State of Presence, State of Mind

This last week found me in contrasting, yet similar situations- both of which required being in a present state of mind.

Typically my week is filled with making hospice visits to older adults diagnosed with illnesses such as Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure (CHF), Adult Failure to Thrive, and/or some form of dementia, like Alzheimer’s. During these visits, I’m providing music therapy services to individuals or their families.

However, last week found me leading a drum group for “tweens” attending a school-based therapeutic summer day program. I’ll admit that I was a little nervous about what to expect from the experience as it had been a few years since I had led therapeutic musical activities with a group of children over the age of 8.

But I went into the classroom with a plan and an understanding that the plan might have to be modified, based on the immediate need(s) expressed in the moment.

And what can I say? The group went beautifully well. Together we drummed, shared, and sang. We entrained as a single group through the music, and at times we sounded to be of “one mind.” Likewise, everyone was present in their own way- whether that was to the group, or to themselves and their own internal state if the group or music were too much for them.

I’d like to now contrast this experience with another one I recently had with one of my hospice patients who has dementia and unspecified debility.

It has been my experience that music therapy in hospice rarely follows a structured session plan because a person’s needs or state of mind can vary greatly from visit to visit. And during this particular visit, my patient seemed most interested in engaging in conversation with me.

To positively interact with someone who has dementia, I make reflective statements based on things they say, or use music as a way to reflect back and support that person’s expressed state of being. The approach I take greatly depends on what the other person is communicating to me, because if they seem content to talk and share, I don’t want to interrupt that self-expression with a song.

Needless to say, sometimes these validating interactions lead to quite lucid and profound statements made by the other person.

That was the case during this particular visit. While the two of us were sitting alone together in the common area of the locked memory unit at the assisted living facility where she lives, she looked at me at one point during our conversation and asked, “Is this all a dream? Isn’t this queer?”

Needless to say, I was shocked by the existential questions she had just asked me. Yet since I’d been recently reading about transpersonal gerontology and gerotranscendence, I was open to the possibility that deeper, psychospiritual processing and meaning-making can occur for those who have dementia.

At another point in our conversation, she told me about her brother who had won an organ competition and went to Europe. She mentioned this several times and questioned where he was. Since there was some quiet space, I sensed an opportunity to sing a song with a theme of longing and loss, so I began singing “Red River Valley.”

By this time, another resident had come into the room and sat down. As I sang, this other resident began mouthing along to the words, while the hospice patient with whom I was visiting closed her eyes as I sang the first verse, and began to speak again after the chorus.

When I finished singing, the other resident who had joined us looked at me and said, “Thank you,” and the patient I was visiting began to tell me more about her family.

When our visit ended, my patient thanked me for the chance to “reminisce.”

I left there that day feeling humbly touched by the clarity and the depth of insight that can still at times be expressed by those who have cognitive impairment.

While the two situations described above occurred in different environments and within different contexts, both required a certain state of mind and presence in order to allow for the positive, therapeutic outcomes that were experienced by all who were involved.

In what situations from your own life do you notice the effect that your state of mind or sense of presence has on how you experience those situations? How might you change your state of mind or presence in order to have the quality of experience you desire?

As always, please share your thoughts and comments below. And you can go here if you’d like to learn more about the hospice and palliative care music therapy services I provide.