13th INTERNATIONAL CONGRESS ON CARE OF THE TERMINALLY ILL

page2: MUSIC THERAPY, ALTERNATIVE, HOLISTIC, SPIRITUALITY
page1:  CLINICAL AND MEDICAL PRESENTATIONS
 

13th INTERNATIONAL CONGRESS ON CARE OF THE TERMINALLY ILL
ABSTRACTS RESEARCH PAPERS, WORKSHOPS, MUSIC THERAPY WORKSHOPS
SEPTEMBER 25-29,2000
PALAIS DES CONGRESS, MONTREAL, CANADA
PRESENTED BY
PALLIATIVE CARE DIVISION, DEPARTMENT OF ONCOLOGY, McGiLL UNIVERSITY

 
 ~ SESSION C27 — Life Review: Grief, Loss and the Creative Process
PATRICE A. REPAR. Sandia Hospice, J. RUSSELL KIEFFER. The Hospice Memorial Foundation, KATHLEEN KINGSLEY-BAEZ, Sandia Hospice, Albuquerque. New Mexico, USA

Tlie Life Review Project was conducted by The Hospice Players in order to determine the impact, if any, the recorded life  review of hospice patients and their families ultimately has I  upon the nature of the dying process. A nonrandom sampling of hospice patients were interviewed with eight specific questions pertaining to life experience. Patients were informed that their recorded interviews would potentially be used by the Hospice players as material for a dramatic/musical presentation designed to educate about death and dying, grief and loss. Families were able to rate their experience of the interview process, with a significant number indicating the belief that the creative procedure assisted in the dying process, facilitated the resolution of "unfinished" business, gave patients I  a sense of meaning and legacy in story telling, provided a "narrative container" for the placement of grief, and was overall a positive therapeutic tool. Recorded interviews have subsequently been used in a dramatic interpretation developed as a creative alternative to traditional models concerning the topic of grief and loss/death and dying. It employs the use of art, drama, music, and interpretive movement as a means of educating, heightening compassion, and augmenting the ability of medical professionals, individuals, and communities to grieve, and to aid one another in the experience of grief. If art imitates nature, then the expression of grief and loss, through artistic media, may be archetypal for the human experience. This workshop will explore the interview process, examine creative approaches to life review, and will include a "life review" presentation of The Hospice Players.
 
 

~ SESSION C43 — Interactive Theatre: the Power of Experiential Learning

CORI SCHRODER, PIPPA HALL, MARYSE BOUVETTE, LYNDA WEAVER, and VAL FISET. University ol Ottawa Institute of Palliative Care, Ottawa. Ontario, Canada

This workshop will provide an opportunity to participate in an interactive theatre session, an exciting experiential method of learning palliative care. Palliative care is challenged to develop effective educational programs that will result in better end-of-life care for patients and their families through improved knowledge, skills, and attitudes of the professionals providing the care. The University of Ottawa Institute of Palliative Care has been involved with the planning and delivery of interdisciplinary educational programs since 1994. Effective education demands respect for the principles of adult education and requires methods that teach knowledge, as well as communication skills and interdisciplinary teamwork. Discussion by team members around cases and the use of role-play can assist learning within the domains of psychornotor skills and attitudes, but these methods have their limitations. As a component of an interdisciplinary palliative care education program, faculty of the Institute of Palliative Care have developed an experiential learning method using interactive theatre. The sessions are designed to recreate actual palliative care situations in which participants arc required to apply their knowledge and skills as they fulfill their roles within the interdisciplinary care team. This interactive workshop will provide an overview of the teaching method, and allow participants to experience an interactive theatre session and to evaluate the approach as a learning method for palliative care.
 

