Episode 11: Music in Hospice and Palliative Care (with Amy Clements-Cortes, PhD, RP, MT-BC, MTA)

Podcast
Written By Marisa de Leon, MS, MT-BC

In this episode, we sit down with Dr. Amy Clements-Cortes to explore the powerful role music plays at the end of life. We’ll discuss how music therapy can bring comfort, connection, and dignity to individuals receiving hospice and palliative care - often creating moments of profound meaning for patients, families, and clinicians alike. Together, we delve into the therapeutic processes that guide her work, the emotional landscape of supporting people during life’s final chapter, and the ways these experiences continue to shape our professional and personal outlook. We also discuss her contributions to the growing body of literature in this field, including the research and writings that are helping to expand understanding and elevate best practices in music therapy. This episode offers an intimate, insightful look at how music can ease transitions, honor life stories, and create space for humanity when it’s needed most.

About Amy Clements-Cortes

Amy is an Associate Professor in the Faculty of Music at the University of Toronto, a credentialed Music Therapist, Registered Psychotherapist and a Fellow in the Bonny Method of Guided Imagery and Music, and Neurologic Music Therapy. She has extensive clinical experience working with clients across the life span, with a specialty in mental health, dementia, and palliative care. Her teaching, clinical work and research aims to recognize power imbalances, redress them, and practice cultural responsiveness from a music psychotherapy approach that does not centre Eurocentric standards but reflects cultural, community and social justice. Her research contributions have had a significant impact in the understanding of understudied phenomenon, resulting in excelled treatments provided by professionals in music and medicine. This includes: relationship completion for individuals at end-of-life, vibroacoustic therapy and singing protocols for persons diagnosed with dementia, as well as experiences in music therapy internships. She is the Managing Editor of the Music and Medicine Journal and Research and Ethics Chair of the World Federation of Music Therapy (WFMT).

Episode Resources

Transcript:

This transcript was computer generated and might contain errors.

Marisa: Hello everyone and welcome to Musical Mindspace. I’m so grateful to be sharing another episode of this podcast with you today.

For those of you who have been following our podcast, thank you for the support you’ve shown in our last episodes. Before this, we talked about the power of vocal psychotherapy and the psychology of singing with the lovely Kelly Meashey.

I’m sure I’ve said this before, but having the opportunity to speak to incredible music therapists has been such an inspiring experience and it makes me want to continue recording and interviewing more people in the field. 

It’s also wonderful to connect with, not just music therapists, but also musicians and avid listeners and share with them the insight that we have being in our field. Music has so much to offer and I feel like, in every episode, we’re just peeling back layers of it. 

This episode explores the profound role of music therapy in palliative and hospice care. We'll hear firsthand about what it means to use music to provide comfort, connection, and dignity at the end of life, and how these experiences shape not only professional practice but also personal perspective. We'll also dive into the process of contributing to the growing body of literature in this area.

Today’s guest is Amy Clements-Cortes. Amy is an Associate Professor in the Faculty of Music at the University of Toronto, a credentialed Music Therapist, Registered Psychotherapist and a Fellow in the Bonny Method of Guided Imagery and Music, and Neurologic Music Therapy. 

She has extensive clinical experience working with clients across the life span, with a specialty in mental health, dementia, and palliative care. Her teaching, clinical work and research aims to recognize power imbalances, redress them, and practice cultural responsiveness from a music psychotherapy approach that does not centre Eurocentric standards but reflects cultural, community and social justice. 

Her research contributions have had a significant impact in the understanding of understudied phenomenon, resulting in excelled treatments provided by professionals in music and medicine. This includes: relationship completion for individuals at end-of-life, vibroacoustic therapy and singing protocols for persons diagnosed with dementia, as well as experiences in music therapy internships. She is the Managing Editor of the Music and Medicine Journal and Research and Ethics Chair of the World Federation of Music Therapy (WFMT).

I have personally been reading Amy’s work for many years and I’m so excited to meet her and share a conversation with her for this episode. 

So, without any further ado, here’s what is on our mindspace today…this is episode 11…music in hospice and palliative care. 

Marisa: Hello everybody and welcome back to Musical Mindspace. I'm so excited to get into this episode today and talk um more in depth about music therapy and music specifically in the context of hospice care and palliative care.

In today's episode, like we mentioned in the intro, we are so so grateful to welcome Amy Clements-Cortes to our podcast to share more about her research specifically in hospice care. although you have research in so many areas of music therapy which is just wonderful to see. So welcome. Thank you for being here today.

Amy: Thank you so much, Marisa. I'm very excited to be here to talk to your audience.

Marisa: You know, part of this podcast we've been you know over the last few episodes I believe this is the 11th one now somehow. And each one has talked about a different area of music - music and social health, music and the brain, um music elements.

It's been a lot of different aspects of music, but this is one that I feel like we have um yet to touch yet. And it's one of the ones that I think um is a little bit…there's not as much discussion about it sometimes in the field or at least specifically here in Texas. You know, I see personally a lot of advocacy with, you know, intellectual disabilities, music therapy and autism. This just our region, you know, I know it's different, you know, in different pockets of the world and here in the United States even, it's very regional, but you know, we don't talk as much here about hospice, about palliative care.

Amy: Yeah, but definitely I would have to say that um the practice of music therapy in palliative care really does vary internationally and I'm I mean I'm so fortunate to have colleagues in many different parts of the world and so to have learned about how music therapy and music-based interventions are being used to support people at end of life.

