boy playing flute
Music Is Hope

A Look Ahead:
Music Therapy as Pastoral Care

C. Gourgey Ph.D.

(This article is Chapter 6 of my Masters in Music Therapy dissertation, The Importance of Love in Music Therapy, published by University Microfilms International and available on this web site - CG.)

Previously I compared a music therapy group in an institutional setting to a small community. A music therapist can play a special role within such a community. As in any pastoral setting music can bring comfort and support, helping people find their inner strengths, bringing them the presence of love in the various crises they may face. I came to feel that this was very much my role in the hospital this past year.

To me, music therapy is really spiritual caregiving, but instead of a clerical collar I carry a flute or a guitar. I want to touch the person’s soul, to let him or her know that love is still possible. As a music therapist, I know there are many kinds of music: a voice’s gentle sound, a hand’s light touch, the soft cadence of loving words. This music is available to all of us. (C. Gourgey, When Words Fail.)

Since the work I do is so much like chaplaincy, I have often been asked, have I ever thought of becoming a rabbi? My answer is yes, I have thought of it, but if I became a rabbi I would only be able to work with Jewish patients. To me, the essence, as well as the challenge, of love is bridging worlds that are different. I want to do the work of a minister without the limitation of being able to minister only to certain populations.

Ministering to people means being present at critical moments in their lives, and not only at the officially scheduled hour. I now see this as one of the greatest potentials in work with music therapy groups. Through the structure of the group one becomes acquainted with many patients, and can follow the course of their progress over time. I have shared the joys of patients as they progressed in rehabilitation and became ready for discharge. I remember when Carmela, in our rehab group, first became able to walk again: she made a point of telling us even before telling her family. I could also remain present with patients who deteriorated, and who had to leave the group. The group enabled me to know them, but it also gave me the opportunity to move beyond its own structure in helping to care for them.

Since my first group was on a rehab floor, it was hoped that all patients there would eventually recover and leave the hospital. However, not everyone gets better. Sometimes patients decline, and cease to be candidates for rehabilitation. These patients can no longer remain on a rehab floor. Either they are transferred to another institution or, as often happens, to the older, chronic wing of the hospital. In such cases I am still able to follow them.

I remember the day Kelvin was transferred. The other members of the group told me about it, and they were worried and concerned. Kelvin had not been making progress, and it looked like he was eventually headed for a nursing home. But first he was taken to the hospital’s old wing, where the patients are sicker, the floors are more crowded, and even the lights are dimmer. Instead of a semi-private room, he was now in a ward. Because patients on these floors are generally lower-functioning, both cognitively and physically, there is little intellectual or interpersonal stimulation for those patients who do come with greater capacities. As a result these patients are at greater risk for institutional depression, and I have seen a number of them deteriorate markedly both in mood and mental capacity once they were transferred.

This started happening to Kelvin. His latent depression increased and became his dominant mood. He withdrew into himself, becoming quiet and sullen.

It so happened that I was already seeing individually another patient on the same floor to which Kelvin was transferred. Hattie was in her eighties, a tall, thin woman, totally blind and unable to walk. I would always find her sitting in the dining room, listening to the radio whether or not she wished to. She would have her head cocked to one side in a thoughtful, or perhaps dreamlike expression. When I came to greet her, I always felt like I was awakening her from a deep sleep.

Hattie lived in terror. Her blindness made it difficult for her to trust: she was not well oriented to her physical environment, never quite knew where she was, and asked for constant assurances that I was taking her to the right place. Still, words never reassured her. She would not believe me when I told her we were in her room, but relaxed a little when I moved her hand so she could feel her bed nearby.

Hattie was a deeply religious woman, and loved spirituals and hymns. “Jesus Loves Me, This I Know” was the song that comforted her most deeply. This song was foreign to my own background, but I was glad to learn it and share it with her. This and others, “Blessed Assurance,” “Take My Hand, Precious Lord,” “Amazing Grace,” made Hattie feel at home and safe in her own world. When she heard them she would smile and say, with her soft Carolina accent, “That’s beautiful.”

I became a part of Hattie’s world. I seemed now to belong to her old church in the Carolina countryside, near the farm where her father worked as a sharecropper, near her home where her mother would sing those same songs to her from behind her sewing. I also became a link to her deep faith, because no one else was sharing it with her in that way. This created a difficulty: Hattie always had a hard time saying good-bye. “Are you gonna leave me now?” she would almost cry, at the end of nearly each session. “Don’t forget about me.” And then her underlying depression would threaten to engulf her once again.

