This paper describes music therapy skills used in facilitating patients receiving palliative care to write songs. In sessions the music therapist should provide enough structure to allow patients to be as creative as possible. Methods used vary according to the patients' physical and neuropsychological impairments and their needs. The author has found songwriting a valuable medium through which extremely disabled patients may ventilate pent-up feelings, gain support, send messages to special people and feel that they are contributing something unique to this world, thereby gain much pleasure and self-esteem. A music therapist should have the skills to aid patients in realising their songwriting potential.
In this paper the use of songwriting to help alleviate the suffering of those with terminal and/or progressively debilitating illnesses is described. Palliative care is the prime philosophy of care used with this population. This implies that the treatment team directs their efforts at improving the quality rather than the length of time of a patient's survival. Efforts are also made to reduce the suffering of the patient's significant others.
The use of music therapy in palliative care has been extensively described and is regarded by many as a valuable asset to the treatment care team. Many music therapy techniques pertinent to the area have been described. These includes:
--Musically supported psychotherapy, including individual and family work (e.g. Bailey, 1984, Munro and Mount, 1987, O'Callaghan, 1988)
--Collages to Music (e.g. Munro, 1984)
--Musically supported life review (e.g. Bright, 1986, O'Callaghan, 1984)
--Groupwork music therapy (e.g. Short, 1983, Munro. 1984)
--Music and relaxation (e.g. Munro, 1.984)
--Guided imagery and music (e.g. Wylie and Blom, 1986)
--Word substitution in songs (e.g. Bailey, 1984)
Literature Review: (1)
Another technique not mentioned at any length in the palliative care literature is songwriting. The earliest mention of clients being encouraged to compose music was by Crocker (1952) who described her experiences with emotionally disturbed children spontaneously improvising an opera. In the 1960s music composition was described as a psychotherapeutic approach with psychiatric patients by Ruppenthal (1965) and Castellano (1969). Ruppenthal encouraged psychiatric patients to 'scribble' (improvise) music while the therapist reinforced positive sounds. She said that the technique should facilitate tension release in patients and guide them to higher levels of social organisation and adjustment. Castellano taught groups of psychiatric patients music composition and reported that it helped them to gain improved self-esteem and also reinforced reality testing.
Ficken (1976) reported on the use of songwriting with psychiatric and alcoholic patients, and a group of adolescents. Ficken stated 'It is an activity which can be internalized by the client leading to socially accepted behaviours'. In describing the use of songwriting with chemically dependent patients Freed (1987) reported that it allowed them to feel supported, have their feelings validated, and that it promoted an increase in self-esteem. To facilitate the songwriting process Ficken and Freed described the method of word-substitution for part or all of the lyrics of an existing song.
Ficken also reported that the clients were encouraged to compose their own songs by first exploring natural speech inflections and rhythms, and then improvisations. The therapist arranged the song by joining song fragments and then provided an accompaniment.
In her paper on 'Music therapy for substance abuse patients' Murphy (1983) described songwriting groups where each member contributed to a song's lyrics through a process of brainstorming. It was intended that this process would encourage patients to develop greater insight about their situation. …