Ali Habashi: On this episode, I want us to focus not so much on the intricacies of music therapy, but on the clinical stories that you’ve collected over the years, the successes and the unexpected, the families and the love, and of course, the music.
So here are the stories.
Lesson One: Boundaries
Tara Jenkins: I saw a client who was diagnosed with frontotemporal dementia or FTD, as most people know it, and they were younger than most of the other residents in their community. They did not socialize in settings, but they used to love music in their younger life; listening to music, going to concerts, going out dancing, and so we thought music therapy might help.
This client self-isolated in their room a lot, and they were the type of person that was always down at the front desk asking lots of questions, always trying to find the executive director, but never socializing with their peers. And so, music therapy at times was extremely helpful with redirection as well as a meaningful experience for someone who sat in their room in the quiet most of the day.
But even though they enjoyed music, they had very clear boundaries on when they were done. Sometimes I was there for 45 minutes and other times I was there for 15 minutes. They loved The Beatles and The Eagles, and they were positively engaged, singing, tapping along, sharing stories. They even saw The Beatles live in concert, which was one of their favorite stories to share, but there would come a time when they would say, “Thank you for coming. I am done now.” And for me, this was a great example of how important it is to give people living with dementia and other forms of cognitive impairment the opportunity to guide the experience and to be able to say when they’ve had enough, especially when it is something that is supposed to improve their quality of life versus something medical that needs to be done.
Lesson Two: Connection
Tara: During my weekly group music therapy sessions in a dementia care community, I work with the same residents consistently, and this allows me to build meaningful relationships over time.
I would walk into this community and everybody knew me, from the person at the front desk, to the maintenance man, to the activities director, to the people who were working in the kitchen. It became a welcoming and friendly environment. Even though I was there as a contractor, I did feel like I was a part of the team.
And as a music therapist, I’m always observing group dynamics and adjusting to meet those group needs. One resident in this group was constantly on the go. They would walk in and out, often unaware of their surroundings or the other group members, and this sometimes caused anxiety for the rest of the group.
They would then become agitated and on occasion the group members would ask that person to leave, despite my reassurances that there is no wrong way to enjoy music. One day I introduced the song “I Feel Good” by James Brown. As the music began, this resident walked by with a big smile on their face.
So I invited them into the circle to dance with me, and they joined enthusiastically. The other residents began cheering them on saying, “You got this” and “Looking good,” celebrating their dance moves. And in that moment, they were no longer seen as a disruption, but as an integral part of the group’s experience.
Over time, this resident began staying for longer periods during the sessions and was warmly welcomed by the other members. In this situation, a trained music ability to observe group dynamics, adapt experiences in real time and foster inclusivity was crucial. Without these skills, this opportunity to transform this individual’s experience and their connection to the group and the music might have been missed.
Music therapists are uniquely equipped to use music intentionally to build self-esteem, foster belonging, and create a positive group atmosphere, even in challenging scenarios.
Lesson Three: Communication
Tara: I had the chance to work with a Telehealth client who was further along in their dementia journey and had challenges at times verbally communicating. What was so great about this experience was this person living with dementia joined with their caregiver.
So I was able to work with them side by side, and they were able to engage together to see the benefits in real time of how music can transform and help communicate with one another. During our first session, they seemed overwhelmed by the computer and the Telehealth format. There was some confusion about who I was and talking at length only seemed to add to that confusion.
Despite this, it was clear that music had meeting for this person, so we agreed to try again and continue working together. In our second session, I simplified everything. I gave them more space and time to react. I chose all the music myself instead of offering choices, and I stayed with live music only.
I also shared lyrics in large font. The change was incredible. They lit up, smiled, danced, and expressed so much gratitude. We had some meaningful exchanges, especially for someone who at times struggled to find their words. After sharing the following songs, here’s what they expressed.
“Once I get started, I can’t stop. It’s a good feeling. I’m loving it. I like singing. It makes me feel good. Never done a thing like this, but it’s good.”
It was such a beautiful reminder of how music can bring meaning and connection, even when words are hard to find. This experience highlights the power of music therapy in Telehealth settings for people who are living with advanced dementia.
For me, it shows the importance of simplifying the approach to meet their needs. Music has the ability to bypass communication barriers and create meaningful connections, fostering emotional expression, well-being, and deep connections, even when verbal expression may be challenging.
Lesson Four: Empathy
In many of my group music therapy sessions, I like to center our music and discussion around a theme. It helps ground the group and it keeps everyone, including myself, focused. Sometimes it’s a specific theme, like the music of The Beatles, and other times it’s more general, like songs about the water or songs about springtime.
During one session I was sharing the folk song, the “Water is Wide,” teaching the lyrics and melody to the group. It became clear that one of the participants was upset but unable to communicate why. So I asked if they wanted to leave the group, and at first they said no. Then they shared that someone close to them had drowned, and thinking about the water really scared them.
In that moment, I was able to validate their feelings and process what they were experiencing. And I didn’t do this in front of the whole group. I played some recorded music and I walked over to that person and we had a one-on-one conversation. I knew this wasn’t something that they wanted to broadcast.
They were a very private individual, so I tried to be very sensitive about how we talked about what was coming up for them, and eventually we decided it would be best for them to leave the group and join the staff for another activity that was happening down the hall. This experience for me highlights how music therapy isn’t always the right fit in certain moments.
It’s a reminder of the importance of letting each person living with dementia lead their own experience. Knowing when to pivot and listening carefully to their feelings. The goal is always to ensure that their voices are heard and their emotional well-being is prioritized. By being flexible and responsive, we create a safe space where the therapeutic experience can truly be beneficial.
Lesson Five: Flexibility
I once received a referral for a client who spent most of their day in bed avoiding social activities and interactions with really any visitors. The activities director thought music therapy might help. So we decided to give it a try. However, when I walked in the door with my guitar on my back, and my bag full of instruments kind of jingling and jangling, the client immediately wanted nothing to do with me.
The sight of the guitar alone was enough for them to turn me away saying, “No thank you,” in so many words. I didn’t give up right away. I tried reapproaching them without the guitar, simply engaging in conversation to see if I could connect on another level. After several visits, it became clear that music didn’t seem to have a meaningful impact for them.
They didn’t have any strong connections to music, and they were really uninterested in engaging, not only with me, but with music. For me, this experience was an important one. It served as a reminder that music therapy isn’t always the right fit for everyone. Sometimes, even though music is incredibly beneficial and powerful for many, it just doesn’t resonate with certain people.
It’s important to recognize when music is not helpful, and to be flexible enough to explore other ways of connecting with clients. Meeting them where they are in the moment and providing choices for how they want to engage and interact with the world.