Hattie needed the stimulation of being with others like her, but the patients on her floor were so impaired that they could be no source of companionship. When Kelvin arrived, I brought the two of them together, and formed a “mini-group.” At first Hattie was reluctant, fearful of any kind of change. But soon she saw that they had much in common.

Each one asked for a favorite Gospel song. I told Hattie that Kelvin is a wonderful singer, and invited him to sing. Kelvin sang a number of spirituals, among them “When You Confess to the Lord, Call Him Up,” which I remembered from the other group. He accompanied himself by tapping a salt shaker on his bed table, in flowing syncopated rhythms. Hattie was enthralled: she waved her hands to the music, and smiled.

Kelvin then did some Bible readings, including Psalm 95, which begins “O come, let us sing to the Lord.” I suggested reading John 14. This is the chapter where Jesus addresses his disciples, telling them that after he departs they will have the Holy Spirit to comfort them. I wanted to send Hattie a message telling her that her faith is within her, and that saying good-bye to people would not take that away from her.

Then Hattie and Kelvin sang more Gospel songs together, some of which I did not know. I was happy to be left on the sidelines, yielding the leadership of the group to them. Hattie wanted Kelvin to pray for her, and he offered a beautiful prayer to God for “servant Hattie, who is blind in her body but who in her spirit sees better than a sighted person.” Hattie’s dark eyes filled with tears.

They lifted each other’s spirits more than I ever could. I tried to bring them together each time I visited the floor. Hattie, so fearful of strangers, would now ask about “Mr. Kelvin” whenever I came to see her. I would tell Kelvin that Hattie had been asking for him, and let him know that it would mean a lot to her if he could find her in the hallway or in the dining room and say a kind word.

I wonder how the hospital’s atmosphere would change if there were a lot of music therapists doing this kind of work, tracking patients as they worsened or were transferred, letting them know they would not be abandoned. Such contact with patients could serve a function similar to a clergy visit, but with the added power of music.

Eleanor was another severely depressed patient from my rehab group who became worse and had to be transferred. Just before she left I remember how black her mood became. She had already lost one leg, due to poor circulation caused by her diabetes, and said if she were to lose the other her life would be worth nothing. She did not yet know that her kidneys were beginning to fail and she would soon become a candidate for dialysis. When she became too sick to come to group, I would go to her room right afterwards and do a couple of songs for her. This always made her smile.

Then one day when I went to her room she was not there, and her name was missing from the door. Carmela, her roommate, told me she had been transferred to the old building, at the other side of the hospital. I looked for Eleanor, and found her on the same floor as Miriam, the woman with severe dementia I had been seeing individually (see chapter 4). There was no longer any hope of rehabilitating Eleanor. She was now in a dementia ward, and had no one to talk to. Her depression became extreme, and in my view, critical.

I resolved to keep in touch with Eleanor and find room for her in my filled-up schedule. I began including her in my sessions with Miriam, forming another “mini-group.” They were good for each other. Eleanor identified and sympathized with Miriam’s isolation and was very kind to her (as not many others were), and this show of affection helped both of them. Eleanor also showed me something: with a fond smile she would hold her hand out to Miriam, who would quietly take it into her own. Miriam could not speak an intelligible sentence, yet a rapport had clearly developed between them.

In time Eleanor’s mental condition badly deteriorated. No doubt her illness was the major factor, but I am convinced that staff neglect and the change in her environment greatly accelerated the process. She developed paranoid ideation and ideas of reference, believing that staff members were speaking about her with hostile intent when they might just be casually conversing in the halls. She became belligerent, yelling and cursing at staff members and accusing them of lying and other forms of abuse. This lost her even more sympathy and aggravated her isolation. The only time I ever saw her mood improve was during music. She said she loved it when I sang to her, and she would always smile.

I was walking through the hall towards the old building one day when I heard screaming. It was Eleanor, sitting in the lobby, waiting to be picked up for dialysis. The pickup was late. She was shouting abusively at the security guard, calling him a liar and a son of a bitch. I stopped and tried to calm her down. The security guard lost his patience and confronted Eleanor: “Now you’ve blown it. You’ve lost your privileges and you’ll have to wait for dialysis upstairs in your room.” He started to wheel her into the elevator when I told him I knew where she lived and offered to take her up myself. He was grateful to hand her over to me.

