, that I first encountered the Body Tambura in the atelier for therapeutic instruments of B. Deutz in Berlin, Germany. The Body Tambura had just been invented by him. When I played the 28 strings of the instrument for the first time, I had the inner image of the deep and endless universe with its stars and galaxies, its power, and its peace. Since that day, the sound of the Body Tambura never left me. It is my co-therapist during music therapy sessions and my best friend in difficult personal situations. After I came to know the Body Tambura and started to integrate the sound into my music-therapeutic work in my practice in Germany, I had the chance to work as a music therapist with the Body Tambura in India as well. After the tsunami hit the south coast of India in 2004, I worked as a counselor in a Tsunami Health Camp in Kanyakumari for two weeks, which was conducted by the holistic South Indian Health Center MUHIL. During that time, I successfully gave counseling with Body Tambura receptive music therapy to a traumatized young woman, who was suffering from severe anxiety and flash backs. During that time, the first Body Tambura instrument was donated to help tsunami victims in South India. In 2010, I received an invitation to participate in a world conference on the paradigm shift in management education at Fatima College in Madurai. I gave a presentation on relaxation techniques and receptive music therapy using the Body Tambura to an audience of young female college students. At the end of the conference, one of the other presenters encouraged me to visit St. Joseph’s Hospice for Dying Destitute, an institution located about a two-hour car drive away. I agreed to visit the institution. After we arrived, I could immediately give a receptive treatment with Body Tambura sound to an elderly woman who was suffering from severe body pain due to stomach cancer. She was holding her legs in cramps close to her stomach and was writhing in pain. When I sat down at her bedside and started playing the Body Tambura, all those present could witness how the woman relaxed her body step by step. After about 20 minutes, she was stretching herself out, relaxed her legs and the rest of her body, and died in peace. After this experience, we agreed to conduct a study on the effect of the sound of the Body Tambura, which was initiated by the Gandhi University in Dindigul, South India in cooperation with the Charité Berlin and commenced in 2010. The results of this study were published in the Indian Journal of Palliative Care in 2015 and will be discussed later in this book. After finishing the study at St. Joseph’s Hospice for Dying Destitute, I initiated the foundation of the “Zuflucht e.V.” trust in Germany to financially support and create awareness about the noble humanitarian work of Fr. Thomas Rathapillil and his team for the poorest of the poor in five different hospices in South India. More or less at the same time, a study on the effectiveness of the Body Tambura sound on dying patients was also initiated by Charité Berlin (Germany). The study was carried out at the Lazarus Hospice Berlin, in which I was also involved. The results were published in 2014 in the BMC Palliative Care journal and will also be discussed later. (page 38ff)

As the sound of the Body Tambura has continuously helped me in many aspects over time, I could both witness and experience how the sound of the Body Tambura could become a strong support to many people from different cultural backgrounds as well. In the meantime, while over 1 000 instruments are found in Germany, some more instruments have already reached other parts of the globe. So far, I was able to take five instruments along with me to South India and left them there to support people in need. The first Body Tambura I brought along with me was in 2015 while I was helping in a Tsunami Health Camp in Kanyakumari in South India. The second one was donated to the St. Joseph’s Hospice for Dying Destitute in Dindigul, South India, and a third one followed some years later to also be used in the hospice. After recently being appointed as an adjunct faculty for music therapy in palliative care, I also took two instruments to Yenepoya University, Mangalore. In the Tsunami Camp in Kanyakumari, traumatized people could benefit from the sound of the Body Tambura. In Mangalore Yenepoya University Hospital, patients of different ages in the late stages of cancer could benefit from the Tambura sound in terms of gaining a feeling of relaxation in their body, mind, and soul. In Kidway Memorial Hospital in Bangalore, the whole palliative care team could witness the positive effect of the sound of the Body Tambura on their patients on the ward.

I would thus like to take you, the reader, along with me to some of these places and special moments. I would like to encourage all of you to be curious about the power of the sound of the Body Tambura especially in the field of palliative care. In addition to the sound of the Body Tambura, I would like to introduce music in general as a resource during difficult times, mainly focusing on grieving and loss, based on the receptive music therapy concept of guided imagery and music (GIM).

3. Palliative Care

3.1. What is Palliative Care?

First of all, I would like to shed some light on the approach of palliative care, which is different from all other conventional medical approaches in dealing with the medical care and support of a patient. By understanding the concept of palliative care, it will become clearer where sound and music can be helpful in this context.

