Music Therapy in Palliative Care: a conversation with Sheila Killoran

"There's kind of a magical quality with music, a healing or a support really that comes from the music. As long as people have been around, we have been making music and it really does connect with us on an emotional level." - Sheila Killoran

Sheila Killoran is the Education Lead for the Covenant Health Palliative Institute. She is a certified music therapist and holds a Master's in Creative Arts Therapies with an interest in guided imagery and grief. Sheila teaches at the University of Alberta and the University of Saskatchewan, and has provided music therapy for the past 20 years in Palliative Care, Hospice, and Continuing Care settings in Edmonton Alberta.

Learn more about music therapy programs:

Canadian Association of Music Therapists: www.musictherapy.ca
Canadian Music Therapy Training Programs:
Related Links - CAMT : CAMT
https://www.musictherapy.ca/about-camt-music-therapy/related-links/

Learn more about the Strengthening a Palliative Approach to Long-Term Care project at: https://spaltc.ca/

Transcript

SPEAKER_00 0:00

Welcome to the Strengthening a Palliative Approach in Long-Term Care Alliance podcast, exploring challenges and best practices and palliative care approaches for individuals in long-term care.

SPEAKER_01 0:15

Sheila Calorne is the education lead for the Covenant Health Palliative Institute. She is a certified music therapist and holds a master's in creative arts therapies with an interest in guided imagery and grief. Sheila teaches at the University of Alberta and the University of Saskatchewan and has provided music therapy for the past 20 years in palliative care, hospice, and continuing care settings in Edmonton, Alberta. Welcome to the podcast, Sheila. Thanks. It's great to be here, Nancy. I'd like to start by asking you to tell me a little bit about your journey to becoming a music therapist.

SPEAKER_02 0:53

When I was in high school, my mom found a clipping in the newspaper that she clipped out about an opportunity to share some of your old music and your old sheet music and music books to support a music therapy program at a local long-term care center. And she said, Sheila, maybe you want to share some of your old piano books here. And then she said, And Sheila, maybe you want to read this article. Maybe you want to think about this as a career option. I was studying psychology and I took a leap of faith and decided to apply to the program at Capolato University in North Vancouver.

SPEAKER_01 1:31

What does a music therapist do?

SPEAKER_02 1:34

A music therapist is one of the interdisciplinary team members. So we work with the clients, with the families to support, and music is our tool. It's sort of a combination between music and the impact of music on the person, as well as psychology or counseling and verbal support. After our assessment of the person, we develop what type of areas or goals are they working on and how could music support that. If I was working with a little kiddo who had Down syndrome, and maybe his area of growth right now that he's working on is his balance and his coordination. I might develop some music therapy games and activities for him that incorporate those physical goals into our session. I work a lot in palliative care. So I might be seeing someone who has a fair bit of agitation. They're unsettled, they're restless in bed. So in that way, the goal is decreasing the agitation. So I might play guitar in time with their breathing and watching how I can slow down my guitar and my voice till I see them settling and calming and maybe getting very quiet and soft in my playing until they're asleep. My goal isn't to help them become a great singer or to learn piano. My goal is to help them be less anxious.

SPEAKER_01 2:59

People often say that music heals. What is it about music that is so healing and that touches so many people?

SPEAKER_02 3:07

There's kind of a magical quality with music. You know, sometimes when I'm in the room playing and singing and sharing music with people, and there can be a healing or a support really that comes from the music that it's hard to describe. I think music has been part of the human experience as long as people have been around. We have been making music, and it really does connect with us on an emotional level. It's very much tied to our memories. So much of our memories can be triggered by music. There's been many studies looking at how the body responds to music. And there is quite universal truths that music is a universal language. So we have a personal connection, right, to songs that we love or maybe don't love.

SPEAKER_01 3:55

People often say you should play music for people that they listen to in their 20s because that's such an important decade for music. Have you found that?

SPEAKER_02 4:06

Yeah. So when we think especially of working with folks that might have uh dementias, Alzheimer's disease, other forms of dementia, in that case, the mind is sort of moving back to an earlier time. And as the disease progresses, um, they may be actually in their memories going back to earlier phases of their life. So certainly some of the music that has a strong emotional impact and connection is music from around someone's 20s, maybe their late teens, sometimes even music from their childhood. It can also be music they heard in the home in their childhood. It can also be music from their culture or music from their spirituality or faith tradition that has a strong impact.

SPEAKER_01 4:59

Can you tell me a little bit about your role, like a day in the life?

