by Ruth Boulton, Registered Music Therapist

I’d like to portray my recent work with a man at a Leonard Cheshire Home, for whom the Trust has provided 19 weeks of group therapy. ‘Dave’ (name changed) is middle aged, suffers from multiple sclerosis and is now living life in a wheelchair with deteriorating memory and minimal use of his hands. He was referred to music therapy due to his social isolation.

Initial sessions were difficult for Dave – he showed resistance to engage with the instruments and dismissed the idea of therapy. He did, however, come to the sessions. He had played guitar some years back, and was still a dedicated heavy rock fan. Being faced with my transportable range of instruments and piano may not have immediately appealed to him! It took some weeks, developing trust, for Dave to feel at ease enough to begin to share his thoughts and feelings. His first comment introduced what he called the ‘F word’, which he clarified as meaning ‘Frustration’. This was a constant, dominating part of Dave’s life. I wondered if one way of helping Dave understand that I was interested in his feelings was to play frustrated sounding music on the piano with jarring rhythms and clashes, which I did. The music did seem to give him direct feedback, and Dave reluctantly began to accept my attempts to acknowledge him. We explored other aspects of frustration over the weeks in the group, and what they might mean, and also if there might be another side to these powerful feelings.

he wasn’t going to be defeated even though he seemed nervous

I wanted to help Dave engage with creative ways of dealing with these feelings. I also played slower, more open-sounding music during this time which Dave responded to as ‘P.O.M. – you need peace of mind’. It seemed that Dave was beginning to reference some important resources within himself which could help alleviate the frustration. Dave was becoming more open to playing some of the instruments, and we set up an African drum comfortably positioned so that he could play. His playing was unconfident at first, but he wasn’t going to be defeated even though he seemed nervous. We improvised music together, which now also enabled us to work together, giving a context for Dave to express himself and gain support through my playing.

The music we played developed over the weeks with Dave adding a new experimental rhythm every so often across the beat, becoming generally much more grounded in his playing. He enjoyed the continuity and structure of rhythmic Latino-style music. I was gaining a stronger sense of who Dave was through his commitment to playing the drum. This gave me real insight, as Dave wasn’t able to verbally communicate much of himself and his frustration often got in the way. Playing the drum with supporting music was expressing a more intact picture of Dave. At this point, I decided to work more specifically on encouraging his physical movement, hoping that this might further enhance his mood. It was a sort of game, where he played with a beater in one hand and a shaker in the other, which might encourage his hemispheric brain crossover.

After a few minutes of this, Dave would become noticeably freer and happier which made me wonder if parts of his brain had gone to sleep through under stimulation, and were now re-awakening. He spoke of ‘P.M.A. – positive mental attitude’, which I felt reflected this shift clearly. We were also still playing our previous music through which Dave had developed a more subtle quality and gained more flexibility to changes in my music. The endings of the pieces had now begun to take on significance and there were times when they were intuitively synchronised, but also times when they felt unconfident and anxious. Around this point in the therapy I needed to introduce the ending stage of the therapy to Dave, so that he could process his feelings about our relationship ending too. He needed these weeks to express some of his annoyance and feelings of rejection. Ambivalent feelings of loss and gain came into sharp focus over these sessions. I was uncomfortably reminded of the reasons for Dave’s initial referral, and that he would soon experience time without the now immediate interaction the therapy was able to provide. I struggled with this, but was partly reassured to discover that Dave’s interactions with other staff had noticeably been improving of late, and his annual review meeting had confirmed these changes as relating to his therapy.

In our penultimate piece, Dave clung on to the music, wanting it to carry on without ending. This seemed a powerful communication of his commitment to, and trust in the music, which he wanted to hold on to. His therapy had had 19 weeks to develop, and had come a long way. It was therefore a lot to give up. Our final piece celebrated this journey in a guitar song with the words: ‘We’re here today to celebrate the things we really want to say’. This seemed a genuine acknowledgement of the process the therapy had enabled for Dave, and the sense of having arrived at this point together. The piece ended with a large, shared crescendo to its cadence.

we’re here today to celebrate
the things we really want to say

My hope is that the transforming musical relationship Dave engaged with in his therapy will remain in his internal, conscious or unconscious memory, and that these experiences will in some way be able to influence the quality of his life as he copes with the next stages of his progressive illness.