Palliative Care is an approach that improves the quality of life of patients with life-threatening illness and the quality of life of their families through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other physical, psychosocial and spiritual problems (1).

Palliative care refers to the active total care of those patients whose disease is no longer responsive to curative treatment. The alleviation of pain, physiological and psychological symptoms, and social and spiritual problems is paramount in palliative care. Hence, the goal of palliative care is to ensure the best quality of life for terminally ill patients and their families. Patients of all ages (both adults and children) suffering from cancer, chronic progressive pulmonary disorders, renal diseases, chronic heart failure, HIV/AIDS, progressive neurological conditions, etc. are referred to a palliative care ward if their disease is no longer responsive to curative treatment approaches.

Usually, medical teams aim to save lives and cure patients of the diseases they are suffering from. However, over the past 50 years, the approach of palliative care has become increasingly recognized all over the world whereby its aim regarding patient treatment is unique as it is an area of healthcare that focuses on minimizing and relieving the suffering of terminally ill patients, and thus mainly applies a caring approach in situations where the patients can no longer be cured from a grave illness. Palliative care provides relief from pain, shortness of breath, nausea, and other distressing symptoms. It affirms life, but also regards dying as a normal process and thus neither intends to hasten nor to postpone death. Palliative care integrates the psychological and spiritual aspects of patient care and offers a support system to help patients live as actively as possible while simultaneously helping the patient’s family in coping with the distressing situation. For this, palliative care uses a team approach to address the needs of patients and their families and it enhances the quality of life of a patient (26).

The word palliate is derived from the Latin word pallium meaning cloak. It is an all-encompassing care that cloaks or protects the patients from the harshness of their distressing symptoms when a cure is no longer possible. A palliative care ward is usually a ward that is inside or adjacent to a hospital but can also exist as a separate service. In some countries, palliative care units are regular units of hospitals that provide crisis interventions for patients with complex symptoms and problems. In other countries, palliative care units can also be freestanding institutions, providing end-of-life care for patients when home care is no longer possible (58).

The modern palliative care and the hospice movement are attributed to Dame Cicely Saunders (1) who founded the first modern hospice in London in 1967.

Dame Saunders practiced as a nurse, social worker, and doctor. This background led her to develop modern hospices/palliative care units with holistic dimensions.

Palliative care includes physical, emotional, social, and spiritual care (1). A multidisciplinary approach to patient care is taken to provide holistic care for the patient in all these different aspects of body, mind, and spirit. It relies on the input of a team of physicians, nurses, pharmacists, chaplains, social workers, psychologists, physiotherapists, music therapists, art therapists, volunteers, and other allied health professionals in formulating a plan of care to relieve suffering in all areas of the patient’s life. Additional members of the palliative care team are likely to include certified nursing assistants, home health care aides, volunteers from communities, and housekeepers.

But, what does it mean to improve the quality of life of a patient? Quality of life is defined by the World Health Organization (WHO) as an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns (59). Standard indicators of the quality of life include, among others, physical and mental health, social belonging, religious beliefs, safety, security, and freedom. Researchers at the Toronto Quality of Life Research Unit define the quality of life as “the degree to which a person enjoys the important possibilities of his or her life.”

This definition of quality of life shows that how it is perceived is very individual and needs to be explored carefully. One of the methods for the assessment of symptoms of patients admitted to palliative care is the Edmonton Symptoms Assessment Scale (ESAS). It contains eight visual analog scales (VAS) on a score from 0 to 10, indicating the levels of pain activity, nausea, depression, anxiety, drowsiness, appetite, shortness of breath, and sensation of well-being. On this scale, 0 means that no symptom is experienced and 10 indicates the presence of a symptom with the worst possible severity. This assessment can either be conducted by the patient or with the assistance of a palliative care team member or a relative (26).

There are different approaches to improving the quality of life of a patient in a hospice or palliative care ward. One key aspect is to minimize any level of pain, shortness of breath, nausea, or other distressing symptoms using suitable medication. Psychological support for the patient and their family members may also free the patient from existing psychological burdens of how to deal with the final moments of his life. Spiritual support, such as a priest or other religious minister who is available for conversation and prayers, as well as facilities to find peace and silence in the form of a meditation and prayer room can also improve the patients’ quality of life. Volunteers donating their valuable presence for conversation or shared silence also greatly enhance the feeling of well-being of the patients. Access to nature in the form of a hospice garden and a window view, for example facing the sea, may invite the patient to get in touch with nature, which may also have a positive effect on him.