We now have a new music therapist at Canmore Lodge. The information below is from 2014 and is a case study from our previous music therapist, Lizzie Nightingale.
Spousal music therapy: Restoring a lost connection (2014)
Mike Haines is living with cerebral amyloid angiopathy, a neurological condition which can cause speech difficulties, confusion, and loss of mental function (dementia).
Music therapist, Lizzie Nightingale has been holding weekly music therapy sessions with Mike and his wife, Heather since February 2014, and the effects this has had on Mike’s behaviour and his relationship with his wife has been remarkable.
In this piece, Mike’s wife Heather, very bravely, shares her experience of spousal music therapy and Lizzie discusses the way she sought to restore the couple’s connection through music. Their intention is to inspire and give hope to other families through their story.
The initial aims of the sessions were to channel Mike’s physical energy into rhythmic activity and to calm and focus him, because he can often be found wandering around the care home where he lives.
Lizzie: “Engaging Mike in rhythmic activity encouraged him to remain seated and settled. This was important for enabling his interactions with Heather. To facilitate meaningful connection, I encouraged them both to use music as an alternative platform for their communication.”
Heather: “It’s something we can do together as there are lots of things we can’t do.”
Lizzie: “Physical goals also emerged after Mike’s physiotherapist shared concerns with me about increasing tightness in Mike’s left arm. I then sought to use strategically placed instruments to motivate Mike to raise his arm, increasing his general motion and flexibility.”
Mike’s sessions typically involve free improvisation on drums or tuned percussion instruments, though on occasion they listen to music and songs familiar to Mike.
Lizzie: “I had not anticipated that improvisation would become such a significant part of our work together but Mike repeatedly demonstrates a draw and engagement to this process. His responses in the sessions are very encouraging; we see positive facial responses, purposeful gesturing and increased eye contact. Mike sometimes uses vocal sounds like ‘swish’ and ‘chh’ to respond rhythmically and he taps his feet to the beat.
“In our early sessions I saw Mike had great capacity for rhythm and so I brought him a variety of drums, including the gathering, ocean and djembe drum. In more recent sessions Mike and Heather have been playing the same instrument, often tuned percussion. I mostly accompany them using my voice and the keyboard. My approach is to ground and ‘contain’ our shared music, musically reflecting melodic or rhythmic fragments from both Heather and Mike in an effort to encourage his awareness of her and increase moments of direct eye contact and connection.”
Heather: “I thought that because of Mick’s condition, many things would only get worse, but a lot of things have gone up through music therapy. There is more eye contact. Mick smiles and winks at me. Something of his old personality comes through in music therapy.
“He works very hard. He concentrates well – it’s about the only thing that he concentrates on for so long.”
Overtime, Mike has been able to engage for increasingly longer periods, and is now regularly able to remain alert and engaged with Heather for more than 1 ¼ hours.
Lizzie: “Mike has increasingly demonstrated his awareness of both Heather and myself through imitation of rhythms and musical ideas. I understand this has been encouraging for Heather who can often wonder whether Mike is really listening and responding to her. As well as being able to follow a tempo, Mike also initiates tempo and dynamic changes. It is encouraging to see him engage in independent creative decisions which he so often delivers playfully and with humour.”
Heather: “He enjoys it. It’s nice to share in something. Mick’s engineering background is also sometimes apparent. I can see that side of him - using a drum stick as a hammer or screw driver, looking to see how they work.”
Music therapy provides Mike with an alternative platform for exploring and nurturing inherent parts of his personality.
Lizzie: “Mike is a “great story teller” because his communication style is very engaging; he leans forward and speaks in an aside when sharing what appears to be a joke, and he uses great intonation.”
Though the majority of his speech is muddled and he amalgamates many words, Heather believes there have been some positive changes with Mike’s speech: “Since doing music therapy I think he has been talking more. In the sessions more of his words seem to make sense, one or two quite learned phrases and some that seem in context. At first he was just whistling and ‘swishing’ a lot to communicate but now he seems to be trying to tell people about things.”
Lizzie: “I recall an occasion where Mike declared ‘That was an amazing one!’ following a long and animated improvisation together. On another occasion Heather was away so I met with Mike on my own. I introduced myself and purpose in my typical way – “Hello Mike, my name is Lizzie and I’m here to do some music with you”, to which he replied “Well it’s funny you should say that because my wife and I have been doing something similar”. I was amazed at his response. He referenced Heather as his wife (until this point, this had been generally rare) and he was able to actually recall having played music with her. It was also a longer coherent statement than is typical. His association with the room, and with music-making, seemed to be becoming established.”
Heather: “Since this occasion Mick has referred to me as his wife more often. The sessions have helped in the process of rebuilding our relationship; he has become more of the lovely person he was. We had a stage when he was at home, where because of the illness he became a different person and could be quite difficult, especially with me. Music therapy has helped restore my love for him.”
Lizzie: “In music therapy, Mike’s neurological condition is not a barrier to engaging in positive, meaningful, shared experiences with Heather. In their music-making, you truly wouldn’t know who was the resident! Sometimes Heather copies the arm movements Mike makes, and he tells her she looks silly so we all laugh. Laughter is so important.”
After the sessions
Heather: “After one session he sat beside me very calmly and held my hand. He was much more focussed and patient than usual. He didn’t wander off.
“There was another occasion after one session when we were in the sitting room. I was trying to contact my friends and went into the corridor to phone several times. Each time his eyes followed me across the room and he looked very lovingly at me. I left after a while to try and meet up with the friends I usually saw on Friday afternoons. By the time I got there they had gone. I was very upset I had shortened the good time with Mick. I was very tearful – sorry also because I was experiencing a glimpse of the old Mick and upset because I wanted more. I decided after that I would make sure I stayed for a reasonable amount of time with him after the sessions.”
Lizzie: “Following our sessions, I now leave the room to give them privacy and let them make music together. This feels important. By the end of sessions I feel I have facilitated their connection. I want them to continue enjoying this together as a couple privately. They often stay for another half an hour, sometimes only leaving because I have to start with another client.”
Heather: “As a family we now use music as a thing to share and we listen to music together. Our son, Tim, brings in a guitar and Mick taps to his music. Sometimes Tim fetches him an instrument so he can join in. Recently when we Skyped Doug, our other son who lives in Spain, we took along the xylophone so Mick could communicate that way and my daughter said that during a visit my grandson played the xylophone and Mick started singing along.”
Lizzie: “I think it’s wonderful how much Heather and the wider family are now using music to connect with Mike. Heather’s willingness to share her story with the wider Barchester network is amazing. And brave. I think our aim is that sharing our work might inspire and give hope to other families. Music-making can form an integral part of facilitating and maintaining both meaningful connection with loved ones and quality of life. Who wouldn’t want that?”