I took Eleanor to her room and we talked for a while. I could almost feel the tension in her body pulsing through the air. She told me again how much she hates herself. Her body was failing her, and she did not know how to react. I sang a song I taught her earlier that day, “Lean on Me.” She sang the chorus with me, remembering most of the words. The melody seemed to carry the message of those words so simply and sweetly, and the subdominant chord in the second phrase always gives me a sense of warmth, which I hoped I was communicating to her. I asked her how the song made her feel. She said she loved it, that it made her feel good. She settled down, and for the first time in a long while I saw her smile again. The last thing I told her was to remember how that song made her feel, and to keep that feeling in her heart, when she is alone and things seem hopeless. She promised to try.

Eleanor died the next day. She developed an infection, apparently resulting from the invasiveness and stress of the dialysis, that she could not overcome. I felt comforted that our work together ended in a warm, intimate moment. To the very end of her life, love was still available to her. She showed love to Miriam when others around Miriam rejected and ridiculed her. And even at the last minute Eleanor allowed music to show her that she could still have a little love for herself.

Pastoral care has many dimensions. Part of the work is looking after the one who gets lost, as Kelvin and Eleanor became lost from their group and nearly disappeared in the recesses of the hospital. Another important part of the work is looking after people at the most critical moments of their lives, even to the end of life itself. In such moments a music therapist can also play a role not unlike that of a rabbi, priest, or minister.

Bella was a 90-year-old woman who was so unresponsive she seemed to be in a coma. She was not actually comatose. Her admitting diagnosis was congestive heart failure; she was also blind, hard of hearing, diabetic, and severely demented. Medical staff described her to me as very agitated, even hostile. When she was verbal she would cry out things like “Leave me alone!” or “Not now!” or she would cry out for her mother. Staff found her difficult to reach, not just because of her dementia, but also her defensive anger.

This was not the woman I found when I went to visit Bella. I was fortunate to be with her alone on my first contact. Bella was dying, and for a while I was back in hospice, an environment totally different from the tense and hectic scene of the hospital. We were alone in the small ward. I played a Jewish folk song for her on my tenor recorder, the one with the low, mellow sounds. Bella lifted her head from the pillow, opened her eyes wide, and looked straight at me.

When I next saw Bella, she was leaning over the side of her bed, coughing. She seemed agitated. I played some folk-like improvisations on my tenor recorder, something soft and low and quiet, then held her hand for several minutes. She covered my hand with her other one.

Bella was a different person when her daughters were present. They were not merely upset; they were cynical. I called the eldest to let her know that her mother had been referred to me for music therapy. She told me her mother was very sick, probably “on her way out,” and that music didn’t make any sense. She told me how frightened and weak her mother was. I explained that the purpose of music in such situations is not to entertain, but to help the patient relax, become calmer, and take away some of that fear. She listened attentively, but I felt her struggling with her grief. I gently let her know this, and she seemed appreciative.

The last time I saw Bella her youngest daughter was with her. She would address her mother in a loud voice, trying desperately to get through. Now I saw what the staff people meant by describing Bella as ill-tempered and quarrelsome. Her daughter was trying to get her to drink, repeatedly making her take water from a cup with a straw. Each time Bella would cough and spit it up. Bella moaned and writhed on the bed. I went to her bedside and began to sing to her. Nothing changed, however, until her daughter went out, leaving me alone with Bella for a few moments.

I stood by her bed and let her hold my hand. Bella’s breathing slowed down and stabilized. She stopped moaning and became still. She grasped my right hand with both of hers and held on with firm pressure. She kept holding on. I spoke to her reassuringly, told her she would be all right, that she could relax now.

Her daughter returned, and noticed the change. I asked her to take over. I withdrew my hand from Bella’s grasp and put her daughter’s hand there instead. I told the daughter this is all she needs to do, that her mother just needs to know that a caring person is present. I left her mother in her hands.

An hour later, Bella died. The floor nurse told me she went peacefully. I was grateful to hear this.

So often in hospice I have seen the effect that a family’s anxiety and grief can have on someone who is dying. I can often minister best to the patient by treating the family members, helping them relax and let go of their anxious clinging as best they can. If the family is receptive, one can feel a noticeable change in the room, and see it in the patient. In such situations music may be the most universal form of prayer.

