Journal of Gerontological Nursing

THE USE OF Music AS A PROGRAM TOOL WITH REGRESSED GERIATRIC PATIENTS

Lauraine Levy Kartman

Abstract

While there has been much writien about music therapy programs in mental institutions, there has been little written about programs involving the geriatric patient. Since music has aptly been called the universal language, its appeal to every stage of the life cycle, including regressed geriatric patients, seems evident. Plato said, "Music and rhythm have their way of entering the secret places of the soul." What could be more challenging than to appeal to their auditory sense to reengage the geriatric patient and provide a socializing experience? The sense of hearing ethnic and nostalgic music stimulates reminiscing and one might speculate on its value as an aid in recapturing basic identities.

I was given this opportunity to explore music as a program tool while working at Levindale Hebrew Geriatric Center and Hospital. The target population for my two music therapy groups included residents who needed intensive nursing and medical care. One group was regressed primarily because of physical factors; the second was regressed physically and emotionally. Both groups were located in separate skilled nursing areas of the hospital. For four months therapy sessions were held with the first group, and for six months with the second group. Goals were identified at the outset as well as the projected appropriate program material relating to the level of regression. Music content, whether ethnic or nostalgic American popular songs, have impact for the geriatric patient.

"eliminary Planning

:rst assumption was the capacity of each il for growth, no matter what age, level of i, or environmental situation.

Initially I played Jewish songs on the piano with my back to the group seated behind me in a semicircle. This became a recreational activity-they listened to the music and applauded with the opportunity for very little professional input by me. Because of the more defined professional purposes, I decided to use a record player with the group around a table, thus setting the stage for more interaction for group and worker. This proved effective because as a song on the record was sung, group discussions followed. It was my observation that the group worker perhaps needs to be more verbal in her role with regressed geriatric residents.

In four months the group members related on an increasingly more qualitative level to each other, even though at times in a negative way. It gave them a sense of relatedness and the socialization component was evident in such things as developing the ability to listen to the music without disruptions, reestablishing such social amenities as asking for kleenex when needed, saying "Excuse me," etc.

Additionally, the group verbalized the meaning of the music selections. The content stimulated them to reminisce and often recapture the most valued part of their past selves. The following are soine illustrations of their reminiscences due to the music:

1. "Roshenkes Mit Mandlen" (Raisins and Almonds). .. Everyone remembered this Yiddish lullaby about a mother singing her child to sleep with promises of how well he will fare. Mrs. L said, "My mother and father sang this to me. I'd rather hear this than anything else."

2. Chopin waltzes... Mrs. F shared with the group upon hearing the music that her cousin had played on the piano for "the President" (it was President Harding) and received a present from him. The song revived the Jewish concept of yiches (family status or prestige).

3. Yosselle Rosenblatt singing "Hamavdil"... The outpouring of emotion of the group was uncontrolled. Even residents across the room, not in the group, were sobbing and wailing too. This worker stopped the music because they were so visibly agitated. The music struck…

While there has been much writien about music therapy programs in mental institutions, there has been little written about programs involving the geriatric patient. Since music has aptly been called the universal language, its appeal to every stage of the life cycle, including regressed geriatric patients, seems evident. Plato said, "Music and rhythm have their way of entering the secret places of the soul." What could be more challenging than to appeal to their auditory sense to reengage the geriatric patient and provide a socializing experience? The sense of hearing ethnic and nostalgic music stimulates reminiscing and one might speculate on its value as an aid in recapturing basic identities.

I was given this opportunity to explore music as a program tool while working at Levindale Hebrew Geriatric Center and Hospital. The target population for my two music therapy groups included residents who needed intensive nursing and medical care. One group was regressed primarily because of physical factors; the second was regressed physically and emotionally. Both groups were located in separate skilled nursing areas of the hospital. For four months therapy sessions were held with the first group, and for six months with the second group. Goals were identified at the outset as well as the projected appropriate program material relating to the level of regression. Music content, whether ethnic or nostalgic American popular songs, have impact for the geriatric patient.

