Ep. 028 | Music Therapy & Dementia Part One
Today, we chat with guest, Kaylee Tilton, a board-certified music therapist, about the benefits of music therapy for people with dementia.
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Positive Approach to Care by Teepa Snow
TRANSCRIPT
Erica: Welcome, friends! You’re listening to The Feeling is Musical — as presented by the Snohomish County Music Project. My name is Erica Lee, and today, we are talking about music therapy and dementia, with board-certified music therapist, Kaylee Tilton. Kaylee was born and raised in Edmunds, Washington, and studied music therapy and psychology at Berkley College of Music in Boston. She has been a board-certified music therapist for 5 ½ years, and practicing mainly in the field of memory care.
[Podcast intro music plays]
Erica: Thanks, Kaylee, for being here this morning.
Kaylee: Thanks for having me.
Erica: Absolutely. So, I’m excited to talk about your experience in the dementia community, and bringing music therapy to that, but then also working with other professionals - um creative arts professionals in those areas. And yeah, it’s gonna be a good time.
Kaylee: Absolutely. I’m excited.
Erica: So, let’s just start with some basic questions for listeners to get to know you a little bit better. What originally got you interested in becoming a music therapist?
Kaylee: That is a really good question. So, making a long story short, um, my - my dad was always my biggest musical influence. He was a musician, and we were always playing music in our house. And when I was 5 years old, um a couple of things happened in my life - the first being that my dad was in a very serious car accident, and suffered a traumatic brain injury. He was airlifted to Harbor View - he was in a coma for a month - on a respirator - tube fed. And when he woke up, he thought he was 15 years old, not 40, so he had absolutely no memory of me, or my mom, or my siblings. He needed to relearn how to speak, how to walk - he couldn’t even hold his head up. So it was - it was pretty earthshattering for me. But m mom was a nurse, and we were really closely involved in his recovery. And she encouraged us kids to talk to him, even though, at the beginning, it was kinda like he almost wasn’t really there, and he didn’t really acknowledge us.
And one day I decided to sing to him. And I think it was just a silly song that I learned at my kindergarten class, but the moment that I used music - the moment that I sang to him was the first moment that the light behind his eyes came back on. And we had this meaningful connection, and from then on, we sang to each other as often as we could. And I really, from a personal place, understood how much music has this power to connect, and to break through any barriers, and to really help us meet a person on a profoundly human level. And it wasn’t until much, much later, when I went to college, that I took a course in music therapy just as an elective ‘ cause I was curious. And the first day, professor Kathleen Howland talked about traumatic brain injury and music therapy - and it was just this lightbulb moment for me. And I thought, oh, I have been training for this my whole life - let’s figure out how to do this.
Erica: That’s really beautiful. I love that - that story and how that came to be. You don’t always know what’s coming down the road, and how a relationship can or cannot be preparing you —
Kaylee: Exactly —
Erica: For things, yeah. How would you describe your therapeutic approach or philosophy?
Kaylee: So I practice a really client-centered approach. I regard all of my residents as fully complicated humans, with very unique stories, and unique history. And basically, that they are not the sum of their symptoms, and that they are not - their disease . I try to practice really radical unconditional positive regard for my residents um as they move through the progressive disease that is dementia - and so often change really drastically throughout that process- so I just try to stay with them, and have a really holistic and humanistic approach, that focuses on success-oriented interventions, and really being present with them in that moment - and with who they are when they come to my group.
Erica: Mmm. I cannot agree more with your philosophy. And like, I know you out of the context of the podcast - and we’re friends, and like, I’m aware of your work. And as somebody with parents and grandparents that are affected with memory loss conditions of different types - and know the degenerative nature of them - I really appreciate how you’re recognizing their whole existance —
Kaylee: Right —
Erica: In the settings you’re working in - and that it’s not just, oh, Bob has dementia, or Mary has Alzheimer’s, or like, whatever the exact nature of the disease is for that person. That - that’s so good —
Kaylee: Yeah —
Erica: To - to hear if I was trying to get your services, or trying to get my parent or grandparent into the facility you worked in.
Kaylee: Oh, thank you. Yeah, so often, I think, it’s easy to kinda diminish somebody down to whatever symptoms they’re experiencing —
Erica: Mmhmm —
Kaylee: Especially if those symptoms are really challenging or frustrating - and they’ll - you’ll just be like, oh yeah, well Mary, she’s really agitated all the time - or Bob is super difficult or violent. And it’s like, well, no, that’s not who they are - that’s a symptom of what they’re experiencing - and so often, just they’re trying to communicate something that they can’t communicate - some sort of unmet need. So, looking at them through the lens of however they’re presenting right there is just so limiting and so narrow.
Erica: Yeah. Absolutely. Can you tell the listeners a little bit about the experience you have working with dementia community and the folks in that community?