I have been using words one might associate with a pastoral setting, words like “minister,” “spiritual,” and “prayer.” Music therapists do not commonly use such language. Is it possible to define a specific area within the field that one might call “pastoral music therapy”? Bruscia (1989) has already offered a definition, or at least a description:

The pastoral area includes all applications of music and music therapy in religious settings which are aimed at spiritual development and the resolution of related problems. (p. 86)

Bruscia portrays “pastoral” music therapy as using music for specifically religious or inspirational purposes, endeavoring “to help the client gain spiritual insights and to develop a relationship with God that will facilitate emotional adjustment and growth” (p. 124). While this may fall within the purview of what I would call “pastoral” music therapy, as a definition it is far too limited. Bruscia’s description seems mostly to apply to religious settings. The specific examples I have described in this chapter point to a way of looking at music therapy as pastoral care that in my view is far more comprehensive.

The word “pastor” means not religious leader but shepherd. As a verb, to “pasture” means to feed, to nurture. Pastoral care means caring for people at all phases of their lives, at times when they are most needy. A “pastor” is not a specialist brought in from the outside to treat people only at certain appointed hours. A pastor is part of a community, and is felt to be so by members of that community. I have already given examples of the need to go beyond the regularly scheduled time and place of the group to follow members who went into crisis and had to be transferred. It was important to me not to lose track of these members, even though they were no longer officially part of my music therapy group. I have done this kind of work before. When I worked for an organization serving homebound elderly people, I would be on call to visit clients who had special illnesses or problems and who would not respond to visitors who could only communicate verbally. Similarly, when I worked in hospice I was on call to visit patients who were entering a crisis, or were becoming close to death. My goal was to make music available as a comforting presence to people at times when they needed it most.

As I see it, pastoral music therapy may or may not be associated with formal religious settings. What makes it unique is the use of music to maintain a presence with people at critical as well as ordinary moments in their lives, and also bringing music to where people actually live, to their homes or hospital rooms. From a spiritual perspective, the presence of music represents a higher presence that we call God, which music can help make more accessible to people, even though God need not be explicitly mentioned. This is as far as I wish to go in addressing the spiritual role of music directly in this thesis; it has been implicit all along, but to go any further would require another lengthy presentation. Perhaps the following tentative definition will briefly summarize this discussion:

Pastoral music therapy is the use of music to enter and to affirm the client’s perceptual world, to maintain a presence with the client over time, to care for the client’s emotional and spiritual needs in all phases of the client’s life, through health, sickness, and even to the moment of death. By expressing awareness of the client’s individuality, pastoral music therapy tries to make available to the client the experience of love and the healing effects of love, using the power of music to help the client become more motivated and capable of loving self and others.

Pastoral music therapists can work in a wide variety of settings. Large institutions are good places for this work, first because the need for a loving presence is especially strong in such places, and also because many patients are concentrated in a relatively limited space, making it easy for the therapist to keep track of them and maintain contact with them. But I can also see this approach applied to other settings. Why not have a music therapist as part of a religious congregation, available to visit the sick or comfort the dying and their families? Or as part of a nonreligious community, which may have no ministers or houses of worship while still needing ways of caring for its members’ needs? When I worked with noninstitutionalized elderly people I visited them in their homes, bringing my instruments and music stand with me. It took a little longer and I did not get around to as many, but the idea is the same as working in a large institution: bring the music to where people live.

If pastoral music therapy is to be considered a specific approach to music therapy, it is important to ask what special qualities or competencies might be required of the pastoral music therapist, beyond those required of music therapists in general. We might particularly emphasize the following:

A strong clinical background is highly desirable. As was emphasized since the very first chapter, issues of intrapsychic and interpersonal dynamics, transference, and countertransference are no less important for music therapy than for psychotherapy. They are especially important for pastoral music therapy, because the pastoral music therapist seeks to be present at the most vulnerable moments of a client’s life and is concerned with becoming part of the client’s world. The relationship can become close and intense. Very strong transferences can develop. I have given the example of Hattie, who did not trust easily but trusted me completely once I became able to join her world. Hattie had much trouble letting go of my presence; the ends of sessions were hard for her. I met this transference by trying to use her own faith to give her an inner strength to help her become independent of me, and by very carefully supervising the transition to another music therapist once the time for me to leave began to approach. I chose someone who I knew would relate to Hattie’s spirituality, and educated him about her world, at the same time introducing him to Hattie and helping her trust him as she had trusted me.

Countertransference issues are also no less important than in any other form of therapy. One takes a risk when one enters the world of another; if one is not certain of one’s own boundaries, there is a chance of getting lost. It is important to have a firm sense of where one ends and the other begins, even while one may need to play a role in someone else’s world. It is likewise important not to confuse love, or entering the client’s world, with merging with the client or feeling exactly what the client feels. Overidentification is a constant danger. If one identifies too strongly, becomes too enmeshed in the client’s pathology, one may lose one’s grounding in objective reality, and the client will lose a lifeline to the outside world.

