In this, our second instalment of this blog series on the ten dimensions of music care, we are focusing on Music Care Specialties. This domain refers to the many specialized fields that merge the power of music with health care. Specialized music care practices range broadly in their approaches and their training requirements. We are re-visiting this post from harp therapist Hannah Roberts Brockow. Harp therapy is one of the many music care specialties currently being used in health care settings. Hannah will be the featured Webinar presenter on February 8th – sign up for free here!
“What is willing to meet me?” This is the question the International Harp Therapy Program invites its practitioners to ask at the bedside of each and every patient. It’s a question that, in my experience as a harp therapist, sometimes has surprising answers, answers that my thinking brain may try to reject as senseless, yet that in my experience are almost always stunningly accurate.
They include…the dying man who moaned in A just after I received the odd-seeming answer that I should play A for him on the harp. When I played other notes, he became agitated; when I softly played A octaves on my harp, he relaxed and his breathing rate decreased from 20 to 14 breaths per minute.
They include the end-stage kidney disease patient who had not awakened in two days, who opened her eyes and smiled at her daughter after the answer came to me to play Chinese folk music.
They include the stoic lung cancer patient silently grappling with her own mortality, who broke down in tears after I received the answer “À la claire fontaine,” played the song and it turned out her mother used to sing that song for her.
Therapeutic harp was developed concurrently in the 1980s by Christina Tourin with the International Harp Therapy Program and Laurie Riley and the Music for Healing and Transition Program. Today, those two programs, plus a third, Harp for Healing, are certified under the auspices of the U.S.-based National Standards Board for Therapeutic Musicians.
The term “therapeutic musician” was created when vocalists and other instrumentalists became interested in playing live music at bedside in the same manner as therapeutic harp practitioners. IHTP only accepts harpists, while Harp for Healing and MHTP accept all appropriate bedside instruments. There are also a few independent training programs which are not affiliated with the NSBTM, some of which accept only harps and others of which accept other instruments.
Although it is a fairly new concept to most people, therapeutic harp has ancient roots. Historically, the harp was used for healing and to accompany the dying in Mesopotamia, Egypt and Greece, as well as medieval Europe. Therapeutic harp also has a more modern link to music therapy: The first comprehensive institutional therapy program in the United States was developed by harpist Willem Van de Wall at Allentown State Hospital in Allentown, PA.
Therapeutic music consists of offering live music to patients at bedside, customizing the music to the patient’s mood, resonant tone and breathing patterns. Different programs teach different ways of creating this prescriptive music. While Harp for Healing focuses strongly on rhythms (pulse tempo, arrhythmic) and categories of music (familiar, unfamiliar), the International Harp Therapy Program focuses on modal music and modulation. Music for Healing and Transition suggests different kinds of music for different types of patients.
Unlike music therapy, a basic certification in therapeutic music is not a degree program. It is more comparable, time-wise, to a 200-hour yoga teacher training. The student completes around 200 hours of self-guided work and a 45-hour internship, and must accrue 10 CEUs per year to maintain certification.
However, a large majority of practitioners come to the work later in life and have undergraduate and graduate degrees. Many have clinical backgrounds in such fields as nursing, social work, psychology, medicine, occupational therapy and speech therapy. Others have advanced degrees in music pedagogy and performance. My own BA is in modern languages (French, Spanish, Italian, Portuguese and German), all of which have proved to be very useful in the multilingual and multicultural hospitals I serve!
In addition to the basic NSBTM trainings in therapeutic music and the IHTP Level 2, there is an advanced therapeutic harp modality known as Vibroacoustic Harp Therapy or VAHT. A larger harp (at least 36 strings) is needed for VAHT as well as a special chair or mat through which a vibrotactile device amplifies the harp music, creating a powerful, direct and immediate effect. A basic therapeutic harp practitioner designation or equivalent training/experience is prerequisite for the training.
VAHT has a uniquely Canadian angle. In 2007, Hawkesbury General Hospital in Ontario became the first hospital in North America to offer the modality through VAHT practitioner Ian Hepburn.
