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.
Take deep breath in. Exhale.
The relationship between music and relaxation is one that remains important over our entire lifespan. The ability for music to create calm and provide something soothing to listen to and feel is an experience most of us are familiar with, and a valuable premise in music therapy.
Whether or not a song is relaxing is up to the listener. For me, relaxing music makes me feel like time is slowing down and a sense that everything is going to be okay. The days and hours often move so quickly for me that I often crave slow and steady tempos with legato melodies to refocus on the present moment with ease. Here are a few songs that I turn to for a peaceful break in the day.
What songs or music help you feel relaxed?
I Am Light by India.Arie
F-Stop Blues by Jack Johnson
Aqueous Transmission by Incubus
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On Monday April 20th at 4pm, I’ll be the guest on MusicTherapyEd.com‘s Mindstorm Mondays webinar- and I’ll be talking about self-care for music therapists. Being a helping professional is not easy, and through my career I’ve learned that to truly provide my clients with quality care, I have to take care of myself. Your most valuable instrument is you.
Register and reserve your spot here to watch it live for free. In case you can’t make it, or if you are reading this after it aired, a recording of the webinar will be available at musictherapyed.com.
Some of the things I’ll be covering:
Why self-care is so important and how to recognize when you need it most.
How to incorporate a self-care mindset into your routines.
Strategies for self-care and maintaining a work/life balance.
Professional and personal self-care practices essential for therapists.
Creative self-care practices to help music therapists protect their relationship to music.
Why empathy puts us at risk for burnout and solutions for compassion fatigue.
Music as a metaphor for life is a common thread in my work as a music therapist. Though I implement this practice with my clients to nurture their growth, I recently had the opportunity to cultivate this concept outside of the clinical setting. This past September, I was invited to lead a 2-hour music therapy experience for a group of psychiatrists.
The Southern California Psychiatric Society has a committee called the Art of Psychiatric Medicine. This committee aims to support the artistic nature of psychiatry, and hosts events with guest artists to promote creativity and community among clinicians. I discussed with Dr. Michelle Furuta, the event’s organizer, how music therapy could support this purpose. We conceptualized a project titled, “Life as A Song: Personal Melodies and Collective Rhythms.”
On a Sunday afternoon, the group gathered to share a creative music experience. The psychiatrists in attendance brought a wide range of clinical experience, knowledge, and musical interests. I felt inspired and honored to be in the presence of these dedicated medical doctors who were taking valuable time for their personal growth, connection, and artistic exploration.
My goal for the day was to use music as a lens to enhance self-reflection and as a bond to enrich positive social connections. We used music as a metaphor to explore individual traits and roles, and to celebrate the collective rhythms present in the group. We spent time with music on a personal level. Then, we created music together.
This seven-minute video captures the essence of our 2-hour session and the product of our creative efforts. Below the video is a brief explanation of the session and process (a full step-by-step guide for the interventions are available in my e-book, The Harmony Handbook, Vol. 1).
Prior to the songwriting experience captured in the video, the session opened by first exploring the elements of music in relation to the self and others. We looked at how our individual lives can be described in musical terms…our voices as melodies, the tempos at which we move, the dynamics we emanate and prefer, the harmonies that exist within and around us, and the rhythms in our everyday lives. These elements exist in unique combinations for all of us. Our group also explored how these elements differed in personal and professional roles.
With this musical language in place, we moved into improvisation, creating music spontaneously. The freedom of expression that improvisation brings allows for a non-verbal social connection and making music for enjoyment, with openness, cooperation, and fluidity. Here, the elements of music exist in pure form, and this allowed the group a break from words before getting into songwriting.
I chose the song “Times Like These” to facilitate a songwriting experience because of its universal themes, adaptability, and form. This song is structured so well for the encouragement of songwriting to describe oneself and reflect on the present moment. Originally written and performed by the band Foo Fighters, this song is also versatile and can be played as a rock or folk song, and I have even seen adolescents turn this song into hip-hop. Our group played the original version together to get a feel for the melody and rhythm, and then each person was encouraged to write his or her own lyrics to the song.
