Can you share your story of how you came to specialize in music therapy with older adults?

I didn’t particularly like my practicum placements with older adults as an undergrad, because I didn’t think they were challenging enough for me. I chose an internship with a pretty varied bunch of clinical settings, and my internship director even commented once that I seemed especially comfortable and natural working with older adults, but I still didn’t think that’s what I wanted to do long term.

Then, when I started my business, I cast my net wide, and the first couple of contracts I got were in long-term care and hospice. I’ve been working in those two settings ever since, even after having contracts and private clients in many other settings. I’ve come to recognize that my skills and interests are most developed when it comes to older adults. I truly believe that my calling is in working with older adults. Maybe that’s why it’s always felt relatively easy to me.                           

What makes an older adult’s relationship to music unique and/or important?

Older adults have, by definition, lived long lives, full of musical experiences and memories. As we know, music is closely connected to memory, emotion, and cultural experiences, so for older adults who are being pulled away from their cultural groups, losing their grip on memories, or having difficult feelings related to all of the changes in their lives, music means familiarity and a way to restore some equilibrium.

What are some of the mental health needs of older adults you provide music therapy for?

A short list of common mental health concerns for older adults would include dementia, depression, anxiety, delirium, complicated grief, and lifelong mental illness (e.g. schizophrenia). However, many older adults are dealing with multiple medical and mental health needs, and it can be difficult for professionals to tease out what exactly is going on. For example, an older adult may no longer speak because of their dementia, and they may be yelling out frequently – is this because they’re confused due to dementia? Or having hallucinations because of delirium caused by a UTI? Or in pain because of bed sores? Part of my job as a music therapist is to help the caregiving team figure out the whole picture for a client.

How do you address these needs with music? 

A huge first step is establishing trust and rapport. Confusion and disorientation are common problems for the people I serve, so I spend a lot of time making sure they feel safe and cared for by sharing familiar music.

Loneliness and disconnection are also common facets of depression, dementia, and other mental disorders among older adults, so I’m frequently inviting people to make music with me and with their peers and caregivers in various ways – by singing, playing instruments, or moving to music. 

What are some of your favorite music therapy techniques or interventions to facilitate with older adults struggling with depression or anxiety? 

For older adults who have cognitive impairments in addition to depression or anxiety, I fall back on sharing familiar music and inviting them to join the music through singing, playing, or moving. Being in the music, especially in a group, can bring joy, connection with others, and an effective redirection from rumination and anxious thought.

When I work with older adults who can do more verbal processing, I still find that songs can hold and communicate more emotion than might come out just from talking. Asking older adults to choose songs, singing or playing them together, then talking about the music or why they chose the song can lead to a rich conversation.

What is the most rewarding part of your role as a music therapist working with older adults?

 I see a lot of joy in my work – sheer pleasure at hearing an old song, or playing a beat on the drum, or shaking one’s shoulders to the music. I love it when the people I work with drop the inhibitions they may have had as adults and just PLAY. What a privilege it is to witness that joy and freedom.

What is the most challenging part of your role as a music therapist working with older adults settings? And how do you deal with these challenges?

The biggest challenge has two sides – on the one hand, older adults have complex needs, and it’s not always easy to figure out what is going on with them and how to help. But on the other hand, it seems “they” are always trying to come up with one-size-fits-all solutions and that “they” don’t understand the depth of what we have to offer as music therapists as compared to other music programs. I deal with this by positioning myself as an expert on music with older adults. Music therapists have a depth of knowledge and understanding on that place where aging and music intersect – many people have no idea how much we have to offer! I’ve made it my job to show people what we know and to help them use music effectively in many ways, whether I’m present with them or providing education and guidance from afar.

What do you love about music?

Music brings people together, no matter how old or young, how rich or poor, or how similar or different they are from each other. People doing music together are living life together, even in a difficult time of life. It’s a beautiful thing to witness.

Rachelle Norman, MA, MT-BC is the owner of Soundscape Music Therapy in Kansas City, MO.
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