SPEAKER_02 5:04

From long-term care, we usually do some music therapy that is in groups. So one of the groups that we've done is a reminiscence group where we will bring um objects, things that are tactile, maybe even things that have a smell, like an odor of that will help bring memories. And we'll have some songs and some music that is connected to that reminiscence experience. And we will then bring in some singing with the clients or the residents, and often with the reminiscence groups, I invite family to come as well, because it can be a really nice chance for them to interact together with their loved one. One interesting thing with music, once you're singing over time, you know, through the session, several minutes in, maybe 15 minutes in, that music really stimulates many parts of the brain at once. As the person is more stimulated neurologically, they might actually have more words as well. So there might be more verbal intervention. And if the family asks them a question, sometimes they're able to answer the question. So we'll see people start to talk a little bit, um, sing, laugh, maybe make a bit more eye contact. So it can be a nice time of connection. We also do a lot of work with instruments, playing, singing, and movement. So having movement is really important to keep strength in the body. Another thing that I do is individual music therapy, and that might be at the bedside, it could be relaxation, or it might be more around emotional support. Music can bring up so much emotion and it can be a wonderful way to reminisce and also to process our feelings and express our feelings, even without needing too many words. With folks with dementia, later on in the day, as the sun goes down, there can be a time when we might see more agitation, a bit more distress, a bit more discomfort. And that's a natural part of the disease, unfortunately, that we see these behaviors coming around that time of day. And music actually can be a great way to support people in that time. So I'll often do one-on-one sundowning session with someone to help them relax and stay engaged, happy, pleasant, relaxed. And singing is so wonderful for this. And often others might come nearby, and now we have a little mini-group of a few, and we're singing together, and we have this calm atmosphere. I keep the instruments very gentle. You kind of create this mood. And now we look and it's 5:30, and everyone is still calm. So you can kind of bypass the sundowning. And we found that when we have music therapy at that time of day, um, people show less symptoms of sundowning. So that can be a real success.

SPEAKER_01 8:04

Absolutely. And it must be very frightening for them to be agitated to begin with, right?

SPEAKER_02 8:10

Yeah, often it's quite scary, right? So, one thing with the music therapy is we're trying to connect where people feel safe. It's calming, it's comforting, and it gives them something to focus on rather than the anxiety in the mind or the confusion of the mind. How do you pick the music? Well, that's a great question. It will depend on the person. So part of the music therapist assessment is finding out who this person is, and that's part of patient-centered care, right? What kind of music do they love? Do they have any connection with music? Where are they from? Um, is there music that might be connected to their culture or their faith? Um, is there any music that they might have a negative association with? If it's in a language that I don't speak, sometimes I learn a song or a few songs in that language. And other times I might use some recorded music or use recorded music, but now we're gonna play along with instruments. Or sometimes, if family or visitors are there, they can sing in the language and I'll provide the musical accompaniment. I had a Korean family and they sang all of their hymns in Korean. So I was able to play the music for them, and then they all sang in Korean, and the patient started to sing a little bit in Korean as well.

SPEAKER_01 9:42

How do you collaborate with the other people working in palliative care, long-term care homes? How does that team come together?

SPEAKER_02 9:53

So I would chart on the sessions that I've had and I can read and see the other sessions that other team members have had. We have team conferences where we connect and share what's going on with different patients and families and discuss the goals. If I'm in a session and maybe someone has brought up some spiritual questions and asked for some spiritual music, I might ask them, you know, would you like to chat with our spiritual care provider or our chaplain and make a referral as well? Healthcare, it's 24-7, right? It never stops. So we have to see each other as part of a team and like a big family.

SPEAKER_01 10:32

I like how you said family because I was thinking about that when you said that, how you know it it might be your grandmother or your aunt or uncle, right?

SPEAKER_02 10:41

Yeah. And the family members themselves are such a huge and important part. Um, you know, especially in long-term care where someone is living there for maybe many weeks, many months, maybe even years. So we do want it to feel like it's their home and we're coming in to their home into their space and hopefully supporting them in a good and respectful way. So I love to chat with families, give family support, find out how they're doing. And that's part of that good relationship too.

SPEAKER_01 11:14

You mentioned the fact that sometimes the person who's there was sort of just sing or say something or answer questions. So it might be a way for family members to facilitate some connection that they may not have had.

SPEAKER_02 11:26

Also, intergenerational sessions are really fun. If we can do music together as an intergenerational session, a way to connect, a way to have a positive memory and keep making those positive memories together, it can be really powerful for the family as well.

SPEAKER_01 11:43

Absolutely.

SPEAKER_02 11:44

Do you run into any challenges in your work? I think sometimes there's challenges around communication. So I work a lot with folks that may have have limited cognition or might have limited verbal abilities. So it takes effort and time and and lots of patience and lots of um creativity sometimes to really try and find out what's gonna work in this situation or what do they need and how can I support them.

SPEAKER_01 12:13

You yourself go through so much emotion, you know, holding space for people, but you know, at the end of the day, that's a lot for you to take on as well.