With these new lyrics, we collectively created a group song that represented each individual and the group as a whole. As seen in the video, each person chose a part of a verse they wrote, and together we wrote a group chorus. With this, we created our own version of the song that allowed each person’s voice to be heard, and for the group to unify. Their song flowed with honesty, vision, and courage, and the support and cohesiveness of the process was powerful to witness and share.
I admired each person’s willingness to reveal their creative side, as the nature of music requires a certain level of audacity, especially in the presence of peers or colleagues. This was also out of my comfort zone, and allowed growth for me as a clinician. Though I have worked with thousands of psychiatric patients over the years, to work with their doctors was new for me. In the end, I was left with a strong sense of gratitude and validation that music therapy may not only be recognized in psychiatry, but that there are clinicians also willing to take a step in.
This day was a compelling reminder that music is not only therapeutic and beneficial for those we as practitioners define as clients. For all of us, practitioners included, music is a catalyst that awakens an awareness of who we are and why we do what we do. Music connects us to each other and to ourselves.
I remember the moment I was accepted into graduate school. And I remember what I did immediately after- I went online and looked over the curriculum of the Master of Arts in Music Therapy program at St. Mary-of-the-Woods College with fierce anticipation. I looked at this list many times before, but it suddenly transformed into a list of courses I was actually going take. Of all the courses, the one I was most excited about was called MU584: Music Psychotherapy. I took the class in the spring of 2014, and it lived up to my high expectations. I am now a better music therapist because of it.
Dr. Yasmine Iliya was my music psychotherapy professor and is a music therapist and licensed creative arts therapist in New York City. In this interview, Yasmine shares her knowledge of music psychotherapy along with her experiences in combining the art of psychotherapy with the power of music to help people with mental illnesses, grief, and homelessness.
What is music psychotherapy, and what makes it a unique approach for treating people with mental health challenges?
I define music psychotherapy as the use of music in a psychotherapeutic relationship to achieve psychosocial and emotional outcomes, such as developing insight, self-expression, and self-esteem. It makes a unique approach for treating people with mental health challenges because these are often the very improvements they are seeking. Traditional psychotherapy may leave clients feeling stuck, because perhaps the level of expression or insight did not get deep enough, or all the time spent talking keeps the therapy and progress on a cognitive rather than somatic level. The arts, and music in particular, can provide opportunities for progress that are deeper, more creative, and more somatic. Music can also be a motivating factor, so that people who may not seek other psychotherapy modalities are more open to working and playing in music. I have been working in a psychiatric hospital in Brooklyn for almost six years, and I find that music has the additional benefit of providing socialization for people with severe and persistent mental illness, like schizophrenia and bipolar disorder. Sometimes my clients may struggle with interpersonally connecting with others due to paranoia and disorganized thinking, but we can sit and play music all together, which is really unique. In talking, cognitively-oriented groups, those clients may instead remain disconnected, isolative, and withdrawn. I believe that every human being deserves the opportunity to connect, because we are all always seeking that feeling of love. We all just want to be heard and seen, and I often remind myself that music psychotherapy is doing just that most of the time.
How did you become a music therapist, and what kind of training did you go through in order to practice music psychotherapy?
The story goes that I first heard of music therapy through random google searches a few months after graduating college! I had never heard of music therapy prior to landing on the AMTA website and realizing that this was my destiny. It felt like I had been utilizing music therapy in some capacity for myself for most of my life, and I could not believe a helping profession existed where I could use music as a tool for healing. My undergraduate studies at Tufts were in Biological Psychology, and although I sang and played flute in several ensembles, I needed to learn piano, guitar, and music theory in order to become a music therapist. I worked full-time in cancer research for a couple of years in New York City while preparing to apply to New York University’s graduate music therapy program. Thankfully, after all that preparation, I was accepted and did my music therapy training there. After I graduated NYU, I did Diane Austin’s 2-year advanced vocal psychotherapy training. That kind of training was necessary to practice music psychotherapy. Supervision and experience are also key elements of ongoing training. Recently, I obtained an advanced certification from the Association of Death Education and Counseling. As a Fellow in Thanatology (Death, Dying, and Bereavement), I had to demonstrate many hours of education and research in this field, and take an exam determining my competencies as a grief therapist.