In Canada where I'm from, there is a small number of music therapists that provide palliative care services. I would say that it's increasing a little bit given just the expansion of palliative care kind of services within long-term care settings. Right?

So, not only in specialized locations where palliative care can be provided but also thinking about palliative care now being provided in long-term care homes for people as they enter their last days. But we definitely uh you know the research and the statistics show that, you know, the number of people that could benefit from music therapy in this context are not you know receiving or being offered services many times due to funding right.

Marisa: Yeah, that's our our ever present challenge, I think, as a music therapist is it's funding. I was so fortunate when I was first starting music therapy and I was, you know, doing… I was a student doing my undergrad, eight, nine, ten years ago. I don't know. Tt feels like a long time ago now a lifetime ago now. You know, I went through different settings and and palliative care is always one that I felt very connected to and I was so fortunate to do my internship all specifically in hospice and they had a nonprofit and they they had you know a lot of um resources with like Russell Hilliard and, you know, just had a really good foundation of of hospice music therapy and I was just so…it was just such a life-changing experience I think at that point in my practice to see music therapy. It's almost a different lens and now I tell my students and for those listening that aren't too familiar with it music therapy in that context is almost the only setting that it's not so rehabilitative focused, you know, and it's more comfort and and quality of life and connection and meaning and support. It's kind of a shift in practice.

Amy: Yeah.  Well, definitely like that term palliation, right? The idea is that we're supporting people and providing comfort measures really so a lot of my work has…well I didn't think, you know, when I graduated a number of years ago and started working I began working with older adults and other populations and I didn't think right off the bat palliative care. It was not as practiced in Canada; although, we are so fortunate that in Montreal Dr. Deborah Salmon really was instrumental in laying the field about music therapy work in palliative care.

It wasn't really practiced as much when I began working and so when I began working in palliative care I looked to the literature and I looked to the research and a lot of it it was about symptom management and music therapy demonstrating efficacy at supporting people with pain management and some of the other symptoms common at end of life. And then I, you know, I this power and the ability of music to be able to help people express emotions, and bring them to the surface. And so I was so fortunate to do that work and that really led me to where I've spent a lot of time, which is relationship completion and looking at how we can use music to help people complete relationships.

So it doesn't mean that the relationship has come to an end or it's stopped. It means that you've expressed important sentiments to someone like I love you, thank you. And those can be done so significantly and have like that much more impact when they're done musically.

And so I've been so privileged to do that work with a number of people - completing relationships with themselves, with other people, with transpersonal or spiritual relationships, with the land, with nature. And walking alongside people really, it's it's an honor and privilege to be able to do that work.

Marisa: I'm excited just hearing about it already. Um, and I'm so excited to to talk a little deeper about it. And I'm wondering before we begin for those listening that that maybe haven't met you yet, you know, can you tell us too a little bit about your clinical work and um you know, how you got involved with with palliative care, end of life care.

Amy: Yeah. So, I always wanted to to do something with music in my life and uh you know, I thought maybe I'd be a performer, but it wasn't calling me to that degree. And so I was so fortunate to do a co-op placement in high school and to do kind of recreational music mostly, but I did observe a music therapist and work with one, one day a week and that was in dementia care. And I knew right away that this was the career for me. Like I I saw the impact. So a lot of my clinical work has also been in dementia care. Um and so my focus has really been split between palliatuve and dementia care.

Um and I was very fortunate upon uh completing uh my internship to start working in a large hospital which also had a whole complex of services for older adults. So, I worked in rehab, I worked in long-term care home, dementia support. I worked with persons recovering from stroke, Parkinson's patients, behavior neurology, so really complicated behavioral and psychological symptoms of dementia. I worked in mental health settings and also palliative.

So, I was so fortunate in that setting to have many different experiences and I just-I really just enjoyed. I loved working in all the areas. I don't know that I really had favorites. I just I really enjoyed being able to see how music could support people with the different things that they presented with. And so my focus has never been so much on the diagnosis that people come with, but rather the presenting issues like what's important to them. How do they see and perceive therapy? And what is it that they need out of this therapeutic experience?

Marisa: I think that's one of the joys of music therapy. And just like one of the biggest tools that we have in music is that it is so diverse and it really can just reach so many people for so many different reasons and it, you know, it's just so powerful for so many, for so many people. Um, and you know, as I think about, you know, I was looking at some of your research, you know, again, in preparation, um, for this episode, and as you were saying that, you know, it made sense to me when I was looking at your Orchid ID especially, and I'll put a link to that for anybody who's interested. Um, you know, it is so diverse. It really is. You have over I think 39 publications listed along with other funding opportunities and it is in a lot of different settings which I think is just really wonderful really wonderful to see.

Amy: Yeah, I really I have been very fortunate to um, you know as a music therapy um instructor as well and supervisor, you know I I'm privileged to also go with students into a variety of different settings and a lot them happen with older adults, but again, they've been with persons across the lifespan, including the neonatal intensive care unit. And and I've also privileged to have done, you know, advanced trainings in things like, NICU, um, also neurologic music therapy and, the Bonnie Method of Guided Imagery and Music. So, that's really expanded as well who I've worked with.

And um yeah, I mean I think it's really important as a clinician that like when we're doing research that we're still doing clinical work. I think that's really kept me fresh and really excited. A lot of my clinical research questions have come from being in the field and wanting to understand things that are happening and so when I I did some really intense work in palliative care and research and then I took a little break for a little while and I started working and doing some research looking at the benefits of singing for health and wellness and I've come back of course in woven in and so I'm still involved in that research as well. That's kept me really charged too is to be able to to have my foot in in some different areas as well.