~ SESSION D28 — A Developmental Framework for Spiritual Experience with Life's End

IRA R BYOCK. University of Montana, principal investigator Missoula Demonstration Project, Missoula. Montana. USA

Spiritual aspects of life often come to the fore as death becomes more proximate. These dimensions of experience are potential sources of suffering as well as potenlial sources of personal strength. Definitions of "spiritual" vary widely. For some people, the terms transcendent, religious, existential, and soulful are synonymous with the word "spiritual". For others, they describe importantly distinct aspects of existence and experience. This presentation will build upon a definition of spirituality that encompasses sources of ultimate meaning, a sense of connection to something larger than the self thal endures into an open-ended future, and a response to the inherent mystery of existence in its wondrous and terrifying aspects. A conceptual model and coherent terminology will be presented as part of a human development approach to personal experience with life's end. Taxonomy for spiritual experience will be introduced and practical therapeutic applications delineated. The model enables individualized spiritual assessment, enhances specificily of spiritual care interventions For dying patients and their families, and provides a basis for reliable valid outcomes assessment. A developmentally based quality of life assessment tool that integrates spirituality can be used to assess subjective intrapersonal and transpersonal realms of spiritual experience in quantifiable, reproducible fashion. This tool can be used in care planning and quality improvement programs.

~ SESSION D28 — What is this Talk of "Spiritual Assessment"?

ZINIA PRITCHAFD, Palliative Care Program, CELIA ROMERBECUWE and YOKO TARUMI. Division ol Palliative Care Medicine, University of Alberta, Edmonton. Alberta. Canada

In the practice of the art and science of palliative medicine, reference is often made to the "spiritual" component ol pain. However, the word "spiritual" is rarely defined and the language of the medical practitioner often depicts a philosophical world view that is at variance with that of the spiritual care giver. This workshop is intended for a multidisciplinary audience and seeks to share the Edmonton Palliative Care Community's own practical-theological process in reflecting upon the following questions: What is meant by the "spiritual?" Who expects what from a spiritual assessment? How regularly ought a spiritual assessment be conducted? What tools are currently in use, and what are their strengths and weaknesses? This workshop will also address the challenges raised by an international group of physicians training in Edmonton. In the absence of the specialist in spiritual care in their home countries, physicians need to be aware ot the spiritual issues of their patients and also know how to palliate these issues. Their dilemma puts into relief the challenge facing many Canadian physicians who do not have access to professionally trained specialists in spiritual care. This workshop will therefore seek to address questions that have arisen out of this interdisciplinary dialogue: How can physicians respond appropriately to spiritual suffering? What are the limits beyond I  which a physician ought not to go? in what way can a physician evaluate his/her own palliation of spiritual suffering? What is the role of the spiritual care specialist? The workshop will conclude by providing participants with the above physicians' personal reflections on their formation for spiritual care, and how their growth has affected their practice of medicine.

~ SESSION D48 — Mindful Spiritual Growth for Dying Persons and Their Carers

IAN MAYOR, and DEIRDRE HANNA. Hopewell Hospice Services Inc., Hope Island, Queensland. Australia

Spirituality is broader than religion and is one of the most valuable aspects of our humanity in caring for the dying. Death is often viewed as opposed to life, but it can be our teacher, and the dying our tutor, reminding us to live passionately in the present moment. Hopewell offers a model of community hospice care where carers are co-travellers with the dying, and death awareness as a means of spiritual growth is linked to hospitality for the dying. Experimental procedures: The presenters have used conceptual analysis to explore ways in which mindfulness and meditation can enrich and promote spiritual growth through working with the dying. An experiential presentation will focus on grief, illness, and death issues to help spiritual processes unfold, releasing healing energy as a springboard to spiritual growth. Cartoons, music, and meditation will provide stimulation for reflection. To guide holistic palliative care, the analysis defines four aspects of spirituality: lifeforce, connectedness, separate identity, and meaning and purpose. Dimensions of spiritual pain are defined and linked to dimensions of human nature. Insights from Ken Wilber's analysis of knowledge identify additional ways of caring mindfully. Conclusion; Our physical form is the context in which we experience spiritual reality, and all life processes, including grief, illness, and death, can be vehicles to spiritual growth.

