Music, Physical and Intellectual Disability and Alzheimer’s Disease

by Anne Colgan

When I first became aware of the importance of being heard in my own psychotherapy training it made great sense to me and clarified many questions I had about my own personality and personal development. This in turn led me to looking at my own voice and being heard not just in speaking but also as a singer. I get great joy and pleasure in my own singing and I began to explore the possibility of sharing this with others. I have always believed that if you can speak you can sing, and that it is a matter of learning how to listen and sing back what you hear. For those of you who may find this hard to believe, I would suggest to you it is because you may not have been supported or encouraged. I am not saying that you could be an opera singer, but you can sing in your own way. Too many times singing teachers only take the best singers; the others can then believe that they are not singers. This is just not true ‒ they just didn’t fit in to that particular way of singing. So many people have been deprived of the joy and pleasure of their own voices ‒ they were silenced.

Since 1998, I have been working with people who wanted to be able to sing for themselves, who wanted to learn one party song, who basically wanted to access their own voice. Many times clients were just singing in the wrong key. They were in the wrong place, too high or too low and nobody ever took the time to explain it. I have a soprano voice myself and cannot sing well in my lower register, so I don’t go there. It is very much like person-centred therapy ‒ meeting your voice where it is at. One of the best natural medicines in the world is singing. The vibration of your own voice massages your cells and promotes harmony within your body. I believe it brings you to your Higher Self.

In 2003, I became involved in working with clients with profound physical and intellectual disabilities as an Artist in Residence in a residential home. This was very challenging and very exciting work. There were many challenges around introducing creative music into a structured regime ‒ creating the space for the music to happen in a safe and yet enjoyable way. I worked with the ‘ability’ of each client. Sometimes nothing would happen and then one small movement would be so rewarding. It was the integration of the humanistic approach into the music that encouraged the clients to be heard in their own way. Most of them couldn’t speak in the way we do, but they could make their own sounds. When I worked with them, I would make their sound after them and this would lead to more and more sounds. At the same time, I knew that there were obstacles due to their disabilities, but I always went after what they could do. The musical experience was about living in the now, part of it would be quiet and meditative, and other parts would be wild and wonderful. I had quiet moments, sad moments, and great fun.

This was my first experience of doing this kind of work with music and my being a humanistic and integrative psychotherapist enabled me to do the work in a way that was healing, exciting and challenging. Since then I have become involved in working with children with autism and with clients with Alzheimer’s.

In working with children with autism, I work the same way ‒ meeting them where they are and looking at them and listening to them and how they communicate in their own way ‒ encouraging them to make their own sounds. If they are in school, they come from a regime that constantly tells them what to do and how to do it. With our music, they are encouraged to make their own sounds. We have to make the container very safe for them around this and it can be very difficult to marry the creativity with the boundaries. However, it is the safe boundaries that allow these children to experiment and explore with their voices.

One of the summer schools I ran included children with autism and their siblings. I requested that their siblings attend because I felt that they may have been excluded from a lot of activities when so much attention was needed by the autistic child. It was during one of the workshops that I learned a great lesson around physical boundaries.

It was a beautiful summer’s day and one of the carers asked if we could work outside. Each child had a one-to-one support person so I thought it was a good idea. However, within five minutes we were back inside. Some of the children couldn’t cope with the creativity of the music and the wide-open space at the same time. For me this was a lesson in physical containment.

One of my vital roles is to explain to the parents/carers that there may be no ‘result’. This is not about performance but experience, the children’s experience of their own music. The parents have observed that the children are singing more at home than they used to. This in itself is actually a result.

Earlier this year I was asked would I work as an Artist in the Community with Alzheimer’s residents in St. John’s Community Hospital in Enniscorthy, Co. Wexford. This scheme is funded by the Arts Department of Wexford County Council and Friends of St. John’s Hospital. I was aware that there were different kinds of music in the Ivy Ward. I was aware within myself that the only way I could work was in a Humanistic and Integrative way and that I had to hold that for the residents.

The music is from ten a.m. until noon with a twenty minute break in between. I mention this because there are so few people working in this way and it might mean that someone reading this could become involved in this kind of work. Creating the safe container in this kind of environment can be very challenging. Some of the residents find it difficult to sit in one place, some repeat words all of the time and some seem to have no response. On the other hand, some of the residents join in most of the time. I make sure that each resident has a one-on-one musical experience with me over the weeks of the scheme as well as with the group.