Marisa: Yeah. Yeah. Just makes us very well-rounded, prepared for anything. Yeah. Well, you know, one of the things um that really called me to have you also as a guest on this topic specifically is that you wrote or co-authored, co-edited two books I believe about hospice and palliative care. One about relationship completion as you mentioned and I'm hoping we can talk a little bit about that. And the second one, this is Voices of of the Bereaved and the dying, right? Music therapy narratives. And I'll put links for those two as well for for anybody who wants to learn more about that.

Can you tell me a little bit about the the process of of writing those of publishing those of you know working with others to create those publications?

Amy: For sure. So the first one, “the Voices of the Dying and Bereaved” is with my dear colleague Sara Klinck and she takes the focus talking about bereavement and music therapy and I take the focus on working with those that are dying.  

So the first part of that is really kind of like looking…it's like a narrative review of the literature that supports why we're using music in palliative and bereavement settings and the themes that arose from that. Right? So, really that music I guess the big takeaway from that really is that music can support persons holistically right and so it has an impact in all the areas and sometimes those more psychosocial issues are not as addressed by other health care professionals at end of life, and not because they - it's merely a time thing, you know. I think there there's a lack of resources and many health care professionals are their case loads are far too big and so sometimes the physical symptomatology is what receives attention and that's necessary.

So the focus on this book is really presenting case studies as well to really augment what it is, you know ,because I do believe when you delve into some specific cases, you really see how music therapy can have an impact and you get into the different techniques that have had an impact and you see the stories. That's always been my big thing in writing in palliative care and all areas of research. I really want the voice of the participant there. It's not about the researcher and my interpretation. I really want it to be driven from the participant. And so I'm very much about co-designed research about participatory action and narrative methodologies. So the case studies in that book I think illuminate the experience of those persons and it's lovely and honor that they they you know allow us to you know publish and talk about their cases.

The second book and I must say that the bereavement chapters Sara also presents a model of bereavement care in music therapy. So that's really helpful for people newer to that area.

The second book is a inspiration that came to me that you know I was doing this work in palliative care and doing relationship completion and talking a lot about it and uh people were asking me about the work and I wrote a number of case studies and then it really dawned on me that we need some guidelines right? People, music therapists, wanted to better understand how they could maybe it do this work and so I'm so fortunate. I assembled a group of international colleagues that work in this area and researchers and clinicians and together we compiled this text on the guidelines for relationship completion.

So it really is a lay of the land of music that supports this type of work and how we go about it. But then there's also specific chapters that talk about how we use receptive methods to do this, how we use compositional methods. So it's really, it's a very practical book I would say. Um the other one is more narrative, also practical, but they're a little bit different maybe in terms of who the audience is for those.

And then just this past it's just actually come out that I've authored - co-authored a couple of chapters - one with Dr. O’Callaghan in the new Wheeler textbook on music therapy and palliative care. So that's the music therapy handbook. So we talk about music therapy at end of life. Um, so that's Wheeler, Viega, and Dos Santos that are the editors of that. And then I've also co-authored again with my close colleague Sara Klinck and Joyce Yip, who is one of the editors of, the relationship completion book. And we've done a review of the literature, and that's also just published in 2025. So really staying on top of all the developments in the field as well.

Marisa: I think that's amazing honestly to to cover so many aspects of what music therapy looks like in this setting both for the music therapist but then also sharing the stories and the voices and the lives of the people that we work with. Um, I think that that is so important. I've been doing I for context here, I work here along the Texas Mexico border. I've lived here my whole life. Um, and similarly there, you know, when I started, there wasn't a whole lot of research or a whole lot of literature about, you know, working with Mexican-Americans. And so, you know it focusing on their stories on the lived experience I think just gives also so much context and so much meaning to music, you know, beyond the goal and which is so important still but I think there's a different level of when you get into more of the meaning you know and what does it mean to them because at the end of the day you know they're the ones that experience this and they're the ones that live it… that live through the the music and and live through these you know various life experiences depending on why they come to music therapy and sharing their stories has just been incredibly meaningful. So it's just so lovely to when I saw it and you know when I was reading through it was just so so beautiful to see and so beautifully written as well.

Amy: Well, really the the inspiration I mean a lot of the direct words come from the actual participants. Umm you know, when you can record you have that permission from them to record and transcribe audio from your sessions then you have, your direct words that are representing them.

Marisa: Yeah. It’s so powerful, you know. And along that in that book “The Voices of the Dying and Bereaved”, you mentioned and I think you touched on them earlier too as as you were, you know, explaining a few things but you talk about that themes of practice and that was something I really wanted to to kind of go a little deeper in today for those who are maybe new to hospice care, new to palliative care, and are looking to understand how music can shape different experiences in terms of social and cognitive health. I know you talk about physical health, you talk about spiritual health also. Um and so maybe we can talk a little bit about those emergent themes that um you mentioned in that book as well. I know you talk about that physical, psychosocial and then also spiritual and whole person as you call it. Can you tell us a little bit about those as well?

Amy: Yeah. So I really I mean, when we were looking at the literature um it was showing that music therapy was helpful in terms of physical support. So helping people with issues like pain, also things like anxiety, nausea, many symptoms that are common at end of life. But then it was also helpful in terms of the psychosocial. So offering opportunities for fostering that emotional connection, fostering social interaction, you know, helping people uh really um I guess connect with others really at such an important, you know ,time and so um really at end of life, relationships are significant and not only relationships with those that we've had a long time with, but also like healthcare providers that are providing such intimate care at end of life and so relationships can really provide a sense of support for people but they can also, you know when relationships are challenged can also cause anxiety and concern.

