The spiritual meaning of pre-loss music therapy to bereaved caregivers of advanced cancer patients
Lucanne Magill, DA, MT-BC, University of Windsor, School of Music
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Objective: The aim of this study was to learn how music therapy sessions, held prior to the death of a loved one, impact spirituality in surviving caregivers of advanced cancer patients.
Method: The method of naturalistic inquiry was used to investigate the spiritual meaning of pre-loss music therapy sessions. Bereaved caregivers of seven different patients, who had been receiving music therapy through a home-based hospice program, participated in individual open-ended interviews. Interviews were recorded, transcribed, and coded. Themes were organized as they emerged.
Results: As caregivers reﬂected on their experiences in music therapy, they reported autonomous joy (music therapy affected the caregiver directly) and empathic joy (caregivers’ joy was based in remembering seeing the patient happy in music therapy). They also noted feelings of empowerment due to the ways they felt they had contributed in the care of the patients through music therapy. The caregivers were found to engage in processes of reﬂection that inspired these spiritual themes: reﬂection on the present (connectedness), reﬂection on the past (remembrance), and reﬂection on the future (hope). They referred to the ways that the music therapy sessions helped them ﬁnd connection with self, others (through bringing their loved ones “back to life” and have a “renewal of self ”), and the “beyond”; and that times in music therapy brought them happy memories and sentiments of hope. Meaning through lifted from remorse into heightened sense of meaning and gained “airplane views” of their lives. Signiﬁcance of results: Pre-loss music therapy can potentially assist caregivers during times of bereavement, as they retain memories of joy and empowerment, rather than memories of pain and distress, and ﬁnd meaning through transcendence.
Advanced cancer and concomitant end-of-life issues can cause heartfelt suffering in patients and their caregivers (Hebert et al., 2007). Individuals coping with these challenges may experience physical health and psychosocial difﬁculties (Cherny et al., 1994, 1996; Holland, 1998; Walsh et al., 2007), as well as dilemmas regarding faith, hope, identity, and belonging (Zabora & Loscalzo, 2002; Blinderman & Cherny, 2005; Coyle, 2006; De Faye et al., 2006). Spiritual concerns tend to play a signiﬁcant role in the lives of cancer patients and their loved ones during these periods of grief and loss (Breitbart, 2002; Sulmasy, 2002; Breitbart et al., 2004; Morita et al., 2004; Sand & Strang, 2006; Puchalski, 2007 – 2008). As spirituality is often described as a construct that goes beyond religion and is concerned with inspiration, hope, meaning, connectedness, and a transcendental way to live one’s life at a deeper level (Muldoon & King, 1995; Puchalski, 2002), it can be understood that those immersed and participating in end-stage care will inevitably face spiritual dilemmas and engage in existential inquiry. The issues surrounding caregiving in the context of advanced cancer are well addressed in the literature. It is understood that caregivers of these patients experience psychological distress, which often increases as the patient loses autonomy (Dumont et al., 2006). Likewise, caregivers endure multiple stressors and losses that complicate their lives and deplete resources for coping, particularly as they persistently witness the patient’s overall decline, detachment, potential loss of dignity (Chochinov, 2006), and struggles with existential meaning (Breitbart, 2002). Along those lines, caregivers often ﬁnd themselves in states of perceived helplessness and isolation (Payne et al., 1999), resulting from separation from the “aliveness” of their loved ones. The literature refers to the beneﬁts of premorbid psychosocial support for caregivers (Holland, 2002; Kissane et al., 2007 – 2008) and the advantages of acquiring creative measures to provide for legacy work (Chochinov et al., 2005) and life completion (Byock, 1996). Once death occurs, the process of bereavement is inﬂuenced by various factors, such as the degree of psychological preparation and preloss and post death psychosocial support (Corless, 2006). Other factors affect grief, such as the nature of the attachment, the mode of death, personality characteristics, and social factors (Worden, 2002). Supportive interventions, before and after death, have been found to potentially assuage feelings of caregiver guilt and enhance the ability to cope with the loss (Folkman, 1997; Kissane et al., 1998, 2006; Holland, 2002). Music therapy is an intervention that is used to address the multifaceted needs of cancer patients and their caregivers (Dileo & Bradt, 2005). In the care and treatment of advanced cancer patients, the music therapist holds sessions often in the presence of the caregiver(s), and it is common for caregiver(s) to witness the sessions (Hilliard, 2001; Krout, 2003; O’Callaghan, 2004; Dileo & Parker, 2005; Magill, 2006a). As caregivers experience a wide range of emotions in relation to advancing illness and as their needs are multifaceted, participation in music therapy sessions has been found to provide for a range of beneﬁts, such as opportunities for anticipatory grieving and for the acquisition of creative strategies to mitigate distressful symptoms, improve communication, and regain a sense of life’s meaning (Magill, 2001). Whereas it is understood that music therapy plays an important role in those contending with the end of life (Munro, 1984; Martin, 1991; Magill-Levreault, 1993; Salmon, 1993; Lee, 1995; Aldridge, 1999; O’Callaghan, 2001; Dileo & Loewy, 2005), the impact of this therapy on the spiritual realm in caregivers is less understood. There is little research that has speciﬁcally explored the spiritual inﬂuences of these sessions on caregivers in the period after the death of a loved one. This study, therefore, aimed to improve understanding regarding how music therapy sessions, held during the patient’s ﬁnal stages of life, impact the caregiver’s time in bereavement. It also aimed to explore the speciﬁc aspects of spirituality, as impacted by music therapy, deemed signiﬁcant by caregivers.
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The Author: Lucanne Magill, DA, MT-BC is currently Assistant Professor, Music Therapy, University of Windsor, Ontario, Canada. She was formerly the Manager of the Music Therapy Program, Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center, where she provided music therapy clinical services to patients, families and staff and coordinated hospital-wide music therapy programs. She has been working closely with cancer and palliative care patients and families for 35 years; and since 1973 and has conducted research, lectured internationally and has published numerous articles and chapters on topics relating to music therapy, cancer, pain management, spirituality and end-of-life care. She received her Doctoral degree from New York University, where she conducted research on music therapy and spirituality with patients and caregivers at Cabrini Hospice, NY. She serves as Chair of the Committee for Global Crisis Intervention, World Federation of Music Therapy.
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