~ SESSION D48 — Spirituality: a Part of Nursing?

JOANNE E. SHELDON, Hospice Institute of Hospice of the Western Reserve, Cleveland, Ohio, USA
Many nurses shy away from providing spiritual care to their patients. This workshop will discuss characteristics of spirituality, barriers to providing spiritual care, differences between spirituality and religion, discussion of one's own spirituality and its impact on patients, assessment of spirituality of a hospice patient, and the use of the nursing process to affirm and confirm our ability and the needs of the patient. Through an interactive workshop, each attendee will be able to use a spiritual assessment to determine her/his role in spiritual care of the patients and families, to recognize specific spiritual needs of a terminally ill patient, and to determine interventions that may be used. We will discuss inner work that the patient may be experiencing and ways that a nurse might be part of that awakening. This will assist the patient in identifying spiritual pain or distress that he/she might be feeling. We will recognize how the role of the nurse and a chaplain or spiritual coordinator can work together for the good of the patient and her/his spirituality. Everyone has spirituality. Since it is such a part of us, spirituality should be nurtured in every way possible and by whoever is able to be present with the dying patient. Spirituality is a vital piece of nursing.

~ SESSION El 4 — Enabling Death at Home

LOUISE POTHIER, PAUL MCINTYRE. FRANCOISE ST.DENIS, GLENNA THORNHILL, RUBY MACDONALD. and MONICA FLINN, Palliative Care Program, Queen Elizabeth 11 Health Sciences Centre. Halifax. Nova Scotia, Canada This workshop will examine the factors that enable death to be managed at home. Evidence will be drawn from published literature and from a six-month prospective review of the experience of the QEII-HSC Palliative Home Consultation team, a hospital based regional home consultation component of a comprehensive palliative care program. This program serves a catchment population of 350.000, and works in collaboration with community physicians and agencies, and is involved with approximately 200 home deaths/year. Components of care to be examined include: (a) initial assessment, identification of caregivers, establishment of roles, (b) goals of care, (c) support needs of patients and family, (d) management of symptoms in last days of life, including continuous subcutaneous infusion, (e) ongoing assessment and adaptation of goals of care, (f) caregiver issues-communication, roles, leadership, (g) evaluation of interventions and outcomes. Clinical issues will be illustrated with case examples, and participants will be invited to share problem-solving strategies and helpful clinical tools. The overall goal of the workshop is to highlight challenges in home care of the dying, and to allow participants to share their experiences and their insights.

~ SESSION El 5 — The Missoula Demonstration Project: a Community-Based Approach to Improving Quality of Life's End

IRA  BYOCK,  University of Montana, principal investigator. Missoula Demonstration Project; Missoula. Montana, USA

The Missoula Demonstration Project is a community-based effort to study and improve the quality of life's end. Missoula, Montana, is offering itself as a laboratory of experience in a longitudinal effort to improve the quality of life of people with serious illness and to support family in their caregiving and in their grieving. Baseline research is being applied to inform public engagement activities in an ongoing process of evidence-based community-wide quality improvement. Too often, efforts to research end-of-life experience and improve end-of-life care approach dying as a set of medical problems to be solved. However, dying is a time of living. In actuality, dying, caregiving. and grief are experienced within the context of personal, family, and community life. The majority of caregiving for people with advanced chronic illness is performed by friends and relatives, and takes place in home and community settings. This workshop will present the conceptual framework of evidence-based community-based quality improvement. This multi-component study integrates clinical, sociologic, ethnographic, and health sendees research to develop a hligh-definition "snapshot" of end-of-life experience and care that can form a baseline for future work. The research design, strategic approach, early community engagement experience, and preliminary findings will be presented.