This is especially true when working with dementia patients. Unless one is able to see the patient’s world and actually assume a role in it, these patients may not be able to relate at all. One becomes like a “double agent,” with two identities, one inside the patient’s world and one outside. It is important to be able to experience both of these fully at the same time. Very often dementia patients are treated with contempt, fear, or indifference because those around them do not know how to relate to and enter their world, and so cannot form a connection with them. It is hard work.

Another important quality in a pastoral music therapist is familiarity with different religious and cultural backgrounds. Love, as awareness and presence, means bridging worlds that are different. Although my own background is strongly Jewish, my familiarity with the New Testament enabled me to speak Hattie’s language, and to form a relationship. I think it is also important to observe that I was not just pretending or simply playing a role. I had a genuine feeling and sympathy for Hattie’s faith, the result of having studied Christian theology and religious practice for many years. I was able to relate to her faith on more than just an intellectual level.

Familiarity with different cultures is especially important when it comes to music. Speaking the musical language of others, especially when it is not originally one’s own, is the special challenge to the pastoral music therapist. I grew up mostly with folk and classical music. Rosemary loved the Beatles. If I was to enter her world and join her, I had to learn to love them too. And I had never even liked the Beatles when they were most productive and popular. Approaching this music required a stretch--entering another’s world always does--and I studied Beatles songs, learned them, and came genuinely to love them. As with Hattie, I was not pretending, or it would not have worked. If I did not genuinely love those songs, I could not have shared Rosemary’s love for them, and thus could not have provided a loving presence for her. Rosemary stretched me--she made me confront some of my musical preconceptions, and she shattered them. And in the process, she expanded my own capacity to love.

Along with being “multilingual” musically, being multilingual verbally is a great help in pastoral music therapy. I was able to include some patients in my groups who spoke only Spanish, and who would not have been in those groups if I had not been able to speak their language. I remember also one patient who was almost completely aphasic, who could speak only in fragmented phrases in his own language. He was usually depressed and ill-humored, but I remember how his face would light up when I found I could still tap well enough into my high-school French to communicate with him, and when I sang with him some old French songs that he used to sing in his childhood.

One simple but highly desirable quality in a pastoral music therapist is maintaining a cheerful and friendly demeanor whenever possible. Because it can be so simple, I think we can easily overlook its importance. This was brought to my attention one afternoon when I was working individually with Miriam. After I sang my good-bye song, a woman entered the ward wheeling in her frail and elderly aunt. The woman saw my guitar, and said she was sorry she had just missed the music. So I did one song, “Amazing Grace,” just for them. The aunt was not responsive; she seemed totally incapacitated. But her niece was very touched. She couldn’t thank me enough. A sudden impulse prompted me to ask: “What would we do without faith?” At this she opened up. She said faith is what keeps her going, and spoke to me about herself and her aunt and what they had meant to each other. What I remember most is what she said at the end: she thanked me for bringing so much joy into the hospital. I did not think I had done anything special. Her comment helped me appreciate what a difference it can make for people in such a place to encounter someone who is warm and friendly, and who does not treat them with “professional” distance.

Finally, an important quality for a pastoral music therapist is to have personally experienced the type of love that he or she wishes to communicate to others. One needs to know what it means to be loved in the sense of being seen and understood by an awareness beyond oneself, whether one experiences this awareness as another person or as God. One also needs to know what it means to see and understand others in this way, to respect another’s world as completely different from one’s own, approaching it as sacred ground.

All these issues are important for supervision. Countertransferences will inevitably arise, and a therapist may well fear that a negative reaction toward the client will impede the communication of love. As in any supervision process, these countertransferences need to be recognized and worked through. Fear or resentment toward the client can become obstacles to love, but they are not reasons for a therapist to become harshly self-judgmental. Rather, they are part of the therapist’s learning process. A therapist struggling with these issues can be comforted by two things: First, love does not require “unconditional positive regard,” an uninterrupted positive response toward the client, but awareness and respect for the client’s inner world. And as a therapist who experiences a negative reaction struggles with it and uses it to gain more self-awareness, a deeper awareness of the client will follow, which can then open possibilities of love.