SPEAKER_02 12:23

Yeah, and for me, there's different ways that I've been trained to deal with supporting people with big emotion. And we all develop our own coping skills or our own rituals around it that help. One thing that I do when I go into a room, we all sanitize our hands. And that's a moment for me to check in with myself, get grounded, take a breath, and let everything else fall away and get ready to meet this person. Because every time I walk in, it might be different, right? Yesterday we've been doing songwriting, the person was very engaged. Today I walk in, they're in pain, they're in distress. So I just have to be ready for to meet them where they are. Then at the end of the session, when I come out, I do the same thing. So this session is done. Whatever happened, happened, and I can let that go. And if I have to go tell a nurse something or make a referral, I will. But it lets me emotionally disconnect from that experience and then let that go and move to the next person that I need to.

SPEAKER_01 13:42

Is it common practice in long-term care homes and palliative care to have music therapists?

SPEAKER_02 13:48

In cities where we have music therapy training programs in Canada, we tend to have more music therapists working in those in those cities or in those areas. But I think there is so much potential for more music therapy to be part of long-term care and part of hospice care or palliative care. And certainly would love to see it grow further.

SPEAKER_01 14:12

What advice should we give to somebody who's kind of interested in that field? What makes a good music therapist?

SPEAKER_02 14:19

Yeah, that's a great question, Nancy. I would say coming back to that idea that it's a combination of music and music skills and also psychology or health sciences, like helping profession. So if you are interested in using your musical gifts, but to support others in their own learning or their own growth, then this might be a good fit. We kind of laugh that sometimes we have to undo a little bit of our performance training as music therapists because it's not about us, right? We need to have our musical skill to be very strong. I have to be able to improvise, I have to be able to change key in the moment and match the key that my client is singing in. But then we need for our music performance to actually be in the background. And I'm more adjusting and shifting my music to be therapeutic right now in the moment.

SPEAKER_01 15:18

So giving an opera performance or it's not an opera performance.

SPEAKER_02 15:23

No. Also, if you want others to sing along with you, it can't feel too much like a performance because when it's a performance, everyone is quiet and they listen to the singer. So as a music therapist, I want it to feel inviting and welcoming. And with our folks with dementia, we actually have to sing slower so that their mind, their brain has some time to process and catch up to the music.

SPEAKER_01 15:56

Do you find it's different for people who have a musical background? I can imagine sometimes you know, you have somebody in long-term care who was a musician at some point.

SPEAKER_02 16:08

Yes, and no. We can sometimes do more in terms of creativity, like songwriting with them. And then the other side of it is sometimes that's actually a place of grief, right? A place of loss. And that's okay. It doesn't mean we don't have music therapy. In fact, it just means that that's part of our music therapy, is processing their grief and talking about the change in their voice or the loss of their ability to play instrument. And sometimes we might shy away from their primary instrument and use other instruments to help them engage and connect. Or we may spend some time grieving that loss and talking about that loss and getting support. Yeah. So it doesn't mean you can't engage in music therapy. You just have to be sensitive and that grief processing might be part of your sessions, right?

SPEAKER_01 17:01

Yeah, that's fascinating. It sounds like empathy and the ability to be curious and open are huge qualities for a music therapist.

SPEAKER_02 17:10

Absolutely. Yeah, flexibility, creativity, patience, being able to have training and that support in providing verbal counseling and being able to meet people with what they're sharing with you, and then find a way to listen with empathy and also find a way to process with them or to offer them some support so that they're feeling they're not alone in it and maybe have some direction of support to go. And that can be verbal and nonverbal. So with the music, we can bring a lot of things into the music that we don't have to name with words. What's the favorite part of your workday? I think the favorite part is seeing the glint in the eye or the smile or the connection with music with the patients that I work with. Maybe seeing someone who's been anxious, seeing their cheeks smooth out and the lines in their forehead soften, and seeing them calm and peaceful, or seeing somebody's eyes crinkle with joy and laughter as they connect with a memory and share something fun. For me, it's really around connection, and then it's also really around service. So, what is it that I can bring to be of service for this person in this moment? How can music support them in what they need and maybe remove some barriers or provide some support or provide some comfort or reduce their pain? Sometimes people assume with music therapy is they say, Oh, Sheila, it must be so nice you sing and you make people happy. Or there's an assumption that music therapy is about helping people distract away from what's bothering them and feel good, right? And certainly sometimes that is the goal. I would say mostly though, music therapy is about helping people feel, helping them feel whatever it is that they are feeling in that moment. So there are not a judgment around sadness or anger or fear. Those are not necessarily like a bad emotion, right? So music therapy can be a way to support people in whatever emotions they're in and to process those. That's wonderful. Thank you for speaking with me today, Shaila. Thanks, Nancy. It's lovely to talk about music therapy. It's something I enjoy doing.

SPEAKER_00 19:43

You've been listening to the strengthening a palliative approach in long term care podcast. For more information about our project, visit spawnltc.ca