It is with great pleasure that we share this guest post from Jessica Josefczyk, a board-certified music therapist practicing with older adults in Dayton, OH (be sure to check out her full bio under Contributors). Here, Jess offers an important perspective about the growing influence of Music & Memory, its potential impact on the practice and reach of music therapy with older adults, and how music therapists may be able to position themselves in relation to the growing trend of music listening services.
Over the last half decade, Music & Memory and other listening programs have sprouted up and taken root within healthcare systems across the nation. Over the past year, I’ve had to carefully evaluate how listening programs fit into the puzzle of my own clinical world at a long-term care facility with older adults. As I began the work of reconciling the responsible implementation of listening programs with my concerns and questions, I found myself trekking a frustrating road of muddled answers, differing opinions, and no clear answers.I openly acknowledge that there can be real value in opportunities for access to preferred music through listening programs. I have truly witnessed positive impacts, and this is not a total dismissal of those impacts. However, at this point, there are more questions than answers, with gaping holes in the areas of research and processes of training for listening programs. Meanwhile, the prevalence of said programs has grown exponentially within healthcare facilities across the country throughout the last five years. They are not a fad. They are not going away. We can’t ignore them.
Where does the field stand now in relation to these listening programs? We appear rather divided. There are clinicians actively hitching their wagons to the trend as fast as possible, those who have assumed a defensive stance, those who hold the position of informed dissent, those who haven’t been looped into the issue, those resting comfortably assuming no opinion whatsoever, and those who live somewhere in the gray area of that spectrum. Collectively, we’re in lukewarm, unchartered waters of ambivalence.
I understand the argument that we should be seizing opportunities to capitalize on listening programs as they provide potential segues into conversations toward advocacy. I’m on board with that- we don’t own music, and I welcome conversations that bloom out of another’s personal connection with music outside of the music therapy context. However, we need to explore our motivations for capitalizing: are we doing so because we truly trust in the benefits of listening programs as a completely responsible supplement to health and wholeness, or are we doing so for financial benefit or broader public acceptance and understanding?
We need to purposefully and collectively “slow down” to tend to this question and others contributing to the blind spots in our mirrors. There are too many vulnerable individuals who could be affected by our collective lack of resolve to have conversations and pursue solutions. In my effort to pull the reigns a bit before we attain a clear assessment of the path ahead, I’ve identified some of my concerns.
First, we live in a world where the very definition of what we do as music therapists is often muddled. Not only are we often divided about how we define our work or its value to other healthcare professionals, but even those closest to us can never fully understand the value of music therapy in a way that we have the privilege of knowing and experiencing as clinicians. Every day for decades we have forged ahead through these advocacy battles; however, with the sweeping arrival of listening programs throughout healthcare, the public sees these services at center stage, and our already muddled definition becomes cloudier to the public.
Money matters, and it’s clear to me that if healthcare facilities don’t understand the value of music therapy and are subsequently presented with the choice between (1) an inexpensive and low maintenance listening program or (2) an expensive contracted or salaried music therapist, the scale will typically tip in favor of option #1. Even if a facility employs a music therapist AND implements a listening program, the music therapist will likely be required to settle for the sandbox instead of the beach and absorb the responsibilities of said listening program, thus eliminating time that could be spent focusing on actual music therapy services. This is a problem. The exponential growth of these listening programs is not congruent with our own strides for advocacy and representation within the field, and we are already experiencing the effects.
Second, listening programs, detailing a tangible blueprint of steps to bring music into our healthcare environments, provide a simple and inexpensive pathway to one more blue ribbon for a “job well done” to display proudly on a website or on a plaque that hangs in the entry hall for all to see. That seems great, but while the exoskeleton might appear sound, stable and appealing, the interior is rather shallow.
With good intentions, listening programs have identified ways to bring music to medically vulnerable individuals, but they fail to appropriately acknowledge the power of music to induce positive and negative reactions alike. They do, in fact, acknowledge that participants should be monitored and AMTA has even listed guidelines for safe listening, but in the end, it isn’t enough because there is no requirement whatsoever that listening programs need to utilize or even consult a music therapist throughout the process of implementation. As a result, facilities are passing out headphones and applying preferred music with expectations (likely unfulfilled) that the music will always elicit positive responses. The possibility of harm is a real issue, especially when a music therapist is not at all involved in a program’s implementation to monitor participant experience. The individuals participating in listening programs are often unable to adequately express preferences or needs, self-regulate, or process emotions and memories elicited by the music in the moment. To compound the issue, facilities are typically understaffed, and the staff that are present are often so preoccupied with administering care and meeting the needs of their patients that they don’t even have time to sit down. It’s unrealistic expectation that staff will be able to closely monitor the responses of participants to ensure a safe listening experience. In an ideal world, they would have time. In the real world, they don’t have time. This concerns me.
While there is a small amount of training to educate listening program staff on how to monitor responses to ensure a safe listening experience, there isn’t accountability for this process in the workplace and because there is an expectation that music consistently “helps” and never harms, there is a lack of impetus for diligent and responsible assessment, observation, documentation. This makes sense! If the average person overseeing the implementation of music listening programs is not a music therapist and is not required to even consult a music therapist, how should they be expected to really know that music can elicit very real potential for harm? Shouldn’t WE be the first people to clearly recognize that music has the potential to elicit negative experiences that, without proper professional support, can cause harm? Shouldn’t WE be concerned about this issue? Why then aren’t there more music therapists questioning the processes of training, advocating for more appropriate assessment and monitoring, committing to further necessary research, or at the very least, asking questions? This leads us to my last point.
Lastly, we must be clinicians who think deeply and seek to explore the “why” in addition to the “what” of our practice. If we don’t exercise deep thinking to examine the motivations and philosophical lens driving our actions, to explore the efficacy of our approaches, or to identify and support the most meaningful and salient needs of our clients, we ultimately do ourselves, our clients and our field a disservice. It’s only when we are brave enough to look closely, stick our faces into the water and open our eyes to see both the ugly and the beautiful in our craft and medium that we authentically connect and facilitate effective change.
Consider this scenario: imagine the potential for harm if an individual with advanced dementia and limited expressive communication re-experienced a traumatic memory in response to a listening experience. This individual, unable to self-regulate and adequately process emotions in response to the trigger, might be unable to remove the headphones, stop the music, or articulate the need for help. Staff may be too busy or may not be adequately trained to notice. Although hypothetical, this scenario is not implausible. We confidently know that music can trigger difficult memories of loss, emotional pain, and unresolved conflict, and an ipod is clearly incapable of processing real human responses ethically and responsibly.
The depths of human experience and condition are rich, complex, beautiful, and already all-too often unnoticed by those in the world of healthcare. We are uniquely situated to not only notice but respond and make a difference as person-centered, depth-grounded clinicians who refuse to settle for surface level connections when we can offer our clients so much more. It’s clear to me that instead of advocating for more easy-access listening programs, we should be advocating for more music therapy services, supporting our clients with increased access to meaningful music experience with the support of trained clinicians. There is rich beauty and deeply meaningful work waiting to be explored, and our clients need us to believe in that depth enough to guide them to that place and support them there.