So music has the ability to also support that. And then in that last theme, this idea that, you know, we're not, you know, sometimes that medical model really treats people like this is your this is the pain. You know, you've got pain, that's your problem. And they don't look it doesn't necessarily look for the underlying cause of the issue. And it's not a fault to the model. It's, you know, that's kind of when you go to the emergency room, for example, like that's what their capacity is, but it doesn't get to this root. And music therapy has the ability to support someone holistically and not, you know, put someone in a in these little categories, but to think about your pain is not necessarily just a physical thing, but it's also existential and psychosocial. And so, I think that's kind of where that last theme came in. and the ability to transform at end of life, you know, the ability to to forgive oneself, to forgive others, to reassess spiritual relationships.

It's really quite significant the work that sometimes is done in a very short amount of time if people desire it and their psyche is there. And so I do feel really blessed that I've done the Bonnie Method of Guided Imagery and Music training because I've done some sessions in palliative using an adapted Bonnie method and that's been really helpful for people that have experienced some significant trauma and other issues that that they want to work through but don't necessarily have a lot of time to do that. And so, I guess you know that also kind of fits into that last theme of holistic care.

Marisa: Yeah. Absolutely. I feel like and I kind of said this earlier and I'll say it again because I think it's so important. Music therapy is so diverse. Um, and that just makes it such an incredible tool especially when we're talking about holistic care because we really can pull from, you know, different techniques and different interventions and, it just gives us so many opportunities to touch on so many goals and I'm going to read a few of them here that are, listed in the book.

You have, you know, decreasing blood pressure, respiratory rate, heart rate, pain perception, anxiety, fatigue, increasing energy, decreasing discomfort. I mean the list goes on. Lessening nausea as more of you know the physical side, tension, pain, physical comfort.

Um the list just goes on, you know, it really really does. And then even when we get more into relaxation, we're still talking about, you know, heart rate, but we're talking about also anxiety, preparation for, you know, um, what do they call it? Um, like procedural work. I remember doing that as well and in hospice while they're bathing, especially particularly for maybe like, as an example, Alzheimer's patients who were combative during, you know, during bathing and things, you know, the music just helped so much. I'm thinking of them as I read through that relaxation, you know, section and I saw the music make such a difference for them and even emotionally.

You have, you discuss a lot of things in the chapter about social interaction and and self-expression and emotional expression, releasing painful emotions and coping. And I think coping with loss, coping with grief, anticipatory grief, you know, all of these things are such strong needs. Um, and it's such an I think in hospice particularly, but you know, in any end of life context, too.

Um, there's so it's such a powerful time, such a unique time. Um, and there's so much happening, I think, especially in those last few months. Um, there's a lot to take in. There's a lot to come to terms with. Um, there's a lot to accept. There's a lot to grieve. um as someone who's lost many you know family members in my life particularly ones that were very close to me, I just I know I've seen it from you know the patient and family side and then I've seen it also in my clinical work and it's just it can be very heavy but at the same time it this work is so beautiful in how it can facilitate you know those conversations and how it can really just you even shape how they view, you know, death and dying and how they, you know, step into those therapeutic spaces.

Um, I just it shapes everything. I'm thinking about all of them, you know, as you were saying that I'm thinking about, you know, reflecting on all of those experiences.

Amy: Right and, you know sometimes people ask me you know, “How can you do this work?” and how “Is isn't it depressing?” or “Isn't it difficult?” and I don't find it depressing but I'm not going to
know, sometimes people that it's not difficult and it's not difficult in that you know, I don't want to do it it's I think you when you're truly present with people, it is heavy.

Those emotions, you know, sometimes impact us and uh we're human. And I think that's also what makes a good therapist is sometimes, you know, we do feel along with people and they take us on these journeys with them at very vulnerable times and reveal very deep important things they may not not have ever told anyone else. And that really that's a lot to to to be privileged to be with but also as a responsibility

And I too have lost many family members as well close to me and it does I mean you do see the different sides, you know, of being umthe bereaved right and also being one that supports those and those that are going through and looking at anticipatory grief and grieving their own losses. Um, and I don't know that it it gets easier.

I think, you know, people say, "Well, it must get easier or you dull your senses." And I don't know that that’s it. I think, you know, I have my own rituals that, um, when someone dies that I've used that support me and saying goodbye to them. Um, so honoring that time. Um, and I really I go into the experience always desiring to learn what they, you know, what they need from the experience, but also like how do they view death and dying? And I have to say, I've been so privileged to like just to learn about so many different views and the way that people choose to come to the final days.

And it really is about me being curious about that and seeing how I can possibly support anything at that stage. So really, I don't think it's, I think it's really rich work but it is it is deep work and you do need to be fully present I think to be an effective therapist in that space.

Marisa Absolutely. I remember when I was preparing to do my internship in hospice, I was kind of just looking for resources locally. I was I'm in South, deep south Texas like 10 minutes from the border of Mexico and we cross you know frequently. Um, but I was moving to Tallahassee to do that from I studied in Denton in North Texas, came back home and then was preparing to go to Tallahassee and I was just looking for resources because I was thinking, you know I think this is what's calling me but I also feel like I'm going to need some support and resources to do this because of just the you know intensity of the space for them in those especially in those you know final moments.