"eliminary Planning

:rst assumption was the capacity of each il for growth, no matter what age, level of i, or environmental situation.

The role of the enabler in social group work is to help the members use the group experience to enhance social functioning (i.e., a growth process), either within the context of their normal developmental needs or in relation to their social and emotional problems.1 Closely aligned with this concept of growth is Erikson's life cycle theme.2 The last stage of the life cycle is ego integrity versus despair. It was my feeling that a task of the aged is a summation or recapitulation of themes integral to their identities, e.g., a growth process. If this is satisfactorily achieved, the elderly will have ego integrity. The way in which I hypothesized this assumption would be implemented through the music content of the group meetings.

Gumming and Henry point out, "If the individual is ready for disengagement before society is, and if he has disengaged himself "prematurely," then society may try to reengage him."3 I speculated, therefore, that socialization of group members would help to deflect the disengagement tendency and help afford an initiation of reengagement with others. This might be achieved by sharing personal memories of music selections or collective responses to music on a rhythmic feeling level. Environmental awareness might be heightened and this would lead to socialization of group members.

The last assumption I had was the value of fun, relaxation, and socialization. The unavoidable effects of institutionalization I thought might be counterbalanced by music in groups where the geriatric residents enjoy and socialize with each other in an informal, accepting atmosphere.

My next step was to think through some basic principles the worker should use with regressed geriatric patients.

Worker's Role, Basic Principles

It seems to me the role of the worker would be crucial for any group work to be successful. The basic principles which I formulated in the beginning were:

1. The worker to be "successful," must develop a warm, friendly relationship with each group member. By their positive transference toward the worker there is a social, interpersonal experience. This interpersonal response was one of the goals of music therapy and a basis for socialization.

2. The worker should be accepting of the regressed elderly and also nonjudgmental.

3. The worker needs to establish a group feeling of enhancement of self-expression so that the group members are free to express themselves.

4. The worker, with regressed patients, must assume a dynamic role, being very verbal and often filling in "gaps" (i.e., silences, incongruent statements by reality orientation). The worker is the unifying bond with group members in the beginning and may be the fulcrum for cohesiveness among members.

5. The worker should be "tuned" in to meta-communications of group members (facial expression, bodily movements, etc.) and be able to interpret according to the musical content.

6. The worker needs to use "touch" appropriately with geriatric patients. A warm use of professional self helps linkage, connecting with the worker and group members and the ensuing activity.

7. The worker's value base must be a deep respect for the elderly, believing in their value and worth and right to live out their autumn years with dignity and self-respect.

After these planning stages I was ready for the actual group work.

Music Therapy Group L

Despite an extremely rich recreational program in one of the skilled nursing areas, there was a need for small group activities and other modalities to reach selected mpmbers on a more intimate, personal basis. Referrals came from social services and nursing staff. My program started with five female group members and expanded to eight who met once a week for an hour. In preparation for the group, I reviewed case histories seeking to find a common denominator in their background (other than regression and institutionalization). What I discovered was that all the women were either first or second generation Americans whose origins were Ashkenazic (immigrating from East European countries). Furthermore, all the women were raised in a shtetl culture or an Americanized version of the shtetl culture (shtetl: Jewish communities of E. Europe before World War II). It was with this in mind that I decided to emphasize Jewish music as my basic program tool.

Initially I played Jewish songs on the piano with my back to the group seated behind me in a semicircle. This became a recreational activity-they listened to the music and applauded with the opportunity for very little professional input by me. Because of the more defined professional purposes, I decided to use a record player with the group around a table, thus setting the stage for more interaction for group and worker. This proved effective because as a song on the record was sung, group discussions followed. It was my observation that the group worker perhaps needs to be more verbal in her role with regressed geriatric residents.

In four months the group members related on an increasingly more qualitative level to each other, even though at times in a negative way. It gave them a sense of relatedness and the socialization component was evident in such things as developing the ability to listen to the music without disruptions, reestablishing such social amenities as asking for kleenex when needed, saying "Excuse me," etc.

