chapter  Chapter 17
17 Pages

Negotiating the border

Music therapy for people in the last hours of dementia
WithAdrienne Freeman

This chapter explores issues encountered when offering music therapy at the end of life. Bunt and Weber pose that hearing usually functions until death, rendering music a relevant means of being present for the dying person. The extreme vulnerability, high dependence and intimacy encountered in advanced dementia and at end-of-life can result in the therapist experiencing powerlessness in the counter-transference.

Nursing tasks around bodily needs can easily become part of the therapy session. Relatives may be present and for them this is frequently a time of heightened emotion. Great sensitivity is required in order to negotiate such territory: this chapter considers factors that equip the therapist, including clinical supervision and liaison with multi-disciplinary colleagues and next-of-kin.

The person in their last hours may not be able to clearly indicate their wishes, necessitating the holding in mind of personal history. Bunt argues that identity remains validated through the use of music connected with life experience. Aspects of spirituality are reflected upon. Ways of offering single session music therapy to new patients are considered. Case material illustrates the Music Therapist’s exercising of clinical judgement. Observations of therapist, colleagues and next-of-kin are included, serving to underline music therapy’s impact at end-of-life.