~ SESSION El 5 — How the Palliative Care Nurse Practitioner Integrates Care into an Underserved Community

   KIM K. KUEBLER. Adjuvant Therapies Inc.. Lake, Michigan, USA

As advanced practice nurses enter into all areas of healthcare, end-of-life care is no exception. The advanced practice nurse with a specialty in palliative care is a vital asset in an underserved community. This presentation describes a rural community-based palliative care model that uses the framework from the time-tested British Macmillan Nurse. The palliative care nurse practitioner using the Macmillan Nurse components of care can provide comprehensive palliative care to persons with advanced illness. The Macmillan Nurse is the advanced practice nurse in the UK, who integrates palliative expertise into many underserved communities through clinical practice, consultation, education, and research. Interactive components of this model will be described, along with the use of practice protocols to improve both access and quality of care for many isolated persons. Demonstration of actual case examples will highlight the efficacy of the rural palliative care nurse practitioner in rural Michigan.

~ SESSION C01 — A Phase II Trial of Reiki for the Management of Pain in Cancer Patients
KARen OLSON, International Institute for Qualitative Methodology, MARY MICHAUD, Cross Cancer Institute. JOHN HANSON, Alberta Cancer Board, and DAWN STUCKLESS. Cross Cancer Institute, Edmonton, Alberta, Canada This randomized trial (n=24) compared cancer pain in two groups of patients, those receiving standard opioid management, and those receiving standard opioid management plus Reiki, a complementary touch therapy. Participants in the opioid plus Reiki arm received two Reiki treatments (Days I and 4). Participants in the opioid only arm rested for 1.5 hrs. in the afternoon on Days I and 4. VAS pain ratings, blood pressure, respirations, and pulse were checked before and after each treatment/rest period. Quality of life was assessed on Days I and 7. There was no significant difference in pain mechanism, nature of pain, previous narcotic exposure, cognitive function, psychological distress, drug tolerance, or alcohol/drug addiction between the experimental and control groups (Edmonton Staging System). VAS pain scores were significantly lower for participants in the opioid plus Reiki arm, compared to the opioid only arm, following both treatments (Day I, p=0.0204; Day 4, p=0.0008), but the change in MEDD was not significant for either group. The quality of life data are still being analyzed.

~ MUSIC THERAPY WORKSHOPS

I ~ SESSION A50 — The Ecology of Song Creations by Children in a Pediatric Cancer Ward I     TRYGVE AASGAARD. The National Hospital, Oslo. Norway

 What happens when hospitalized children with cancer create and use their own songs (in cooperation with the music therapist and others in the hospital environment)? This paper presents a qualitative methodology for describing and understanding sonf, phenomena in music therapy practiice. The research material consists of the histories of 18 songs by five children with various malignant diseases. The author has worked I  out a practical method for studying and presenting the "lives" (processes and meanings) of the songs. Some songs' lives are just momentary, other songs are remembered, written down, I  recorded, etc., and are being used and re-used by the child in a variety of situations and during many months or even years. I  This longitudinal study reveals that many songs are not only helping very sick children to express themselves and to handle tough experiences. Song activities also contribute to provide pleasurable moments and to increase the role repertoire, not only of the child, but also of relatives and hospital personnel. To achieve an   understanding of these phenomena, our scope of study is directed towards the song as a source of interplay between the child and others, and how this may further influence the actual culture of the I  sickroom-ward-hospital. The epistemological perspective of this I  study of music therapy practice is ecological. A change in an individual or in an ecological context will ultimately lead to changes in I  the other (Brusda 1998). Preliminary' results from the project indicate that the health-promoting influence of song creation goes beyond that of the individual patient

  ~ SESSION A50 — Music Therapy in the Care of the Terminally III

 LISA GALLAGHER. and LOUISE STEELE, Harry R. Horvitz  Center lor Palliative Medicine, The Cleveland Clinic Foundation, The Cleveland Music School Settlement, Cleveland, Ohio, USA

