The Orchestra In Your Nursing Home

Do you have a symphony living in your nursing home? The answer might surprise you.

I recently read a research article that explored the metaphor of a grand orchestra for describing a music therapy group. This group included participants with early- to mid-stage dementia. What I learned helps to explain how music therapy works for people with dementia.

The Role of Aesthetic and Creative Research Evidence

Music therapy is an evidence-based practice. That means we do our best work by drawing on the knowledge gained from scientific research, our professional clinical experience, and what our clients say about their own needs and desires.

Music therapists draw on many kinds of research evidence. One kind of evidence comes from the familiar types of studies where one group receives some kind of therapy and another group does not, and the researcher compares the two groups on an outcome measure. For example, a 2006 study by Svansdottir and Snaedal found a significant reduction in activity disturbances for people with moderate to severe Alzheimer’s disease who received music therapy, when compared to those who did not.

Since our field centers on a creative medium, though, music therapists also draw on artistic, creative evidence to reach a deeper understanding of how music therapy is working for our clients.

The Grand Orchestra: A Humanistic Conceptualization of Music Therapy in Dementia Care

Using creative means to reach a deeper understanding was exactly the point of Melissa Jessop’s research published in the Canadian Journal of Music Therapy in 2014. Jessop worked with a group of seven people with mild to moderate dementia over the course of 13 group music therapy sessions. With the intention of understanding and representing these participants in their full humanness, the author used poetry, metaphor, and visual imagery to represent how the research participants engaged in music together.

As she reflected on their shared music therapy sessions, Jessop saw the seven participants as a grand orchestra, with participants filling roles of Violinist, Opera Diva, and Conductor, Percussionist, Dancer, Virtuoso, and Listener. To describe just one example, the researcher saw the participant Gertie as the Dancer, because she offered movements in the place of speech to express herself musically. Jessop came to see herself as the Concert Hall, providing the container for the participants music-making, while she acted in a supportive role and handled extraneous details.

Who’s in your orchestra?

Having reflected on this article, I can immediately think of the musical roles some of my clients play in music therapy sessions. I like this way of musical, metaphorical thinking, and I think it will help me to understand these clients better so I can provide the support they need for deeper, more meaningful music-making.

Perhaps you can think of how the people you care for interact musically as well. Is someone more likely to lead the group in small and large ways, like a Conductor? Or are they more likely to listen, not producing as much sound but still bringing the value of their presence to the group?

Thinking musically leads to better music therapy.

When I can think as music therapy clients as musicians first, I get to put the participants’ music front and center, instead of their diagnoses or the problems caused by their disease. (Wouldn’t you rather be thought of as a music-maker than a dementia sufferer?) We can make more beautiful music together, and we can have stronger connections and better conversations with each other. Decreased agitation, improved mood, increased engagement with their surroundings – those outcomes happen, too.

Do you have a symphony living in your nursing home?

I bet you do.


Jessop, M. (2014). The Grand Orchestra: A humanistic conceptualization of group music therapy in dementia care. Canadian Journal of Music Therapy, 20, 49-64.

Svansdottir, H. B. & Snaedal, J. (2006). Music therapy in moderate and severe dementia of Alzheimer’s type: A case-control study. International Psychogeriatrics, 18, 613-21. 


  1. Melissa Jessop on June 20, 2015 at 3:07 am

    Thank you. I truly enjoyed reading your blog about my research.

    • Rachelle on June 20, 2015 at 1:41 pm

      Thank you so much for your research, Melissa! I love your perspective.

  2. Jennifer Hicks, MT-BC, RYT on September 9, 2016 at 6:06 pm

    Thank you for sharing this, Rachelle! My intern just reviewed this article for one of her assignments for us – fascinating! Melissa, thank you for introducing me to this incredibly powerful research method! I am truly grateful to the contributions both of you are making in the field of music therapy for those with dementia!

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