Another harp-based training program which focuses solely on hospice and palliative care patients is music thanatology, which, while it uses harp along with voice to provide prescriptive music for patients, presents a different perspective and curriculum than that of therapeutic music. It’s also a degree program, one that lasts two years and includes a large focus on medical texts and terminology. It is inspired by medieval musical accompaniment of the dying practiced by monks at the l’Abbaye de Cluny in France.
Now that music therapy is happily so widely known, I find myself explaining the difference between music therapy and what I do as a therapeutic music practitioner to patients, visitors, staff and prospective employers very frequently – on an average of four times per hospital shift!
All NSBTM program graduates are required to do this when they present their work to the employers and the patients they serve. To me, it’s an opportunity to educate people and help to make therapeutic music as well known as music therapy.
I like to tell people that it’s similar to the difference between a physical therapist and a massage therapist. Both of those therapists use physical manipulation. However, a physical therapist’s work is goal-oriented and a specific treatment plan is set out. A massage therapist’s work is to promote relaxation and well-being. While the music therapist’s work is like the physical therapist’s, focusing on goals and treatment, mine is like the massage therapist’s, focusing on relaxation and well-being.
Therapeutic music as practiced by a NSBTM basic practitioner has three main purposes: to relieve pain, reduce anxiety and promote restful sleep. Because it is primarily not an interactive therapy (although IHTP does teach some interactive work), it is especially well-suited to non-verbal, autistic, memory-challenged, and comatose patients, to name but a few. The practitioner practices inclusive attention (the art of being attentive to the patient) and altering the elements of the live music she plays such as tempo, mode and key signature in response to the patient’s mood and body rhythms.
Experienced practitioners have used therapeutic music to address conditions as mysterious and sometimes frustrating as autism and fibromyalgia. Ontario VAHT practitioner Ian Hepburn in published a study in 2010 about the effects of VAHT on fibromyalgia patients. After 10 sessions of VAHT with 20 fibromyalgia patients, 10% had no benefit; 80% had benefits ranging from the elimination of constipation, improved sleep, and the reduction of pain and pain medication; 10% had a complete reduction of all symptoms up to 2 years later. Both he and Laurence Marie, my IHTP mentor and VAHT practitioner in New Brunswick, have had great results using therapeutic harp with children with ADD, ADHD, autism spectrum and OCD.
Ideally, a facility would have both music therapists (MTs) and therapeutic musicians (TMs). The two clinicians can give each other a great deal of support and a TM can often act as a handmaiden for an MT’s work by using certain music, scales or rhythms identified by the MT. I am fortunate that one of my facilities has a music therapist and we are able to share information with each other for the benefit of our shared patients. Learning from each other that a child responds well to a certain genre of music or what some of her favourite songs are can save hours of time in finding the best music to work for our respective purposes.
Therapeutic music is growing quickly in the field of hospice and palliative care, as we as a society have begun to question how we die and how we can make it a more peaceful and meaningful time, filled with quality right up to the end. It is my hope that music therapists, therapeutic musicians and music thanatologists, along with the many non-therapeutic musicians who fill common hospital spaces with their beautiful music, can walk together hand in hand as we accompany our patients with dignity, direction, purpose and grace.
National Standards Board for Therapeutic Musicians www.nsbtm.org
Harp Therapy Journal www.harptherapyjournal.com/
Hannah Roberts Brockow, CCM, is a therapeutic harp practitioner in the palliative care unit at CHUM Hôtel-Dieu, a historic general hospital in downtown Montréal, and at the children’s palliative care centre Le Phare Enfants et Familles. She is a graduate of the National Standards Board for Therapeutic Musicians-accredited (NSTBM) Harp for Healing program and currently studying in the NSBTM-accredited International Harp Therapy Program to obtain her CHTP Hospice designation, and plans to obtain her VAHT certification thereafter. Visit her online at www.hannahrobertsbrockow.com or Harp by Hannah on Facebook.