  The purpose of this presentation is to demonstrate that music therapy can be effectively used to assist terminally ill patients  with: (a) anxiety reduction and pain distraction through mu'  sic-assisted relaxation and music-making, (b) self-expression through the writing of life songs, (c) solace, comfort, and spiritual affirmation through listening, (d) communication, interaction and support between patient and family mem1  hers through musical gifts and music-making. Using a computerized database, the impact of music therapy interventions on 160 patients seen from 1998 through 1999 has been analyzed. This is the first time a data pool has been used to track the effects of music therapy in palliative medicine. The database is ongoing and is currently being used to compare i  data taken on an inpatient palliative medicine unit with that taken in hospice. The results of this analysis (including goals utilized, effectiveness of interventions, styles of music used, decreased perception of pain, improved mood, decreased anxiety, etc.), patient and family evaluation of services, and staff satisfaction surveys will be discussed. Handouts, recordings, and visual aids will be used to supplement this presentation.

~ SESSION A50 — Guided Imagery in Music Therapy: Unity in Diversity and Diversity in Unity

SARA S. BATTAR, VA Central Iowa Health Care System, Knoieville, Iowa. USA

  Music is considered a universal language, capable of delineating the subtle shifts of emotions. It can also be potent as any consuming passion. Guided Imagery (Gl) may enhance such I   effects of music. It has the potential to evoke one's innermost quests and questions, thus promoting avenues for subconscious interactive communication channels. Gl may also facilitate reality of existential morbidity and mortality when l  offered by uniquely qualified individuals. Eastern India has rich cultural heritage, and has had an abundance of distinct musicians and composers. Gl has been in vogue for centuries, I  assisting vulnerable and dying population. Gl is considered  an acceptable and successful modality for preparing the dying and other involved persons in a spiritual ritual. Assurances are emphasized offering companionship until threshold to Divine entrances. Such practices are also continued in several .  immigrant families facing end-of-life scenarios abroad.
  Themes from Gl cross cultural barriers and serve as vital adjunct alternate therapies to comfort the dying. The author offers a live demonstration of Guided Imagery as practiced in Eastern India, depicted in classical music, folk music, light music, bhajan (leader and chorus) formats, often used to .comfort the needy. An exposure to classical Indian string   instrumental music, often used as complementary relaxation technique, will also be offered.

t I ~ SESSION A50 — Chanting the Bridge between Life and Death: a Cross-cultural Model to Use the Voice in Palliative Care
         SILVIA NAKKACH. American Music Therapy Association, Bolinas,California, USA

 This workshop provides the theoretical foundation and the experience of shared chanting and singing as a gateway to gently comfort the person who is making the final passage. As a therapeutic instrument, the singing voice becomes a vehicle for the patient to transcend the limitations of the physical body, as she or he lets go of tensions and fears. Particular  focus is on the healing potential of the singing voice as the ,  rimordial sound source, beyond the use of pro-recorded music. A sequence of cross-cultural vocal practices are introduced including chanting, lullabies, story songs, microtonal melodies, invocations, and self-generated prayers. The repertoire includes both indigenous and classical vocal styles from cultures as diverse as those of Brazil, Norway, Spain, Africa, India, and Tibet. The method combines singing with a drone and echoing strategies with ancient techniques of breathing. Strings, harmonium, percussion, and bells provide the instrumental accompaniment, facilitating an atmosphere of spiritual intimacy   and   open heart.   As a result,   participants   learn   about the capacity of meditative singing to lessen depression and anxiety, and the therapeutic value of building a multicultural repertoire of vocal applications to assist specific terminal conditions including cancer, AIDS rekated syndromes, and degenerative diseases. This presentation introduces the Vox Mundi Voice Work, which is an innovative training program and process developed by the presenter during 20 years as a musician and a clinical music therapist. The method integrates vocal development, grounding, and an in-depth exploration of the emotional texture of vocal expression. In addition, clinical case material is presented.