And one of the local hospitals had a program called No One Dies Alone and they do vigils of employees. They sign up and for I think 48 hours once they know that someone's imminent. They'll actually have like a rotation. They sign up all the employees and they sit with them for an hour, two hours, any time that they could give so that they're there, you know, the whole time.

And I went and did that, just because kind of like an introductory experience and the person that ran the program, I remember him telling me “You know it doesn't get easier but we do have resources” and we do learn doing the work we we learn more about ourselves and about how we think about death how we understand life and that was one thing that really always stuck with me. We have the resources to to cope and to recharge and to renew ourselves after every loss that we experience. And that was just something I never really forgot, I think, working in that setting.

Amy: I think you know it speaks to mean supervision right and I'm not solely you know having formal supervisor I mean sometimes people do that though they connect with someone, you know, once a year, right? Um that people that have been working for a long time, but but even a peer support network for those that work in this space can be really helpful.

You know, just to talk with other colleagues that have been doing the work for a long time, and sometimes music therapists are fortunate that in the setting they're in, there is like debriefing that can happen or within the team, but many unfortunately are not privileged to that because they're on contract. So, they go in to do a limited amount of service and they're not actually part of a team. Um, well, they're part of the team, but they're not part of like any formal debriefing or opportunity to kind of talk about those processes.

And so it is important to have whatever method works for you. And I think sometimes we I talk a lot about self-care when I'm teaching and self-care really looks different to everyone.

It has to work for you. And um I think so you know sometimes we laugh about you know as students you know we laugh about well, that you know this kind of generalized idea of well you know you take a bubble bath and you you know, you tune out the world and you know maybe that works for someone that's certainly not going to work for me and I have found my own way of self-care and I so I really encourage that for the music therapists listening but also any caregivers that are listening you know to also have your own um way of of providing care for yourself.

Marisa: Yeah. Oh, definitely. Definitely. That support is is everything. Um it can be make and break sometimes I think in those moments of burnout that we experience, you know.

Um and you know, you talked a little bit about, you know, rituals as well. And I think one thing that kind of came up for me is just being here in in such a Mexican-American community, you know, being a part of the community and the culture myself. Um, one thing that's been interesting now, you know, something looking back, you know, from those days in my internship and focusing on practice here in palliative care is so different.

And you said something earlier that reminds me of that too. It's so regional. It's so cultural how we, you know, conceptualize death and dying. And um, here we do Dia de Muertos (Day of the Dead) and that's been like a really powerful thing for us lately here in our team. We've been doing it every year and, you know, at first we would do family members we put them on the ofrena and you know share their stories and kind of bereavement for us.

And then slowly as the community started to participate more and now we have a few clients that go on our ofrenda and their families come and put their picture their musical instruments on the altar and seeing you know that side of it now too of of how the family even becomes a part of those rituals for us and how we continue to honor their lives after and and even musically like you know putting their instruments there singing their favorite songs. Um, it's just been such a such a beautiful experience and something that I think really helps us as a team to to cope every year and just where it's like a like a check-in of like, okay, it's time again, you know.

Amy: Yeah.

Marisa: It's just been really really meaningful and I I imagine it's probably different in Canada than in the United States than, you know, in the Mexican community. And so everybody has their own um rituals in coping with with these experiences.

Amy: For sure. I mean you know some of my colleagues in other parts of the world you know palliative of care services are more prominent in the home so people going into the home and that does happen here but it's really not as prominent you know a practice I would love to see more of that um so it really, you know, sometimes unfortunately as I mentioned before like it does come down to where funding is provided and also but also like how the community views death and dying can also impact where um things take place and and rituals and other around that a topic um, you know, that we haven't actually gotten into which again really varies considerably around the world is physician assisted suicide and in Canada known as medical assistance in dying and music therapy is playing an increased role in that in being able to support people.that are preparing for that procedure or even during that during that procedure.

And then there's also just the long-standing application where music therapists are often asked to perform music at funerals or other celebration of life services. And so a lot of times the music we create with clients, songs and significant songs to them sometimes go on tribute websites and they become legacy gifts which I think again is so wonderful that the work lives on.

And Brian Shrek in the United States has done some amazing work um with heartbeat recordings and that practice is really just taking off considerably around the globe and uh that's another wonderful area for your listeners to have a check into.

Marisa: Yeah. Can you tell us a little bit about them, what they are, and what's included in the heartbeat recordings for anybody not familiar?

Amy: Yeah. So essentially, you know the heartbeat of the person that's that's dying is is taken is recorded and then it really varies in terms of the practice but that heartbeat is set to original music or it's put into music that is preferred, you know, pre-composed, preferred music.

And then that can become, you know, a gift right for the family or it can be used in various ways that tool perhaps for discussion, relationship completion, just emotional expression. But it's a really lovely I think practice in terms of a legacy gift.

I myself have done a lot of songwriting with patients where you know they're writing songs to say thank you, to say I love you, to sometimes chronicle their illness trajectory or other topic.

And then those songs can sometimes be recorded and given to the family if they desire. Sometimes those songs have been played at memorial services. I've composed, compiled auto musical autobiographies with people looking at significant music from different parts of their lives. So doing a life review.

I think you know music can really be part of of helping people and you know work through some of the losses they're anticipating as well, right? So that anticipatory grieving and then I guess yeah, grieving the loss is inherent in death. So grieving not being able to see grandchildren get married or perhaps not making it to a significant anniversary. And music can sometimes be used to help support processing that as well.