Kaylee: Yeah, absolutely. So the first time I worked with someone with dementia was in my sophomore year of college, during a music therapy practicum course. And it just so happened that my supervisor during that practicum course would eventually become my internship supervisor, though I didn’t know it at the time - so I ended up getting a lot more experience um with folks with dementia when I was in my internship. And when I went into internship, I initially thought that I wanted to work with kids. So I had the opportunity to make a music therapy pilot program on a pediatric unit at a hospital where I was working during the internship - and I had a lot of fun doing it, but realized that it wasn’t really a sustainable population for me to work with, and that - that I would eventually burn out on that. But at the same time in that internship, a bunch of my other experiences were with people with dementia, and I was really just falling in love with it - working in memory care. So that was kind of my introduction, and then during my 5 ½ years uh working as a professional, I’ve been working in this setting that whole time. So it’s - it’s the bulk of my professional experience as well.
Erica: Yes. And you serve as an internship supervisor now, right?
Kaylee: That’s right, yeah. My second intern graduated in April —
Erica: Yay —
Kaylee: Super-duper proud of her.
Erica: That’s awesome.
Kaylee: Um, and right now I’m accepting applications for my next intern, who would be my third. I - I absolutely love supervising students - practicum all the way through internship. I think it’s so important and so useful, and it makes me a better therapist - makes me more accountable - and is just like one of my most favorite parts of the job.
Erica: It’s so fun to watch the development of a person —
Kaylee: Yeah —
Erica: And as they’re growing into their professional being, and other identities that we’re working on etc. For folks that maybe are aware of what music therapy is, but have never like had a session - are wondering about signing their parent or grandparent up for music therapy - can you walk us through what are like the qualities of music that you use to support a dementia patient? And then, what is an example of what a session looks like - what can a person practically expect to see?
Kaylee: Yeah, absolutely. So lemme start with the first part of your question. So music is a really amazing tool for somebody who has dementia, because memories associated with music are sustained longer than all of our other memories which are lost during the progression of the disease. So that is a fundamental part of music, and how we can really use that to our advantage in our therapy. And then, also, because music is a whole-brain activity, it’s a really healthy activity for anyone who’s impacted by any neurological disease.
So, to delve a little bit deeper there, the melodic aspects of music can really help them to regain some speech as they’re losing it - some verbal fluency. If they’re developing something called aphasia, which is really common in dementia - and that’s just a disorder that they think they’re saying something completely clear, but it doesn’t quite come out of their mouth the way that they are thinking it. So the rhythmic aspects of music and the melodic aspects of music can really help in the areas of speech. We also work on fine and gross motor skills, and maintaining those for longer with, you know, playing instruments and with dancing. And it’s also really important to remember that, with this population, the goal isn’t to really improve their skills - the goal isn’t to heal them or to cure them. This is a degenerative disease, and it’s a progressive disease, and that’s the fact of the matter. So they are going to get worse. Rather, my goal is to help them maintain the skills that they have for longer - and slow down the decline of their abilities so that they can experience a greater quality of life.
So what does that look like in a session. What - what does a session look like? One of the biggest things is the social connection with their peers, family member, and staff. Because dementia can be so isolating, music allows them to engage in activities really successfully, in ways that their symptoms from dementia aren’t getting in the way, and aren’t stopping them from really fully participating. So, it’s this beautiful platform where we’re all kind of equalized, and they can interact a little bit more easily. There’s also expression - verbal and nonverbal - musical skills, and then, a lot of what I do in my work is this non-pharmacological pain management intervention. SO, if somebody’s experiencing some pain, it can be tempting to just go straight for a pill - ‘cause it’s kind of a quick, easy fix. But obviously, we don’t want to just over-medicate our - our residents. So I can go in with music, and music can help to promote deeper breathing - and the deeper breathing helps with the physical relaxation and the release of some tension. And that’s really helpful.
It’s also a non-pharmacological approach for some mental health goals, like anxiety or depression, which are just so prevalent for people that are living with dementia. And music allows them to give voice to their experience, and help them work through this process - and work through their feelings. They have feelings of loss of independence - they’re dealing with their own mortality - and one of the more profound things that I love to do is, toward the end of life - in hospice care I’ll do bedside music therapy sessions. And the elements of music allow for respiratory entrainment - which means that their breathing rate will automatically sync up with the - the rhythm of the music that I’m playing. So their breathing can become a little bit more steady and even, and, therefore, their body becomes a little bit less tense and can help with some of that pain. And, of course, choosing those songs that are most meaningful for them can really be a profound moment for their loved ones, and provide the space for this emotional and spiritual connection to process the grief and have some closure with that - with that loved one as they pass on.
Erica: That’s really beautiful. How do you choose the music that you would play in that circumstance? What are you taking into consideration when you’re choosing the song or songs you’ll play for a person?
Kaylee: That’s a really great question. So, the best music to play is the client-prefered music. So, what that means is the um the music that’s most meaningful for them - the music that they most enjoy - because that’s going to be the stuff that really connects - that’s gonna be the stuff that makes those memory connections in their brains - that’s gonna be the stuff that excites them and engages them most.