~ SESSION A50 — Music Therapy at Malachi House: an Examination of the Music Therapy Process and Resistance in Work with Persons Who Are Indigent and Terminally III

   KARLA MRAMOR, Malachi House, Cleveland, Ohio, USA
Malachi House (MH) represents an entirely unique concept, both in its approach to care of the terminally ill and in its focus on the marginalized of our society. This home offers total care, completely without cost, to the poor of Cleveland, Ohio. It provides the actual home and, in many cases. surrogate family for terminally ill individuals who are indigent, alone, or do not have an available or adequate caregiver. Care and support are provided by a small staff of caregivers, many volunteers, and nursing staff, and social workers from local hospices who visit residents at MH in the same way they would make rounds of home-based patients. The Life Enrichment Program of MH, composed of music therapy, massage therapy, and art therapy, specifically addresses the emotional, spiritual, and physical needs of the residents who are coping with end-of-life issues within the harsh context of social isolation, dysfunction and poverty. Presentation of this paper will include a thorough examination of the therapeutic process specific to this unique subgroup of the general population identified as having terminal illness. Case examples will illu' minate each of three phases of the music therapy process — engagement, relationship-building, actively dying — as well as the musical and non-musical interventions employed within each phase. Finally, the author will provide results of a resistance survey, developed and implemented to increase awareness of the ways in which resistance is experienced by the caregiving staff.

~ SESSION B29 — Between Heaven and Hell: Music Therapy in the Nowhere Land of Children's Bone Marrow Transplantation

BARBARA GREISSMEIER. Frankfurt University Hospital. Frankfurt,  and WOLFGANG KOESTER,  Muensler, Germany

Although bone marrow and stem cell transplantation (BMT) are considered a potent therapy in childhood leukemia, it still creates an atmosphere of "nowhere land" for individual children undergoing the procedure. With this paper the authors want to show how music therapy can be an important means of helping children cope with this extremely difficult situation, especially when the procedure is not successful and the children die. As BMT is used only when the child's prognosis is poor, after one or several relapses, the risk of the child's situation is met by very high expectations from both parents and hospital staff. In this atmosphere of life-threatening illness, with the risks and dangers of BMT on one side, and expectations in high-tech medicine on the other, children's personal view — their fears, anxieties, and inner knowledge of the situation — can easily get lost, while everybody is expecting them to fight for their lives and "think positive". The authors have been working as fulltime music therapists on two different German children's cancer units (Frankfurt and Muenster) for more than 12 years. They want to present their work with six children, aged 6 to 8 yrs, who had to undergo BMT, and who died during or after the procedure. They want to show how music can help establish a relationship between the child and an adult who is neither emotionally involved (like the parents) nor occupied with medical concerns (like the other staff), thus creating an atmosphere of openness and trust. With the help of little case studies, the authors want to describe how children use music in very different ways to keep in touch with both the outer and their inner world, to experience fun and joy together with their families, to train physical abilities, and to communicate their inner     support children undergoing BMT, to build a feeling of personal importance and self esteem, especially when all the high tech medical procedures fail and the children must die.

5 I ~ SESSION B47 - The Use of Music Therapy in Meet ing the Psychosocial Needs of Hospice Patients and Families

RUSSELL HILLIARD. Big Bend Hospice Inc.. Tallahassee, Florida, J  I    USA
 This session serves to explain the use of music therapy in meeting the psychosocial needs of hospice patients and families.
Case studies will be used, along with didactic and interactive experiences, to illustrate the goals music therapy addresses in serving patients and families. Techniques employed by music therapists will be explained. A review of current literature re garding pain management and anxiety reduction will be dis cussed. Spiritual needs and the use of song writing and group singing show the importance of music at the end of life. Age appropriate music interventions will  be   explained  in assisting  loved ones in the bereavement process. It will be explained how music therapy serves to enhance the work of the intendisapli nary team in meeting the psychosocial needs of hospice patients and families throughout the end-of-life continuum. Participants will engage in live music experiences which provide first-hand knowledge of the power of music as a therapeutic tool.