Marisa:  Absolutely. Heartbeat recordings, I think, are one of the more emotional ones for me personally. Um, and I they're just so beautiful. I really enjoy being able to do them. And you know, for any music therapist listening, you know, our team DIYed one. We just we bought a stethoscope and cut the tube and stuck a little baby condenser mic in it and have been able to get some, you know, pretty pretty decent recordings for, you know, a lower cost.

And the families just are always, I think, um, that's just such a unique experience to have and then to to place it onto the music. It's just it's so powerful, so beautiful. Um, and I'm wondering now that we're kind of getting more into the intervention sides of things and what music therapy really looks like in terms of the session and maybe even just like the trajectory, the disease progression.

Could you share a little bit about what some of your sessions look like and I know you mentioned a few interventions just now. Um, but can you walk us through maybe what what would that look like for a client receiving music therapy?

Amy: Yeah. So, palliative care is, you know, so different. You never know what you're going to walk into. I think I mean that's often with many clients, right? And we don't want to come with assumptions, but sometimes I only, you know, you might only work with someone one time. It's your single session and um other times you have a series of sessions oftentimes not knowing exactly how many you're going to have, right?

So, you know, a single session might be very supportive like it might be more receptive things that are happening. So more of the therapist playing um music that's maybe indicated. Um sometimes it can be improvised music as well. Uh I know that I've used improvisation to chant people's names to chant different kind of meditations with them.

For someone that maybe is a bit more in the unconscious stage at you know that's closer to end of life, it can be that family are often present. So people, music therapy doesn't only involve the individual. Um it can also involve family and that creates a different uh dynamic and way of working as well, right? Um in terms of being able to support your patient, but then also if they desire family with them. And so it can be that the music therapist facilitates opportunities for them to interact musically with each other.

And that could involve anywhere from singing to actually dancing and moving with someone that's in the bed and just moving their arms. It could be relaxation experiences. So that really varies. Could be playing instruments and improvising together.

And then someone that really desires it and has you know the energy once their physical symptoms are somewhat managed then that that sometimes the work can get deeper. So the there's a model of music therapy that Dillio and Denister put out in 2005 which just talks about different levels of practice. So at the supportive level, at the communicative expressive, and the transformative.

So the supportive level is really about supporting people's you know their main symptoms. So providing support for pain or anxiety. And then at the communicative express of the idea is that music's going to help bring those emotions to the surface. And that can be done with lots of different techniques. It could be lyric analysis and discussion. It could be songwriting. Um, it could be improvisation that brings those to the surface or instrument playing. Um, and so that's kind of the idea there being to express emotions, and talk about the experience and interact.

And then at the transformative level which is their third level of practice. It can be about these more, these different explorations of a lot of times people have spiritual, existential questions they want to explore. They might want to complete relationships. They want they may want to be asking for forgiveness. Um and so that kind of happens at that level.

And that's a number again of different techniques that that can activate that. Um, I found that songwriting again is really important in that work. And musical autobiographies where you're doing life review through music. So really it's, it's being open to what that person desires.

And I think there's also a place for, you know, we're also fortunate that music- based interventions, so not solely music therapy that people can participate in, but I also think there's a lot of value in music- based interventions supporting people at end of life as well. So, um, you know, there's things such as bedside choirs that come and sing to people that are actively dying or that are close to dying. Um, and then also for a music therapist, I mean that's also sometimes what we're doing is actively supporting someone as they transition from this space to the next. And that often is uh, you know, involving, you know, improvised music or music that we know if we know as the music therapist um, that is significant to them that I mean maybe even they've expressed the music they desire to hear if you're fortunate enough to have had that conversation.

And that's often involves family members being present too, being there. One that sticks out to me, with, I was providing music therapy in the room beside this room where there was an active, a person was actively dying, and the two daughters heard me and came and found me um and said, "Could I come and provide music?" And I walked into the space not knowing that the person was actively dying. And so we sang together.

Marisa: Wow.

Amy: They indicated that, you know, they wanted hymns. So it was acappella. I held their hands and we sang some hymns and that the person died and transitioned and so sometimes you don't know what the work is going to be like.

But I found the voice so important in this context - probably the most, I would say that for me, it's been the most significant instrument - for its ability to reach people for its its connection. I think and maybe I'm a singer so I'm biased but I use lots of instruments but I really find the voice is something that connects with people at that stage.

Marisa: Yeah. Yeah, I can definitely see how significant the voice can be. Yeah, in just hearing what you describe, too. I just love hearing different experiences, in these settings especially. And I know one question that we're going to get or some people might be thinking already is, well, what kind of music is used? I know that's one of the biggest questions we get as music therapists, but specifically in this setting, you describe different types of music. Um can you tell us a little bit about, you know, what music what music would it be?

Amy: It's such a great question. I mean, in all the context, what should we be using, you know, like and of course in music therapy, the music therapy audience will know that, you know, there's so many different approaches and thoughts.

For me, I do believe that preferred music is really important. Um, and so I try to find out what people's preferred music is. Um, and part of my thinking behind that is that music connects us to identity. It's part of life's journey. So, um, you know, if I love a particular song, it might help me feel more like Amy. You know, I we we we do we connect and those memories can be very intact along the lifespan.

So I do think preferred music is really helpful but also there's a lot of improvised music especially if I don't know you know someone's music and I don't want to make assumptions. Um, and at times I mean a lot most of it is live, but there's also been times where it's been recorded music and that's to ensure that I'm not, you know, creating, recreating music in a poor way that maybe is something that's maybe more difficult in a genre or culture that I'm not as familiar with. So, it might involve using recorded music.