How can music influence the therapeutic process when working with people who are experiencing grief?
As part of my doctoral studies at Lesley University, I studied music’s influence on the therapeutic process when working with people who are experiencing grief. Music holds tremendous potential for grieving individuals, as it can intrinsically help facilitate the expression of emotions, which is a necessary component of grieving according to J. William Worden. I used music to help facilitate and maintain a connection between the grieving individual and the deceased person, based on new theory and research emerging in the field of thanatology. The intervention I created and studied asks individuals to improvisationally sing to their deceased loved one, and then sing back to themselves from the role of the deceased person. It has some elements of Gestalt therapy and drama therapy, and is highly influenced by Diane Austin’s method. In addition to eliciting emotion, this imaginal dialogue has the potential to allow for resolution of unresolved issues (i.e., exchanging apologies and forgiveness) and can help people move forward in their grief. I think it’s important to also add that grief is commonly overlooked and misunderstood by clinicians. Grief is not sadness, anxiety, nor trauma; it is a unique experience that can overlap with those other experiences, but needs to be understood and addressed all on its own. One of my music therapy studies with bereaved adults with mental illness will be published soon in Death Studies journal. People with mental illness have drastically higher rates of prolonged, complicated grief than people without mental illness, and this needs to be addressed by mental health professionals. Prolonged grief puts people at greater risk of suicide, cancer, and poor quality of life, overall.
You have also done work with people with mental illnesses who are homeless. How did you use music therapy when working with them? How did they respond?
I loved working with men with mental illness who are homeless. This was during my internship with Noah Shapiro, an incredible music therapist, at the largest and most well-known men’s shelter in New York City. It was a beautiful and enriching experience. Noah taught me to trust myself as a musician and to trust the process of therapy. Therefore, I used mostly improvisational methods. I played flute in the groups, and our improvisations would often continue for 30 minutes or more. I also explored the use of the voice, and wrote an article in Music Therapy Perspectives about those interventions and experiences. The men were very open and willing to try all my vocal improvisational methods! We just played using our voices. One of my clients sang about how getting a state ID helped him feel like he had an identity, and I remember feeling very moved by that. An identity! Aren’t we all searching for who we are? I felt like it was about more than just the ID card, but that he was healing and finding himself in the process of therapy, and that was a beautiful process to witness.
What is the most challenging part of your role as a music psychotherapist?
The most challenging part of my role as a music psychotherapist is being patient when people are not ready to move forward in their process. There are good reasons for these defense mechanisms; they were developed to protect us and help keep us safe. But, I often ask people, are these mechanisms still serving you? Many times the answer may seem clear to me, but the person is just not ready, and that’s what matters. Patience is key in those moments. Robert Neimeyer, a wonderful grief therapist and researcher, talks about the intersection of “Need Street” and “Readiness Boulevard.” People need to be ready to risk letting go of those mechanisms in order to really try and live healthier, more insightful lives.
What is the most rewarding part of your role as a music psychotherapist?
I think the most rewarding part of my role as a music psychotherapist is developing intimate relationships with people. The trust and connection that develops with individuals and groups within a psychotherapeutic relationship is a true privilege for me. I am often struck by the willingness and courage people have to open up, be vulnerable, and trust me. From that, I have the additional privilege of watching people unfold, grow, and gain beautiful insights about themselves. It’s an honor.
What do you love about music?
I love many things about music, but mostly I love the way music can symbolically communicate emotion. I am thinking about the philosopher Susanne Langer and her thoughts on music and symbolism. Music is incredibly powerful, and for me, the way it can help us feel and express joy, pain, and sorrow is why I love it. I also love how music is universal; it is listened to, played, enjoyed, and ritualized all over the world. It is within all of us. I love the impermanence of music, too. When we play or sing without a recording device, the magic happens in the moment, and then it’s over. That reminds me to live in the moment. Music is abstract and difficult to describe using words, which I also love. We need to feel it to understand it, and that is a welcome gift. Lastly, I am grateful to music for helping me survive many difficult times in my life, and for giving me wonderful moments of connection, joy, and love with so many people in my life.
What I love about you is YOU.