Advocacy

Finding meaning in the journey, not the destination

One of the unintended benefits of having a child has been learning to cook and, for the first time, finding meaning in it. Cooking for my daughter has helped me come to respect its art and craft. Whereas I once valued the tasks of cooking only by the isolated products those tasks produced (e.g. a chopped carrot, simmering sauce, etc.), I came to understand these purposeful actions as choreographed movements in a much larger dance that function as an act of service representing love and nurturance.

My appreciation of “old world” cooking materials (cast iron cookware and carbon steel knives) has been an extension of this evolving perspective. Both require a high level of care and attention that helps them mature over time, developing unique aesthetics and performance characteristics. No two cast irons season the same, nor do two carbon steels patina the same. This means that as each pan and knife matures they will interact with ingredients in their own way, and that owners will learn to work with these unique characteristics as their own relationship with the cookware and blade develops. While some prefer these materials over modern technologies due to better performance, the beauty for me lies in these evolving relationships and interactions. I can make a dish using any pan or knife, but preparing a meal using materials matured and nurtured through labors of love and caring? That’s a quality you can taste in the food.

I remember having reached a similar crossroad with music therapy in end-of-life care. Legacy projects. Songwriting. Goodbye songs. Quality of life measures. Since I first began work in this area, I have felt inundated with such terminology. Not that there is anything inherently wrong with these interventions or goals – clearly there is a lot of room for each to be of significant value to patients and their families. However, they are nothing more than products. Products that, in truth, can be provided or manufactured by many other disciplines. There are no special skills involved with providing music during active death, or compiling pictures/music into a slideshow or album.

So why the emphasis on them? Why do these concepts so thoroughly saturate hospice music therapy presentations, clinical explorations, and informal discussions? To frame in another light, why do we as clinicians continue to dip into this well if we don’t own the expertise?

Look, I get that products are attractive. In a field such as ours, one steeped in the intangible creative energies that even we struggle to fully understand and define, a tangible artifact or concrete intervention helps provide answers to questions that come either internally (“What was I just doing exactly?”) or externally (“Why did you do that?”). Music is a transitory experience, and products offer more of a definitive footprint that can say “Hey, I was here and good stuff happened!”

For me, however, our expertise is not in crossing the finish line but in assisting others in the journey to the finish line. That final product is truly secondary to the clinical process by which we arrived there. What difference does a delicious dinner make if it’s not prepared and cooked with the intention to care for loved ones? In that same vein, what difference does a life legacy project make without an intentional and purposeful process infusing that project with meaning?

At this point in my career, I feel far more interested in hearing about a rich clinical process that did not end in the completion of a product, or even a process that intended to complete a product but was unable to. An incomplete product by no means represents an incomplete process – in fact, that incomplete product may be a necessary expression of that patient’s dying process. By shifting that focus away from the destination and onto the journey, we can highlight certain functions of therapy that are not paid due attention in end-of-life work:

  • Clinical decision making (i.e., How did you know to select that song? How did you know to engage that client in that song using those stylistic and aesthetic choices?). These types of questions have not been extensively explored and has real live consequences for both clinicians and patients. Are we doing our best by patients if we are not in a constant state of self-reflection about how and why we are utilizing music in service to their end-of-life needs? And if our research glosses over this clinical nuances, how can clinicians be expected to integrate findings into their practice?
  • Theory and philosophy (i.e., What theoretical construct underlies your practice, and what principles inform and shape your clinical decisions?). It’s interesting to me how little theory development there has been in music therapy and end-of-life care. At times it appears the field is seemingly content to found the work on interventions that are rationalized by after-the-fact, vague theoretical concepts rather than rich and illustrative theory that provides invaluable structure to the clinical process.
  • The therapist as central to the process. At times I feel that the showcasing of products has more to do with how it makes us look as clinicians than it does demonstrating the wellness it provides patients. When that occurs, it lead me to similarly question whether that product was the most appropriate therapeutic intervention or experience for that patient.

Deeper examinations of these considerations may lead to insights in the literature that can allow us to (a) more definitively distinguish our craft from others who use music for healing purposes, (b) better position us to stake claims to expertise in the practice of music for healing, and (c) develop a theory and lexicon specific to music therapy in end-of-life care. This last point is a great hurdle that will need to be leaped at some juncture if we are to establish ourselves in the end-of-life arena. Nurses and physicians have already been working in this area, and we need to follow suit if we’re going to be able to keep pace, both clinically and professionally, with that evolving expertise.

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