And then there's also times when um, a person wants to hear an original artist. And I totally get that. You know, if you love the voice of, you know, a particular singer or artist, then there is value in in hearing that and and singing um or, you know, singing along, listening, etc. So, it's really difficult, I could never answer this question. I think you try to take your cue, you know.

And then there's always the patients that are you know so so lovely, you know, in terms of like whatever you want to play and, you know and so you know there are definitely songs that are, you know, that I've used many times in that space that I think are a little bit more comforting but again we must never assume that what I think, you know, what we think is like comforting or relaxing is like maybe you like heavy metal and that's your comfort music and I do think you know people would be surprised by sometimes the music that people like. So, you know, I really do encourage people to like write down some songs that are significant to you so that your family can know in case you you don't.

And that's a whole different topic, but I'm a really big advocate for you know, older adults having a music care plan, you know, when they go into long-term care, so that perhaps down the road if they aren't able to tell us, we have somewhere to at least start from in music that's been important to you.

Marisa: Yeah. Yeah. It's funny that you say that with metal. I remember um just when I started doing the work and, you know, people naturally ask oh so you miss sing a lot of spiritual music and yeah of course I do I mean that's you know that's a given and that's so powerful in those moments, but there was several clients that I had I'm thinking of this one older lady who was probably like 95 at the time and her family was like, I you know, I walked in and they had candles you know she was imminent, expected to pass in the next day or two, and they had candles all around her room and I remember thinking, "Wow, this is, you know, a serene environment."

And I get there and I'm talking to them about what music they want. And they were like Metallica, Guns and Roses. And then they started listing like a bunch of metal bands and I was like, "Oh, absolutely." You know, and that's what she was known for. She was known for driving around listening to really heavy metal and yelling at people and you know talking about that kind of music and that's what they thought she would want and that's what they wanted to hear also to say goodbye to her and to remember her as she you know was to them in those memories, and so yeah, you know, you never you really never know and I remember yeah I remember just that being a big lesson moment you know for me. Yeah.

Amy: Yeah. And yeah, and so important that you honor that, right?
I think that's what makes a true therapist present, right? because I mean you could just go in and you know say okay I'm here to provide some music and start playing something that that isn't congruent and probably they're still you know thankful for it but I think that's where the skill comes in being able to go with what you know comes and that's why as music therapists we must continue to learn new music all the time. Try to you know improvise in different styles so that we're just constantly building our skill set.

Marisa: Yeah. And as you mentioned, you know, music is so important throughout our lives. I don't know how many times, countless times I've heard now, you know, “Oh yeah, well, that song reminds me of this point in my life” or “That song? Oh, yeah. Immediately I'm taken back. I'm in high school”. “Oh, my dad used to play the piano”.

And even like clients with, you know, more late stage dementia that you know aren't really able to recognize their loved ones you know their spouse of 30-40 years, people in the room, themselves even, and you play a specific song usually one that a family member will say was significant, at least in my experience and, you know, playing those songs they say, “Oh yeah my dad used to play the piano and he would play that song when I was a little girl” or you know “Oh that was my wedding song" and I remember you know this and this”.

And it just really um brings so much of who we are back to those moment in those moments where it sometimes I think it feels so far away um you know in those difficult times, it just feels like you know we're far away from you know who we were, how we remember ourselves, or how the loved ones remember them sometimes and it just takes them right back and gives them those moments again.

And they'll say you know like “Oh I I haven't, you know, seen so and so like that in I don't know how long”. And even though it's just a few moments, it doesn't, you know, it's not a cure or, you know, anything like that, but it's it while it's there, it's just a really important moment, you know.

Amy: Yeah, it's and and I think that's it's quality over quantity. I think you know having that quality minute or seeing that person in a different light maybe um who has been less responsive is significant you know and can really be etched in memory and it's so true you know songs that we have a connection with bring back the memories of that time the feelings so much comes back with that memory and I think we just need to spread the word, you know, about the significance and the importance.

And I love what you what you talked about in the practice where you were working where no one dies alone. And I also think that that music should be part of everyone's end of life if they want it, you know, that that there should be access to to hearing that music.

Marisa: Yeah, absolutely. Absolutely. There's so much meaning in music. I feel like I say that all the time on this show, but there's just so much meaning in music um in who we are, our identity, how we express ourselves. And one thing I might ask you to maybe touch a little bit on for those for music therapists working in this setting, I know you're familiar with that phrase life review that you mentioned earlier. But for musicians or music lovers listening as well, can you tell us a little bit about about that, about life review?

Amy: Yeah. So um essentially, you know, if someone is desiring to kind of look back and celebrate different moments in their life or even look at things that they regret, you know, that they might want to talk through um or issues that they feel are unresolved that can cause a lot of angst at end of life. Doing the life review can actually alleviate, you know, help reduce some of that anxiety and help people feel like they've said but they need to or worked through they had to.

So, it often involves, you know, just and it's so different like maybe people want to do a life review of the last 10 years. Maybe it's a life review of their marriage, maybe it's a life review of of raising children, or maybe it's a complete life review. And so then sometimes that involves picking songs that were significant at that time that represent that or writing original songs that go along with that time, song parodies.

So it's a real mix of how and of course the amount of time someone has right. I have been fortunate to have, you know, had some sessions with people where we've had a number and so then you can compile a longer musical autobiography.