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I try to gauge where the residents are at when I arrive. I found in the beginning I was very earnest, very much wanting to do everything to ensure that I was doing the right thing. As well as creating the container, I also realised that I was in their home ‒ this is where they live. I felt that it needed to be not only therapeutic but also relaxing and fun.

A few years ago, I made two CDs. These came out of a need to create appropriate music for workshops and this kind of work. I use these, the instrumentals, and the voice in the sessions so that they can continue with their music throughout the day. Early on one of the residents said to me, “I’m confused, I can hear you when you are not here”. I took out the CD and played it for her and she understood. I was very struck by that and how I could have missed it.

I believe that my voice is the voice of my ancestors. That it is in my genes. One of the ways I like to sing most is through chant and I use this extensively in my work. Another kind of singing I use is classical music and songs from the musicals – songs that they would have known thirty-fourty years ago. I have sung Gounod’s ‘Ave Maria’ in my soprano voice and found that this really gets a reaction. There is something about the way the music is written and how the vibration of my voice comes across. We also have a great time with ‘Oklahoma’, complete with the loud yelps! We sing Irish songs and we are gathering up a repertoire of the songs that they know and love. We also try to find out favourite songs of the residents. We find that they will sing them with us and that it enhances the experience of the here and now.

This scheme only lasts for five months of the year and then there may be funding for next year. These are some of the constraints of this kind of work. As well as doing the work, you have to look for funding. I have invited other musicians to come and sing on a voluntary basis. When we have more music in the room, it can bring about different results. This doesn’t happen every week, as it is important that the residents are given their own musical experience.

Recently, we had a very moving experience. One of the musicians sang ‘Boolavogue’ which, of course, is a great Wexford song. One of the residents was able to sing all of the words. He got very excited and passionate and then broke down crying. This to me was a great breakthrough. We were able to hold it and go in to a soothing lullaby. This brought home to me all of the frustration and rage that may be present when a person has Alzheimer’s Disease and cannot communicate how they are feeling. One of the carers was concerned that the resident had become upset, but I explained that it was actually good for him. I was supported by the Nurse Manager in this.

The Ivy Ward has won an award for its person-centred approach with Alzheimer’s so it dovetails really well with the music. In his book Challenging Behaviour in DEMENTIA: A Person-Centred Approach, Graham Stokes (2000) states:

“This book contrasts the medical interpretation that sees disruptive behaviour as mere symptoms of disease with a person-centred interpretation that resonates with the opportunity for change and resolution. This radical and innovative interpretation of challenging is consistent with the new culture of dementia care, focussing on needs to be met rather than problems to be managed.”

This commitment by the hospital makes my work much easier.

There have been other experiences where a resident will suddenly connect with the music and you know that they really ‘get it’. In addition to voice, we use percussion instruments. I place the instruments within reach and invite the residents to play them.

Sometimes they do, sometimes they don’t. I bring my bodhrán and play it sometimes. I feel it can create a heartbeat. The work is very rewarding and humbling. I feel it is my soul work. It brings together all of my musical training and experiences. In my own home, we always had singsongs, so I know all of the old songs. It is like home to me. St. John’s Community Hospital is a very friendly place and in particular the Ivy Ward. I find that the process of Humanistic and Integrative Psychotherapy fits in very well with the work. I can feel the relationships with the residents changing all of the time. One of the great benefits of the work is that I get to sing every week. This keeps my own voice in good shape and brings to me the joy of my own singing ‒ the reminder of how good it is for us to sing.

The plan for the future is to hopefully do some research so that the work can continue and also to engage the community in person-centred singing. To engage in the joy of the singing ‘in the now’ and not be worried about performance or perfection.

Anne Colgan is an IAHIP Accredited Psychotherapist and Supervisor. She is also a Creative Musician/Composer. She released two CDs, ‘Courage’ and ‘Croí’. Anne can be contacted at Mobile 086-2501452, Office 053-9420707.

References

Stokes, G. (2000) Challenging Behaviour in DEMENTIA: A Person-Centred Approach. Milton Keynes: Speechmark.