On November 2nd, I had the opportunity to spend the afternoon with Music Therapist Karen Popkin at Memorial Sloan-Kettering Cancer Center and observe her interaction with a 68 year old patient undergoing bone marrow transplantation for a hematologic cancer. Karen’s perspective is pscho-dynamic and humanistic, emphasizing a therapeutic relationship with the patient. She is sensitive to the patient’s particular needs, molding her music to each individual and maintaining a constant awareness of the patient’s emotional status and needs. She told me how important it was to stay focused in the moment and to be flexible to minute changes. She said that she wants to enter into their world rather than forcing them to enter hers. For this reason she is careful to study each patient’s background, cultural roots and preferences.
The day I observed her work, Karen told me that the patient we were visiting was particularly fond of meditation. She asked him if he would like her to speak in addition to hearing her play music and he said that he would. While playing the guitar, she spoke about rhythm and the breath in a soft, musical voice. “Breathing in, I nourish myself. Breathing out I let go. Breathing in I give myself energy. Breathing out I let go of stress.” Karen played chords on the guitar, creating a folk-like improvisation that transformed the hospital room into a peaceful pastoral setting. The aura of calm contemplation resonated with the patient, who was transported, his eyes closed.
After a half hour, the patient was peacefully sleeping and we tiptoed out of his room. Karen explained that he had been in the hospital for several weeks already and would stay for an additional month. Because he was unable to control his circumstances, soothing his anxiety was an important part of his treatment. He told her that the three elements that made him feel best were a visit from his wife, meditating and the music therapy sessions.
I asked Karen about the words that she had spoken over the music. “I most often talk about the breath because it is both automatic and yet we have control over it. It is the quickest way to calm down. Sometimes the patients offer imagery of their own, and I use their imagery while I play music.”
I wanted to know more about the nature of the music that she chose to play. “While most patients need soothing music to help them overcome the stress they experience, some can actually be helped through greater tension and dissonance.” I asked her to explain how this works and she said that when suffering from chronic pain, a patient may be asked to describe his pain. Interpreting this sensation, Karen creates music based on the patient’s description. Hearing this played, the patient may experience a brief intensification of the pain, but as the music moves towards greater harmony, it may help him gradually resolve it.
Karen spoke about tempo, and how, when working with patients whose heart rate is very high, she chooses a fast speed, meeting their tempo and emotional state gradually slowing the tempo to promote a relaxation response. Her goal is to find what is comfortable and appropriate to each person. Although family members may suggest the kind of music they think the patient wants to hear, old favorites are sometimes not optimal during a hospital stay. Karen wants to meet each person where they are in the moment.
The musical elements that she feels are the most important are timbre and dynamics. She also says that the sound of the voice can have a healing effect, and she sometimes sings as well as plays.
The instruments most often used in music therapy, in addition to the guitar, are keyboard, harp and recorder. Because of the small inpatient rooms and the live acoustics, even instruments like the flute can seem too loud and overpowering. However, percussion instruments that patients can play themselves either alone or in a group are popular, particularly with children. Karen showed me a drum filled with small metal pellets that made a gentle swishing sound when tipped from side to side, like a traditional rain stick. I asked Karen if the harp was ever used, and she told me that once a volunteer harpist played in the recovery room, and an awakening patient thought she had died and been transported to the pearly gates!
After Karen’s session, we visited Dr. Barrie Cassileth in her office in the outpatient Integrative Medicine Center. I asked if she thought that music could, in and of itself, heal. “Healing and curing are two different things” she explained. “Cancer is sometimes difficult to cure, but healing is always a reachable goal. Music can improve the quality of life and help individuals participate in their own care. It’s hard work to get well. Music can increase mental and emotional energy. It can’t shrink a tumor but it can promote relaxation and control stress. And it offers hope.”