   ~ SESSION B47 — Music Therapy in the Community for Palliative Care Patients

 J. O'KELLY. Rowcroft Hospice, Torquay, Devon, UK ~
In the UK, the last 20 years have seen a considerable increase in community-based health care initiatives. Our palliative care increment   in   particular   has   recognizeded   how   care   at   home   or   in community bases is not only beneficial to some patients, but  also helpful in freeing hospice beds for priority cases. Where I  these units have large rural catchment areas, patients also may I   suffer from up to two hours in transit between home and daycare or outpatient appointments. The Towersey Foundation was set up in 1996 to promote music therapy in palliative care, drawing  its inspiration from Dr. Colin Lee's pioneering work with AIDS sufferers in the 1980s. Now, alongside Macmillan Cancer Relief, they are pioneering a music therapy outreach project to benefit patients in the rural areas surrounding the South Devon Hospice.    Using    both    receptive   and    creative   approaches,   music I  therapy takes place in patient's homes and community centers.

    ~ SESSION C26 — Music Therapy to Support Nurses in Palliative Care

NATHALIE LEDUC, Palliative Care, The Sir Mortimer B. Davis Jewish General Hospital, GHISLAINE GAGNON. St Mary's Hospital, Montreal, Quebec, Canada

Palliative care nurses are faced daily with the undeniable suffering patients and families go through. They are also faced with changes in the health care system — cut backs, workload increases, decreased resources available to do their work and help their patients. In being solicited continuously to give and keep   active,even   in the face of   very   difficult   situation,   they  provide supportive and comfort care but are often alone with their feelings and emotions. Finding a way to provide adequate support (in a short period of time) may prevent burnout and high turnover of nurses. However, feelings are often difficult to express verbally. How can nurses get support from a perspec  tive  which  goes  beyond  the  verbal  processing?  Music  therapy taps directly into emotions (Salamon, 1995). Creative arts are a   beginning to be used as a supportive intervention for professsional caregivers (Belfiore, 1994 and O'Neil, 1995). To address  this,  we  propose a  supportive  music therapy  intervention based  upon   the   use   of   live   music   listening   in   a   group   setting.   The premise   for   this   intervention  rests  upon   the   understanding   that  playing live music for nursing staff allows them to access a safe space for tension release. During and after music listening, nurses reported being more relaxed, better able to identify and share feelings and emotions, as well as more interactive with a  others. This may lead to more effective group discussions and foster coping skills. Music therapy interventions will be described in order to articulate the therapeutic process and the outcome.

~ SESSION C28 — Creativity and Self-care for Caregivers: the Music Therapy Segment

MARY RYKOV, Music Therapy Services. Toronto. Ontario, Canada

Paid and volunteer work in a hospice or palliative care setting is rewarding and stressful. An experiential workshop designed to prevent burnout was developed at Casey House Hospice on the premise that self-awareness is a critical starting place fur self-care. These daylong workshops, title "Creativity and Selfcare for Caregivers", involve journal-writing, art therapy, and music therapy to facilitate self-awareness. They are available to all caregivers, both within and beyond the palliative care community. Conference participants will experience excerpts from the music therapy component of these workshops.

~ SESSION C47 — We are Weaver

KATHRYN NICHOLSON. Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, British Colunnbia. Canada

How do we find healing rest and comfort for body, mind, and spirit, especially during times of suffering and grief? Taking time to listen to the quiet within enables each of us to rediscover our own sources of wisdom, strength, and peace. In this experiential session, an improvised tapestry of music, sound. and collected images will provide a safe and nurturing container and vehicle for a unique relaxation experience. The innovative music therapy program at the Vancouver Cancer Centre (British Columbia Cancer Agency) includes drop-in relaxation sessions for patients and support persons. These popular groups arc held three times weekly, facilitated by a music therapist and a social worker. The elements and techniques incorporated into this experience include breath work, autogenics, imagery, affirmations, soothing touch, and live music. A recent qualitative research study carried out at the clinic by this music therapisi has indicated that many patients, family members, friends, and staff value these relaxation sessions highly as a complementary treatment option at the clinic.