So, because dementia is a progressive disease and is a memory disease, often, our residents will kind of regress through the process. And so, I’ll usually be using music from their youth - so from their teen years to maybe their early 20’s - their young adulthood. That tends to be the music that is most strongly rooted in their memories -and also is the music when they’re kinda coming of age and figuring out who they are, and making their own taste and deciding what they like and what they enjoy. So, I always —
Erica: Mmm —
Kaylee: Go for client-preferred music.
Erica: Absolutely. Yes. And that kinda ties into an aspect of how we mutually practice trauma-informed care within the clinical practice. What are some ways that you additionally practice trauma-informed care?
Kaylee: That’s a really great question. One way that I see this come up a little bit more in my particular population in memory care is - this is coming up a lot more around Veterans’’ Day. Broadly speaking, World War II veterans tend to be proud of their service - they welcome people thanking them for their service. And in my internship and in college ,that was the experience - that Veteran’s’ Day was a celebration, and everyone really welcomed it, and felt a sense of pride and - and enjoyed being kinda the center of attention, and getting a day to recognize them. However, this population is changing. So, people that served in Vietnam have a drastically more complicated experience with their time in the service. A lot of them were anti-war, or maybe they were - they were pro-war and then they went and saw and did some things that they disagreed with um on a moral level. Of course, the context of the social unrest at home is a big part of that too. So as the demographics change in my groups, and I begin to have more Vietnam era veterans —
Erica: Mmhmm —
Kaylee: I mark Veterans’ Day a little bit differently - and I try to include discussions of historical context - I always include protest music, music about promoting peace. And then I make sure that I follow up with those veterans one on one that day to make sure that I’m understanding their feelings, and that if anything came up for them in a group setting, that we have a private session - that we can process those feelings that might come up for them —
Erica: Mmhmm —
Kaylee: When we mark that day.
Erica: Mmm. In like the private sessions, what are some examples of responses that residents have had?
Kaylee: The first one that comes to mind is actually somebody - he was exempted from the draft for a medical reason, but his opinions on war are very staunchly anti-war —
Erica: Mmm —
Kaylee: Staunchly pro-peace. Even though he didn’t serve, he has a really strong reaction - he’s touched by those experiences because, though he - he didn’t put on a uniform himself and he didn’t deploy, all of his classmates were impacted by this - everybody in his graduating class, unless they were like him and they were exempt, served. And so many of them did not come home. And so he has a lot of feelings of anger around that. And he loves loves loves Bob Dillon —
[Erica chuckles]
Kaylee: So typically, [chuckles] typically when I process those feelings of anger that he has - about the loss of innocence and the loss of so many of his classmates - we let Bob Dillon kinda give his feelings voice. Um, particularly the song “Masters of War” - it’s a really powerful song by Bob Dillon and really exemplifies the anger that he feels about the people in power and how they used many of his classmates for their gain.
Erica: Mmm. Wow, that’s powerful. Trauma-informed care is important, and so, how, as an internship supervisor are you passing on that value of trauma-informed care to future therapists?
Kaylee: So, first of all, we’re having conversations just like this one. Um, I had this exact conversation with my past 2 interns um right around Veterans’ Day. But also, the way that I structure my intrsnhip, I make sure that there are plenty of opportunities for them to observe me in a group and in an individual setting, to make sure that they see some of these issues come up. And then we verbally process together afterward how to meet those, and how to support a resident through working through those. And then, when they become more independent, we are still verbally processing together - as supervisor and intern - about things that might have arisen, and the best things to contextualize, and the best ways to support residents.
Erica: Mmhmm.
Kaylee: I’m just starting to have kinda conversations with myself so far - ‘cause I don’t have a new intern yet - but I have been seeing more discussions about songs that have a dark history in terms of racism in our country —
Erica: Mmm —
Kaylee: The black face minstrel songs of our history. And thinking about if those have a place in our practice, and if we do include, how important it is to contextualize them. This is something that I’m really just starting to think about - and has been kinda brought on - online in music therapy circles - but I think that’s another big area to really consider carefully.
Erica: Absolutely. We’re recording this episode mid-June, so it’s gonna be about a month and a half before it actually goes out into the world. But we’re in the middle of like the height of Black Lives Matter for June/end of May 2020, and reframing how we look at songs - and even how we look at the words we choose - there’s so many different ways that racism becomes insideus and just imbeds itself into the system. That encourages me that the music therapy community at large is hopefully gonna start reexamining, especially in Washington State, the music we choose, and the connotations we hav - with our practicum students - with our interns - and with our peers.
Kaylee: Right. If we think about just how language has developed over time, like there are certain words and phrases that are really not acceptable to use today that were not offensive in our parents’ generation or our grandparents’ generation.
Erica: Mmhmm.
Kaylee: Same is true for music. They’re inextricably woven together.
Erica: Hi, friends. It was so fun getting to chat with Kaylee about her work and experiences that we want you to hear the whole conversation. So, tune in next week to hear part 2, where Kaylee addresses some of the biggest misconceptions that she encounters about her work in music therapy and dementia. Be safe, wear a mask, and we will talk to you next time.
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