The practicalities of therapeutic music from a dulcimer player's perspective
As a complement to our "Stories from the Harp" series about the benefits of therapeutic music, this post features some questions and answers about some of the more practical issues related to playing this sort of music. We hung out with Certified Music Practitioner Bill Johnson at the Northwest Hammered Dulcimer Rendezvous this spring, and were very intrigued by his dulcimer stand on wheels - his own invention. He had clearly put a lot of thought into the best way to move his instrument around a hospital, and this prompted us to ask him more about the daily life of a hospital musician.
Can you describe what you do?
I play therapeutic hammered dulcimer music at the bedside of patients under hospital or hospice care. Hospital patients vary from those in for rehab or other chronic care to those in for trauma, pain, or other severe acute disorders. Hospice patients can have varying degrees of dementia, pain, or be in the process of actively dying.
Music played depends on the condition and may be very simple, improvised chord progressions with no structure, or full arrangements of a known piece of music. Additionally elements of music are consciously used to “flavor” the tonal vibrations for optimal physiologic effect.
In facilities, I travel from room to room, knocking lightly on the door to ask if peaceful music is desired. If it is, I then enter and introduce myself, speaking to the patient while visually searching for monitors and patient boards to learn as much as I can about their condition. I then play appropriate music for the condition I think the patient has. During the average 20-30 minute session I closely watch the patient and any available monitors in order to change and adapt the music to the patient’s changing condition.
Is your presence specifically requested by patients or families, or does it happen more on a drop-in basis?
I currently play at a local hospital and hospice on a regular basis each week. Since patient census is constantly changing from week to week, it’s not possible to get requests from patients. I do, however, get requests to play for patients in various departments of the hospital from nursing staff, and frequently get directed by nurses in the wards to specific patients who might benefit from music.
I currently play only at the hospice in- patient care facility. However, I am scheduled to demonstrate/play for the nursing staff who take care of people in their homes soon. After this, I expect to receive calls from these nurses for therapeutic music in the homes of hospice patients.
What training program did you go through, and what was it like? Did it require any particular skills (being able to read music, for example)?
I completed the Music for Transition and Healing Program, Inc. ™ (MHTP) which consists of about 80 hours of classroom study. Classes cover such topics as: Music as a Language, Patient Assessment, Physical well-being of the CMP, The Physics of Sound, Music Theory and Vibration, Medical Terms and Hospital Procedures, HIPPA Regulations, Alternative Medicine Modalities, The Business of CMP Work, and much more. The class work, spaced over 5 weekends during the year in several locations nationwide, is followed by 45 hours of internship playing at the bedside of patients in health care facilities with the help of an adviser. At the end of this training I was awarded a Certified Music Practitioner® Certificate. Though not required by the organization, a CMP® should be able to improvise music and play their instrument while watching the patient’s reaction to the music. Some individuals carry extensive music books and play only off of music, but the ability to improvise and play by ear makes you much more effective in delivering therapeutic music. (IMHO)
Health care facilities also require varying degrees of training/ qualification through their volunteer office. Learning an institution’s policies and procedures and meeting all their health and vaccine requirement is essential to successfully working there.
How long have you been doing this, and what prompted you to pursue this path?
I first heard of MHTP through a panel discussion at the 2014 Hammered Dulcimer Rendezvous in Sandy, Oregon. I always try to do what I can to help people out, and this type of work seemed to be a particularly gratifying way to use dulcimer music for the benefit of others. I started the course in September 2014 and finished in August 2015. I finished the Practicum intern hours and all other requirements in April 2016.
Tell us about the features of the dulcimer cart you designed!
The rolling stand was designed specifically for use in health care facilities with a hammered dulcimer. I needed a stable unit to transport the dulcimer through hospital parking lots and hallways on the way to playing areas and also quickly move the instrument out of immediate patient areas in case of emergency.