Additionally, the group verbalized the meaning of the music selections. The content stimulated them to reminisce and often recapture the most valued part of their past selves. The following are soine illustrations of their reminiscences due to the music:

1. "Roshenkes Mit Mandlen" (Raisins and Almonds). .. Everyone remembered this Yiddish lullaby about a mother singing her child to sleep with promises of how well he will fare. Mrs. L said, "My mother and father sang this to me. I'd rather hear this than anything else."

2. Chopin waltzes... Mrs. F shared with the group upon hearing the music that her cousin had played on the piano for "the President" (it was President Harding) and received a present from him. The song revived the Jewish concept of yiches (family status or prestige).

3. Yosselle Rosenblatt singing "Hamavdil"... The outpouring of emotion of the group was uncontrolled. Even residents across the room, not in the group, were sobbing and wailing too. This worker stopped the music because they were so visibly agitated. The music struck the core of their early shtetl life that was wrapped up in religiousity.

4. "Tog ein, tog eig" (Sunrise, Sunset from Fiddler on the Roof)... Everyone mentioned their children and grandchildren with great pride to the accompaniment of the music. The shtetl mother's life was wrapped up in child rearing and this was basic to their reminisces.

5. "Chussen, Kalle, Mazeltov" (Bridegroom, Bride, Congratulations!)... Mrs L asked me if I was married (I replied no) and then asked if I had met her brother (I replied I hadn't). Then Mrs. L said, "I wish my brother would come. I'd like for you to meet him." Mrs. L wanted to make a shiddach (an arranged marriage, a match which was common in her generation).

After four months the initial objectives were achieved and the group ended. The final session reflected the use of music and a professional service as a way of helping people. The last song which we all sang in unison was "Hatikvoh" (Hope), the symbolism the group members expressed being that one can end gracefully if there is hope.

This first group, where the basic content was Jewish ethnic music, led me to draw the following inferences in working with regressed patients in a Jewish setting:

1. A knowledge of Yiddish music on the part of the worker is essential so that group members can reminisce about collective cultural norms and values, religious affiliations and attitudes of their origin, the East European shtetl.

2. Closely aligned with a knowledge of Yiddish music is a knowledge of Jewish culture. The group members use time in the present to rework the beginnings of the life cycle and recapture the valued parts of their self-image that is of the deepest value to them. The worker, with a knowledge of Yiddish music and culture, can understand more sensitively what the regressed patients mean and the value base for their disconnected statements.

3. Use of music programming can be put on a spectrum of rites of passage* used at appropriate times, e.g., Birth-"Roshenkes Mit Mandlen"; Bar Mitzvah-"Haftorah blessings"; Wedding- "Frailech"; Death-"Abrevale Mamme."

4. Most helpful, in addition to the above inferences, is a general knowledge or background in music, especially music from the turn of the century as well as some classical music. The most important attribute of the worker, however, is knowledge of the sacred and secular Jewish songs and the context in which they were sung and played.

Thus a general knowledge of the deeply felt ethnic background of a cultural group is used to deflect disengagement tendencies. The method of group work relied primarily on the auditory sense through appropriate music selections to stimulate reminiscing.

Music Therapy Group LL

My second group was with the more emotionally impaired aged who, because of their physical and mental states, were of little appeal to some staff. Consequently, few consistent group activities had been held in the months prior to my work. Since I wanted a small group, a list of five women were selected with the help of social workers and nursing staff. I looked up each member's case history and found, once again, all were Ashkenazim (immigrating from East European countries) except one lady who was Sephardic (immigrating from a Mediterranean country). The members of the group had marked psychiatric disturbances such as delusions, paranoia, and disorientation. In further preparation for the first group meeting, I spent considerable time during a two-week period going to the solarium of the unit, chatting with the ladies in order to become "familiar" to them. In this way I was no longer an "outsider."

