Music,spirituality and dementia: Exploring joint working between pastoral care professionals and music therapists to improve person-centred care for people with dementia (Innovative Practice)

Introduction

This study explores whether music may prove a useful tool for accessing spiritual needs and providing meaningful spiritual support for people with dementia. Spiritual needs are an important aspect of good-quality health care. Kirkland, Fortuna, Kelson, and Phinney (2014) determined several therapeutic benefits to acknowledging spirituality in people with dementia, including meeting the following needs: making sense of a situation, finding a purpose, to know we are loved and can give love and perceiving life in terms of values that we attribute to our experiences. Current literature in the field contends that music therapy can enhance quality of life while providing the means for spiritual renewal and healing. However, there is evidence in literature of a lack of confidence in how spiritual interventions are facilitated with people who have cognitive impairment issues (McClean, Bunt, & Daykin, 2012).

Defining spirituality is problematic and has different connotations for different people and in different cultures. For this study, a person’s spirit or spirituality is understood to be concerned with a connection to their essential wholeness, a sense of ‘being’, a connection to a higher purpose and to the essential meaning of their life (Crowe, 2004).

There is evidence throughout history of the link between music and sacred space, and the ability of music to transform and transcend present reality (Salmon, 2001). Music is embedded in most cultures and religions as a vehicle for spiritual expression and is an essential part of religious traditions, used at rituals such as funerals and weddings throughout the world. Music and religion are linked in almost all cultures and one reason for this may be that music functions at multiple levels of human experience: physiological, psychological, sociocultural, ritual and spiritual, thus reaching people on all the levels at which religious experience functions (Magill, 2006). According to Maslow (1977), music allows us to access peak experiences, moments of highest happiness and fulfillment. Musical taste is individual, unique and an expression of one’s personality. Music has been shown to improve mood and regulate arousal also.

Music therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy programme (American Music Therapy Association, 2019). In a study conducted by Tsiris (2016), 78% of music therapists reported that spirituality mattered in their own practice, yet 91% clarified that a person’s spiritual well-being was not their primary responsibility. Clinical therapists tend to focus on evidence-based, clinical, objective practice, and the subjective and esoteric experiences of spirituality can be difficult for clinical professionals to embrace in this culture (Tsiris, 2016).

The connections between music and both medicine and religious experience are well established, but little is known about how the musical and spiritual aspects of human experience work together to influence well-being. This is the focus of this study. Music-based interventions are believed to be of great benefit for the psychological well-being of people with dementia, with benefits including orientation to the ‘here and now’, an accessible medium at any stage of dementia and the potential for an emotionally meaningful experience (Kirkland et al., 2014).

There is a dearth of research on the study of combining music therapy and spiritual care, specifically in the treatment of people with dementia with very few specific studies in this area.

Methodology

A qualitative study using interpretative phenomenological analysis (IPA) was adopted for this study, utilizing Jonathan Smith’s approach (Smith, Flowers, & Larkin, 2009). In-depth interviews were conducted with four participants between September and December 2018. Ethical clearance was given by the University of Limerick ethics board. Purposeful sampling method was used to select participants for the study in order to identify participants who could give in-depth perspectives on relevant experience. Four participants were interviewed: three music therapists (one of whom had experience in running a music therapy and spiritual care group alongside a chaplain) and one pastoral care professional. The inclusion criteria was that they were (1) either a music therapist or a member of the pastoral care service in a hospital setting (2) had experience of working with people with dementia in a hospital setting.

Procedure

Once ethical approval was received, emails were sent to the four potential participants and informed consent was obtained. The length of each interview ranged from 14 to 27 minutes. A qualitative interview is described as a ‘conversation with a purpose’ (Smith et al., 2009) and incorporates the use of open-ended questions to allow the participant to have freedom when describing their experience. All interviews were recorded via an audio recording device and manually transcribed onto Google Documents. Data were stored on a password protected laptop. Pseudonyms were assigned to each participant for the purposes of protecting their anonymity.

Results

The four stages of Smith’s IPA were used for data analysis, resulting in five themes: (1) Music has the capacity to facilitate spiritual expression; (2) Spirituality is necessarily a broad and evolving term; (3) Spirituality may be a coping mechanism for people with dementia; (4) Music therapy contributes to validating the individuality of the person with dementia; and (5) Collaborative work between music therapy and pastoral care is worthy of further exploration.

Discussion

This study reports the experiences and reflections of healthcare practitioners who encounter music, music therapy and spirituality in their work with people with dementia.

The findings suggest that defining spirituality as a phenomenon is a complex and difficult task. This may contribute to why there is little research currently on the phenomenon as it appears so subjective and there are relatively few guidelines or training for healthcare professionals on approaching the topic of spirituality with their patients or providing spiritual care to encourage well-being.

The study also highlighted the importance of upholding the individuality of people with dementia beyond a label or diagnosis of dementia. Music and spiritual care contribute to addressing this need.

The stigma surrounding a diagnosis of dementia was identified in this study, suggesting that the misconceptions that people have about dementia can put limitations upon people living with dementia. The significance of the aesthetics of the hospital environment was also noted, citing the importance of choosing quality and personally meaningful music choices. This parallels with studies of the aesthetic environment of hospital, whereby positive impacts of engaging with the arts in hospital environment included feeling cared for and the discovery of new interests and achievements at a time of great loss (Moss & O’Neill, 2014).

The study also outlines the benefits of engaging with spiritual care, that a person’s spirituality can be utilised as a coping mechanism. Although one’s spirituality is central to appropriate health care of people with dementia, it is not a subject that is currently explored in much depth during training for music therapists. During Mary’s interview, she suggested that creating interdisciplinary practice with pastoral care services would put spirituality on the agenda more directly for all health care professionals.

The main limitation identified by the researchers is the small sample size. Although it allowed for the researcher to gain an in-depth and detailed perspective into the phenomenon, it makes it difficult to generalize the findings. Secondly, the study focused on hospital settings only and therefore the results cannot be viewed as an overall summation of the phenomenon. Further research with a larger sample size may be beneficial to gain increased insight into the phenomenon of music therapy and spirituality and exploring joint working between the services. Research on combined approaches between music therapy and pastoral care in residential care settings, community settings and at home is recommended. This may further enhance an understanding as to how to deliver effective spiritual care using music and to devise concrete recommendations for joint working between music therapists and pastoral care workers. A larger scale study to incorporate international perspectives would also be valuable in gaining insight into current practices. Finally, research from the perspective of people with dementia and their families would significantly enhance understanding of this topic.

This study highlighted how, as individual services, music therapy and pastoral care are exploring how to provide good-quality spiritual care for people with dementia. Both services facilitate time for reflection, processing of difficult emotions and providing opportunities for coping. The creation of a more concrete link, referral or otherwise, would allow for increased attendance to the spiritual needs of this population. The study found that there is potential for collaborative work in hospitals to provide benefits for people with dementia. It also confirmed the importance of acknowledging the spirituality of people with dementia within hospital, and how music and spirituality complement each other within hospital care services. Collaboration between music therapy and pastoral care services is encouraged to investigate further the potential for improving spiritual care for people with dementia and to develop excellence in this innovative practice.