The stand features:
- Large 4” diameter wheels positioned in a cross at the base with a wide footprint for stability and ease of traversing things like elevator doors and door sills.
- Steel inserts in the leg cross pieces to lower the center of gravity by providing extra weight and stability at the bottom.
- A fold-down top and bottom folding legs provide ease of transport in a car trunk.
- A telescoping, removable handle that swivels 360o is attached to the base of the stand at the wheel arms allowing motive pressure to be applied low near the center of gravity.
- A height-adjustable support post that extends playing position from high seated to standing. I play while standing in health care facilities for mobility.
- Rubber coated clamps gently secure the instrument to the top instrument support base. In use, the clamps do not touch the dulcimer but prevent it from being knocked off the stand thereby securing it from damage while still allowing full instrument resonance.
- The top instrument support base has two ½” square felt buttons at the top such that the bottom of the dulcimer contacts the base only on these two buttons and at two additional places on the bottom rail of the instrument. This allows the instrument to be almost totally suspended in air so it freely vibrates and produces its best sound.
- Velcro holds a plastic box to the center post. The box is also chained to the stand to prevent loss at a gig. It contains hammers and a small tuner.
Are you ever asked by hospital staff to disinfect your dulcimer?
No. Rooms in the hospital that are under infection control are clearly marked and I do not go into those rooms. However, I do play outside the door at the foot of the bed where the patient can see me and hear the dulcimer. This includes most standard rooms and the ECU in the Kaiser hospital I play in. I cannot deliver therapeutic music to the second patient in these rooms who is away from the door and therefore out of my sight.
One does need to “gel in, gel out” (disinfect your hands) when going into standard patient rooms, and this leaves a gummy residue after several applications which I wash off in a sink with soap and water. It would be impossible to disinfect the dulcimer without major damage, so the only alternative is to not enter infection control rooms.
We hear a lot about harp being used for therapeutic music, but not so much about other instruments. Do you know of other dulcimer players who do this? Are there other musicians who play regularly at the same hospital?
The MHTP™ roster contains mostly harp players but also includes guitar, voice, flute, keyboard, autoharp, mandolin, violin and more. I know of at least three other hammered dulcimer players who are CMP®’s. Probably the most well-known of these through her workshops, performance and writings is Karen Ashbrook. There are no other musicians that play regularly at the hospital I play at but a non-CMP violin player performs for hospice patients in their homes.
What are some of the challenges you face in your work?
Therapeutic Music is not played for entertainment. Yet this is what family members often want while their sick loved one is weak in bed. It is difficult to play the often low and slow music necessary for patient benefit when the relatives want dance music or a pop tune. In addition, playing for people who you won’t see again because they are dying can be hard.
What are some of the rewards?
Patients and people love it! The dulcimer is such a “strange” unknown yet hauntingly beautiful instrument in my part of the world, and it’s fun to introduce it to people- especially when I am able to provide some degree of comfort or rest to them at a time of need. The Joint Commission, which inspects and accredits healthcare facilities, caught up with me in one of the hallways one day. After a few questions and my explanation of therapeutic music and the desired effect on patients, they left. Starting a week later and still continuing, I get compliments from hospital staff who have never heard or seen me play in rooms. I learned this came about because the Commission report identified Therapeutic Music as a “Best Practice” and praised the hospital for instituting it!
Do you have any advice for dulcimer players (or other musicians) who are interested in therapeutic music?
While it is possible to play music for patients without CMP® training, I feel the knowledge provided in this program allows me to focus musical efforts toward specific therapeutic goals to enhance patient quality of life. If you have an interest in helping people at what can be their most trying time, I would highly recommend enrolling in CMP® training.
Update August 5th, 2016
A big thank you to Helen Wolfson, who has shared a photo and the plans for her rolling dulcimer cart! The cart was designed by her husband, Eric Thomas, and built by Greg Pugh. We don't currently make anything like this, but if you have handy woodworker friends, it wouldn't be too hard to build your own!