~ SESSION C47 — Music Therapy in the Management of Pain

LUCANNE MAGILL. Inlegrative Medicine Service. Memorial Sloan-Kettering Cancer Center, New York. New York USA

The management of pain is of primary concern in the care and treatment of patients contending with life-threatening and terminal illnesses. Pain can exhaust patients and their families, and can have a significant impact on quality of life. Management of pain consists of ongoing assessment in order to provide for complete care of the multi-faceted needs presented by the patients and their surrounding loved ones. Music therapy is a non-phannacological, multidisciplinary method that can promote comfort and enhance overall sense of well-being. Music therapy in pain management aims to treat the pain and to address symptoms of suffering. The music therapist works closely with the patient and family to gain an understanding of the physical, psychosocial, emotional, and spiritual components of the total pain experience. The therapeutic process involves careful, ongoing assessment of needs and issues by observation, questioning, and creative exploration. The multidimensional nature of music can help alter the pain experience by enhancing mood and communication, by refocusing mental activity, and by altering physiological responses. There are music therapy techniques that assist in the management of pain. The music therapist can choose from a variety of vocal and instrumental methods that can help patients regain control and experience improved comfort. Vocal techniques such as the singing of songs, musically guided imagery, toning, and chanting combine the use of gentle melodies, tones, and rhythms with the soothing presence of the human voice. Vocal techniques can be used to personalize the musical experience and assist in the exploration of thoughts and feelings. Instrumental techniques provide opportunities for listening and creative nonverbal expression. Through the use of live and recorded music, the music therapist can assist the pahent in refocusing attention away from pain, onto pleasing sensations. Music therapy techniques vary and are selected according to patient preferences and individual needs, and are provided to diminish symptoms of suffering and enhance quality of life.

~ SESSION D30 — The Sounds of Loss: Music and Imagery in Bereavement Support

   NICKI S. COHEN. Texas Woman's University, Denton, Texas, USA

The death of a loved one is a profound and life-altering experience. Although grieving is a natural response to loss, those who are actively grieving may benefit from therapeutic services that address their physical, emotional, and spiritual needs. Music therapy may help to facilitate the individual's movement through the sequential stages of grieving. This presentation will explore the use of music and imagery techniques, specifically the Bonny method of Guided Imagery and Music (CIM), with persons who are bereaved. The presentation will include the following: (a) the theoretical basis for grieving, the stages of grieving, and the characteristics of normal and pathological grief, (b) the GIM method, including its history, how the role of the music makes it differ from other guided imagery approaches, qualifications for training, and components of a GIM session, (c) different types of imagery, levels of imagery, and functions of imagery in the healing process, (d) music therapy considerations, such as the function of music in grief support and recommendations for appropriate music. Two case examples will be reviewed. Both individuals were referred for music therapy services by a hospice agency after the loss of their spouses. Both claimed to be stuck in their grief. The participants attended one to two music and imagery sessions per month, over a period of six months. The therapist will share each participant's personal process and victories through a series of narrations, drawings, and musical examples.

~ SESSION 030 — Good Grief: Music Therapy and Childhood/Teen Anticipatory Grief

MARLENE JACKSON, Palliative Care Services. Regina Health District, Regina, Saskatchewan, Canada

This presentation will address the role of music therapy in supporting children with terminal illnesses and children experiencing anticipatory grief when facing the impending death of a parent or sibling. This approach to meeting whole-person needs of palliative care patients and their families, within the context of a comprehensive, integrated palliative care program, will be demonstrated. Individual case studies will be shared illustrating the benefits and impact of specific music therapy interventions, including song writing and improvisation. Audio and visual examples will highlight the presentation.