I had one gentleman um that I worked with uh he was so dynamic my goodness in his 90s and he'd already written an autobiography of his life and that he wanted to turn that into an opera. And I said, "Well, I've never written an opera. I'm not sure that I can do that." But wrote a number of songs and created an opera, you know, an opera in I guess the sense of the opera for us, but you know, it really was like a music theater kind of um compilation.

And uh so he died just before we finished writing the last piece, but we already had talked about this and he knew he was, you know, coming closer and he asked me to finish the last piece if we didn't finish and he also gave me permission to go to the family and present this.

So they knew he was doing this and um so then I recorded all of it and and went to visit with the family to present it to them and uh it was significant and it was stories from um he was married two times. His first wife passed. So there was uh you know a song that celebrated that marriage, celebrated children with his first wife and then he remarried and there was some beautiful music about being with that in that relationship and saying goodbye and yeah, it was just such a - he was so dynamic. He would write so motivated. He would write ideas down in between sessions of what he wants and yeah he he will always remain you know such a strong memory for wanting to do that work and um and really being committed to it, you know, so I'm so lucky to have just met so many of these people.

Marisa:  Yeah, it's almost like that closure of just looking back at your life and the music like we talked about, you know, can help with just those different stages of our life, our adolescence, our adulthood, our older adulthood, our childhood. Um, and kind of help us maybe place those memories, go through those emotions again.

You're almost transported back to those places in time. And like you said, you can work through those issues, get closure on those things, find some peace I think along the way, too, is is really important. Um Yeah.

Amy: I think just for I mean for all your listeners I think it like it's just important to be think about sometimes like the music that is important to you. Like sometimes step back think about like what music is important to you right? It's like you know we are we are so privileged that music is everywhere and we consume it, you know, all the time in spaces we're not even aware that you know music is there ,you know. You go to the mall, music is there. It's everywhere right? And we don't purposely necessarily are listening to it with intention.

And so what is the music that's significant to you? And I know there are some songs that are significant to me that if I hear that music like it really does change my mood like we know that about music. So it's I think it's important as uh we are connected with our own music and we stay connected and and passionate for it.

Marisa: Yeah. Mhm. Throughout our whole life.

Amy: Yeah.

Marisa: Yeah. I love that. That's an important I think reflection for our listeners, too. Um and maybe we do polls for each podcast. Maybe I'll open up a poll if anyone wants to share any of the music that's important to them. Share your songs with us. You know, what's been important throughout our lives. Look out for that one. That one’s coming.

Amy: I love it. Yeah.

Marisa: Yeah. I'm curious to see what songs people might share in their own lives. Yeah.

Well, I guess that brings me to my last question here and this is just something I like to ask all the guests that we have because I think you know our experiences shape so much of, you know, the settings that we go into like the observation that you had that you know kind of started you on that path and working with individuals with dementia.

Um, and it shapes, you know, how we think about music therapy and how we practice and, you know, the areas that we're interested in and things like that. But I also I always like to ask you know the flip side of that is that you know how has the work now after doing you know this work for a number of years. How has that in turn, you know, shaped how you think about I guess in this context music at the end of life or about you know grief and you know the role of music like you said throughout different parts of our life.

Amy: Yeah. Yeah. Oh, you know, I think it's it really has shaped me, right? I mean, all my those experiences have shaped me as a person. Um, and I believe there is such a strong role for music in grieving and helping us grieve and activating, supporting, and it's been important in my own like personal loss, using music to help express emotions to help stay connected with people.

But I guess yeah, I I think I just I believe that we underestimate this value of music and I would just love to see it being included as standard of care in work with older adults, with end of life, in so many areas of practice. And I really try to advocate I think me seeing the benefit has just made me a lifelong advocate. So I'm always talking up about music um and the benefits to whomever. I think advocacy happens on all the levels. It happens with the big, you know, government like we need funding, but it happens with your neighbor who doesn't know what music therapy is and sharing that.

And so I love to also talk to interdisciplinary professionals and get them to support. Um, and so when they know that they can refer and music therapy grows and music- based intervention care grows. And so I think it's just reinforced to me that I need to be a lifelong advocate for this work and share the work and share the stories and uh that people privilege me to share and the music. I think there's nothing better than to share the benefit than hearing someone's composed song that they allow us to share.

Marisa: Mhmm.

Amy: And so I do. I'm lucky that I've been able to share the music that some people have composed and I think that's really changed people's opinions about the importance of music at end of life.

Marisa: I love that. H Yeah. Yeah. Absolutely. And you know, on a similar sentiment, you know, I appreciate you coming and sharing your stories and your experiences and advocating for, you know, the research and the work that you do um and your practice.

It's just so wonderful to to hear from you and to meet you today and and to learn more about this area of practice.

Amy: Well, thank thank you very much, Marica, and thank you for what you do. I think these podcasts are they're wonderful and they're essential to reach lots of different listeners, right? Music therapists, but also like your whole other audience, which um you know, supports us and also uses music in the care that they provide and in their own journeys.

Marisa: Yeah. Thank you. So for anyone listening before we close today, I do want to say that we will have this episode posted well on all streaming platforms, but we will also have a blog on our website that will have the transcript and then we'll have um more information that we share today, links to books, links to articles, and ways that you can connect with Amy Clements Cortez after the podcast. So thank you again for listening. Thank you again for being here today and for sharing your experiences and we'll see you all in the next episode.

Thank you so much.

Marisa de Leon, MS, MT-BC
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Episode 10: The Psychology of Singing (with Kelly Meashey, MT-BC, MMT, FAMI, AVPT, LCAT)