The tool I used in this group was rhythm instruments. Maracas were given to each member so that they could accompany the music, hopefully, on a feeling level. As a group leader, I also used a maraca to set the example and lead the rhythm band. Records utilized for group meetings were old-time favorites rhythmically pronounced to accentuate the beatas well as the nostalgic element. For example, Sousa marches, Wurlizer theatre player songs used for silent movies, Jewish wedding dances, coin-operated piano music of the Twenties, Middle East Arabic music, and some Mitch Miller records were played.

The group met weekly over a six-month period for 45-minute sessions. Some personnel would pass through the area during the course of the meetings, but this worked favorably since it enhanced the socialization goal of the group. At the end of the six months, I taped a music session introducing each song in the radio style format of the Thirties. The last meeting was a party where juice and cookies were served. Although using denial at my leaving, the ladies enjoyed the happy ending.

To illustrate positively what can happen with group members are the following notes taken from my records on two women in the group after three months:

Mrs. Κ has good days and bad days. She has a history of mental illness. Usually she refuses to play the maracas but she is part of our group whenever she's available. For the first time in three months, today she played the maracas and commented on Miss R's perennial confusion. When I played the record and sang the words to "Tea for Two" and "Bye, Bye Blackbird," Miss Κ sang along with me and we laughed together over the punchlines. This seems like a limited amount of overall progress but it actually is a major improvement in her ability to relate to others. Only the week before, Miss Κ was raving about cancer, poison, and my not giving her medicine, etc.

Mrs. S, a Jewess from Cairo, speaks mostly French and Arabic. We converse in French. She greets me with an expectant smile and I say, "Bonjour Madame S. Comment tallex-vous aujordhui"? (Good morning. How are you today?) She is so happy to hear French that she beams and replies, "Je t'aime" (I love you). When she is handed Pepsi (her favorite drink) she even offers me some (a very social act of sharing.) As far as her use of the maraca to rhythmic music, she is the only group member who relaxed and used the music for fun-the others used it more seriously. I must also add that sometimes her fantasies get carried away with her and she uses the maraca as a phallic symbol. Music group work may exert its benefits in a variety of different ways-at times unanticipated.

With this second group, where the basic content was rhythmic music, I made the following specific observations in working with several mentally impaired patients:

1. According to Dr. Karl Menninger4 mental patients who have suffered breakdowns have in their histories a lessened ability to pursue pleasurable activities. It is often easier to teach them to play than work; therefore, I observed that fun and relaxation could be enhanced through rhythm.

2. The use of maracas in rhythm group so that pent up feelings (aggressive, libidinal) were released positively.

3. Music, coupled with body rhythm, activated severely impaired elderly patients, thereby aiding in developing a greater degree of social awareness.

4. The worker's knowledge base of music that is both rhythmic and familiar to the geriatric-patients proved essential.

5. The freedom of the worker in bodily movements, vocalizations, dancing (i.e., spontaneity in response to music) was transmitted to group members and helped them have fun, relax, and socialize while "playing" the maracas.

6. In both music groups a positive relationship was the key to interpersonal responses first, to the worker, and then transferred so that members related to members.

Conclusion

This paper describes how music was used in group work with both physically and emotionally impaired geriatric patients in an institution. It was assumed that in using music as a therapeutic tool in group work, the primary factor was each individual's capacity for growth, even in the last stage of the life cycle. Goals of reminiscing to recapture basic identities and socializing in order to reengage the geriatric patient were achieved as a result of interpersonal relationships with the worker as a beginning, and then transferred to other group members. A knowledge of Yiddish music is useful in working with the Jewish-aged population and familiarity with nostalgic American popular songs is helpful in implementing the established social work goals.

Acknowledgment

The author expresses appreciation to Harry Citron for his encouragement and assistance.

References

  • 1. Falck HS: Social group work and planned change. Social Work Practice 1964, p 215.
  • 2. Erikson E: Identity, Youth and Crisis. New York, WW Norton and Co, 1968, p 139.
  • 3. Cumming E, Henry WE: Growing Old. New York, Basic Books Inc, 1961, p 215.
  • 4. Middleman RR: The Non-Verbal Method in Working With Groups. New York, Association Press, 1968, p 90.

10.3928/0098-9134-19770701-08

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