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Top 10 Rules To Break In Music Therapy Groups In Senior Living

Yes no maybe…or rather, “rules.”

As diligent students, we music therapists graduate from our programs and become board-certified with certain ideas of how things should work in music therapy sessions.

But of course, music therapists work with people, and with human beings, there is an exception to every rule.

As I’ve matured as a clinician, I have gained flexibility in working with clients in music therapy, learning which “rules” to break so that we can go deeper in the the music and serve their greater needs and desires.

One of the most popular posts I’ve ever written was on the top 10 rules to break in hospice music therapy.

In the same spirit, here are my top 10 rules to break in music therapy groups in senior living:

1. Always use preferred music.

Offering client-preferred music is important for building rapport with older adults. It shows you recognize their individual desires and that you have made an effort to connect with them on their own turf. These are also the songs that can most easily get past cognitive impairments so people can engage with those around them.

Sometimes, though, it’s nigh impossible to play a song that is everyone’s favorite. Plus, many people get bored doing the same song over and over again.

In groups especially, I like to use a mix of songs I know are favorites, and some that might not be. We’re still sharing the joy of making music together, and sometimes we discover songs that participants didn’t even know to name as favorites.

2. Always use familiar music.

This “rule” might be the corollary to “rule” #1 above, especially in those cases when someone can’t specifically name a favorite song, musician, or genre. Instead of going by stated preference, you might choose something bound to be familiar, like big band music for a woman of the World War II generation, or Hank Williams for an 80-something-year-old man who grew up in the country.

Still, you run into the problem of getting stuck with the same set of songs played over and over again. Boring. And potentially ageist, too – who says older people don’t want to try new things every now and then?

Using unfamiliar music – modern songs or music from other cultures – is another way to mix up the routine and keep participants engaging in music in new ways.

3. Memorize everything.

Sure, it’s best practice to know your music so well that you can sing and play it memorized, and be able to walk around the group and interact with individual participants.

If I’m trying out new songs or sight reading music requested by group participants, though? I don’t mind having my iPad there to help me remember all the words. (I just make a point not to need it for the whole session.)

4. Avoid recorded music

“Live music is best” is a common refrain among music therapists. Playing music live allows music therapists maximum flexibility for changing tempo, lyrics, song structure, volume – basically all of the elements that make up music – to meet the clients’ needs. Plus, we do have research evidence showing that live music can lead to very different outcomes, especially for engagement in social interaction.

There’s a whole world of music that I can’t replicate on guitar and voice, though, and Lord knows I will never sound like Elvis Presley or Tennessee Ford. And then there are those times during allergy or cold/flu season when I can’t sing at all.

A recording can be a pretty solid backbone to play around, by moving musically or playing rhythm instruments. I use recordings as a musical partner on a regular basis.

5. Track measurable objectives.

One big difference between music therapy and entertainment is that in music therapy, we target individualized therapeutic goals. Progress towards these goals can be broken down into smaller, short-term objectives. For example, Mary might have a goal of increased social engagement, so I would track the number of times she engages verbally during a music therapy session.

For music therapy groups in senior living, though, tracking these minute objectives can distract from the big picture – the MUSIC that everyone has come for. As I’ve matured as a music therapist, I’ve come to find it more important to pay attention to the aesthetic quality of the music we make, and the musicality of our interactions, than to count the number of times someone plays the drum or taps their toes.

That is not to say that I can’t or won’t take meticulous data on measurable objectives when needed, but in this setting, I want nothing to distract from our music.

6. Keep up the pace.

When I worked in other clinical settings, I felt like I needed to move from intervention to intervention pretty quickly, without a lot of pauses between music experiences to interrupt the flow of the session. For good reason, I feared losing the attention of participants if I couldn’t transition smoothly through the list of interventions I had planned for a session.

With older adults, though, I have settled into a more moderate pace. Since many of my clients have cognitive impairments, they need time to process what’s going on. Occasional silences and pauses are a fine trade-off for the time it takes to look up a song someone has requested or to take an extra moment to talk with a participant individually.

7. Keep it light.

Music therapists often come into senior living communities under the entertainment budget, with the attendant expectation that we’re there to entertain the residents – to make them happy and cheerful and definitely not sad or angry.

This is bunk. Older adults have all the feelings every other human being has, and music is one of humanity’s best tools for expressing and validating and experiencing feelings.

Most of the sessions I do in senior living are focused on socialization and reminiscence and creative engagement more than processing difficult feelings, so I don’t often bring up difficult topics. But the music can bring up that stuff on its own, and if a participant needs to feel sad or talk about being in pain, of course, I’ll go there with them.

8. Always plan a session with an appropriate theme.

I learned in college to plan group sessions in senior living around a theme like “Valentine’s Day” or “road trips.” Themes provide a structure – a big idea around which to plan various music experiences. Themes are also a great springboard for reminiscence and group discussions.

As much as I like using themes, though, they can sometimes be too rigid. What if we’re singing songs about travel, and a participant starts singing “Hound Dog?” Well, I’ll probably go there with him, especially if the group starts going that way, too.

9. Plan only to follow your clients’ lead.

Of course, the flip side to “rule” #8 is that you always follow the group’s lead, asking them for a starting point and letting the music develop from there. This can lead to some amazing, beautiful, spontaneous music experiences that no amount of planning could bring about.

The problem with this idea is that participants don’t always have an idea of what they want to do musically. You might find yourself starting with the same few songs and getting stuck in a musical rut.

This is why I prefer a moderate approach – using thematic material as a springboard, then walking with the participants wherever our musical journey takes us.

10. Never admit your mistakes.

Okay, I doubt my professors ever taught this as a “rule,” but I sure thought as a new music therapist that I was the person who should know what she was doing at all times. I believed that I should know all the songs, every word of the lyrics, the answer to every trivia question, and the exact right music experience for any situation.

I know better now that admitting my mistakes – like when I can’t remember something – just makes me more human to the participants in music therapy groups. It’s nice to know that no one is perfect, and I imagine that would be especially true for someone who is having more and more memory slips every day.

So there you have it – my top 10 rules to break in senior living groups. What would you add to the list?

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