I would like to conclude with two examples, both from hospice, illustrating how music therapy can become a ministry not only to the patient but to the family as well. Isabel was a 61-year-old woman dying of cervical cancer. At first the nurses told me she would probably not be receptive to a visitor, but when I spoke to her in her native language, Spanish, she warmed to me and let me in. She asked specifically for religious songs, which seemed to comfort her--she wanted nothing else, not even love songs.

I visited her again two weeks later. By this time she was in a semi-coma. Although her consciousness was fading, she was hyperactive. She seemed almost to jump when I touched her, and if I played too fast it agitated her. I slowed myself down, and felt a connection starting to form between us. Her family was with us in the room: her son, grandson, and a close friend. I sang some songs, new to me but familiar to them: “Pescador de Hombres” (“Fisher of Men,” a song about Jesus’ calling his disciples) and “Noche de Paz” (“Silent Night”). They sang with me, while the friend held Isabel’s hand. Coincidentally, at the word “sonriendo” (“smiling”), which occurred in the first song, the grandson, about five years old, came up to me and gave me a big smile. For a moment I felt part of the family. And I also felt Isabel’s agitation dissipate, as her family comforted her.

Another woman, whose first name I never learned, was also in a semi-coma, suffering the effects of gastric cancer. This type of cancer produces extreme cachexia, a wasting away of the body, which can no longer properly utilize available nutrition. I sensed in her presence an overwhelming sadness, and I felt drained. The nurses told me that her relationship with her daughter, who had many emotional problems, was very troubled, and suspected this had something to do with the patient’s response.

The daughter arrived, and I asked her if she wished to be alone with her mother. She said no, she might need the music for herself as well. And so I stayed and sang at the bedside. Virginia, the daughter, told me her mother liked church songs, hymns and spirituals. I asked Virginia to hold her mother’s hand, then sang “Amazing Grace,” “Jesus Loves Me,” “There is a Balm in Gilead,” “Swing Low, Sweet Chariot.” Virginia took her mother’s hand in both of hers, and caressed it. Then she went to the head of the bed, began stroking her mother’s forehead, and telling her soothingly, “Your work is done now. You don’t have to cook and clean anymore. You don’t have to iron anymore. You did really well. You’ll be all right now.” The tears on Virginia’s face also brought tears to my own. The nurses were surprised at this connection; they told me Virginia’s relationship with her mother had been distant. Hospice work has shown me how music can become a healing bridge not only between the worlds of therapist and patient, but also between the worlds of family members and friends, even when relationships have been estranged.

Pastoral music therapy therefore means not only ministering to patients themselves, but to their families, who often may need more attention than the patient. It means bringing people together. Crossing bridges into worlds that are different, emotionally, culturally, or linguistically, requires a great deal of energy, far more energy that one needs when remaining within familiar territory. The Bible recognizes this, and therefore both the Hebrew Bible and the New Testament make a big point about loving those who are different. Pastoral music therapy will therefore bring these additional issues to the supervisory process: What prejudices or preconceptions may be elicited by a particular therapeutic encounter? Because the therapist gives so much of himself or herself to the process, how is the therapist’s energy level affected?

There are many ways of doing pastoral music therapy. The examples I have provided reflect only my own way. With so many ethnic and cultural groups represented in a large city, no one person can learn how to minister effectively to all of them. There is a need for people of many backgrounds and capabilities to be trained in appreciating the “pastoral” perspective of music therapy. I am sure that therapists working with populations very different from my own can find many different ways of applying this comprehensive approach to what is now sometimes called “caring for the soul.”

This is how I would like to continue working as a music therapist: working in a home or an institution or a community where I can get to know the residents, share their joys as well as their losses, be with them when they are sick, and even help them prepare for their final moments. Such work requires many levels of training: musical training, clinical training, and familiarity with the cultural and spiritual backgrounds of many different kinds of clients. Music therapy deserves respect as a full clinical discipline, and I am afraid it does not always get this respect in the real world. I would like to see a time when music therapy will be considered a discipline in its own right, and not automatically subsumed under the heading of recreation. Music offers recreation, but it also offers much more. The healing that results from the therapeutic use of music takes place on many levels.

I have learned a lot this internship year about music, about therapy, and about the struggle to understand what it means to love. I may always see this as an ideal I will never fully acquire, but I feel enriched by the process of working with it and learning more about it. Music adds a dimension to therapy that takes therapy to the boundaries of life itself, the places that fill us with awe and anxiety, and even deep peace. Working this way, as a “clinical pastoral music therapist,” gives me a chance to make more real, to bring a little closer, the words that have always filled me with wonder: “There is no fear in love, for perfect love casts out fear.”