boy playing flute
Music Is Hope

Music Therapy and Spiritual Care

C. Gourgey Ph.D.

I have spent my career as a music therapist working in hospitals, nursing homes, and hospices. There have been some exceptions, but usually when such institutions hear “music therapy” they think “recreation” or “activities.” While music unquestionably has recreational value, to think of music therapy only in such terms greatly limits the scope of what music therapy actually can do. The music therapist is then seen primarily as an entertainer, which is a shame because that is not what music therapy is really all about.

Music therapy at its best can support the emotional and spiritual needs of patients and families in ways not available through the use of words alone. To make clearer just what music therapy can offer, I would like to share a few brief stories from my hospice experience.

Ileana was a woman in her fifties who knew much tragedy in her life. She was dying of AIDS she contracted from her cheating husband, long gone, and after she became too sick to attend her church she lived mostly in isolation. When she came to the hospital and I went to visit her, I would often find her with her face towards the pillow as she softly cried.

Ileana would tell me how much she enjoyed singing hymns in church. She was born in Puerto Rico, and even though she spoke good English, my ability to speak Spanish was a comfort to her. I know many hymns from the Spanish church, and as I sang them to her I could see her reawakened faith restore her spirit.

Ileana wrote some hymns of her own, which she used to sing at services with her friends. She wanted to teach me one, so one day I brought a tape recorder so that I could catch every note. She could not speak above a raspy whisper, so I held the tape recorder very close to her mouth. The notes came with frequent pauses, though I could still make them out. But her strength seemed to fail when she was just halfway done. Seeing how tired she was, I told her we should stop and maybe the next day she would feel a little stronger. She stubbornly refused - she wanted the entire song on record that afternoon.

After a little rest she did get through it, and I took the tape home and learned the song that night. It starts like this:

Cuando miro al cielo
Siento que te veo
Sé que algún día
Tú lo harás realidad.

Cuando tú la iglesia
Busque aquí en la tierra
Y nos lleve al cielo
Al trono de Dios.

Cuando miro al cielo,
Cuando miro al cielo,
Cuando miro al cielo.

(When I gaze up to heaven
I feel that I can see you.
I know that one day
You will make it a reality,

When you look for your church
Right here on this earth
And bring us up to heaven
Before the great throne of God.

When I gaze up to heaven,
When I gaze up to heaven,
When I gaze up to heaven.)

The sad, simple tune was like a prayer as strong as Ileana’s voice was weak. I put chords to it and sang it for her with my guitar. Being able to receive the words of her own song through someone else’s voice consoled her.

As the weeks passed, Ileana suffered increasing pain. While her pain medication helped, it also sapped what little energy she had left. I would often find her sleeping, but one day just as I was ready to leave I discovered she had just awakened. The first thing she said was “Please sing me ’Cuando miro al cielo.’“ I sang it to her and she fell into deep sobs that shook her body for several minutes. I sat with her for a while, and then reassured her that God must love her very much to have given her such a beautiful song. She said nothing but simply nodded.

Ileana’s song became a bond not only between the two of us, but also between her and the faith she needed so much right then. She came back and forth to the hospital many times, and every time she returned, a little weaker than before, I would greet her with her song. It always lightened her mood and made her smile. After Ileana went home for the last time, her social worker informed me that she died very peacefully.

Sarah was another woman in her fifties, dying of pancreatic cancer. She loved all kinds of music - music of faith, but also country music and anything “folky-rocky.” One of her favorites was “Puff the Magic Dragon” and she asked me to sing it often.

One day Sarah fell into a crisis. No one could determine the cause - one of the nurses thought it might have been a severe allergic reaction, but Sarah had no known allergies. Her blood pressure took a precipitous drop, and for a while she lost consciousness. The nurses rushed in, gave her emergency oxygen, and elevated her feet to stabilize her blood pressure. Still, Sarah was not responding. Her daughter was present and crying hysterically, afraid she was going to lose her mom. She phoned the doctor and I heard her saying, “Are you telling me she’ll always be like this, and that she’ll never respond again?”

Sarah looked extremely agitated, almost as if she were seizing, and her face was drained of color. The nurses tried to calm her, but it wasn’t working. I suggested singing soft lullabies to relax her. Sarah’s daughter said yes, so I began to sing this song by Gordon Bok:

If I could give you three things
I would give you these:
Song and laughter and a wooden home
In the shining seas.

When you see old Isle au Haut
Rising in the dawn
You will play in yellow fields
In the morning sun.

The nurses continued their ministrations, and I continued singing. Very slowly Sarah began to relax, and color started coming back into her face. When she opened her eyes and saw me she smiled. The first thing she said was, “Sing me ’Puff the Magic Dragon.’“

The spiritual care that music therapy can provide offers support not only to the patient but to the family as well. Edward was an elderly man from Kentucky, a real Southern gentleman. He was frail and weak and not up for a lot of contact, but he wanted me to sing one song for him, “My Old Kentucky Home.”

The sun shines bright in the old Kentucky home,
’Tis summer, the people are gay;
The corn top’s ripe and the meadow’s in the bloom
While the birds make music all the day.

The young folks roll on the little cabin floor
All merry, all happy and bright.
By’n by hard times comes a-knocking at the door
Then my old Kentucky home, good night.

Weep no more, my lady,
Oh, weep no more today.
We will sing one song for the old Kentucky home,
For the old Kentucky home far away.

Edward, the displaced Kentuckian in a New York City hospice, needed only to be reminded of his original “home far away.” That made him happy. When I sang that song, regardless of how he had been feeling earlier, he lay back comfortably in his bed and his lips began forming a smile.

Two or three weeks went by and finally Edward died. His wife was at his bedside, so overwhelmed with grief she could hardly speak. They called for the priest and he said a final prayer. After that, I sang a hymn version of Psalm 23:

The King of Love my shepherd is
Whose goodness faileth never.
I nothing lack if I am his,
and He is mine forever.

Where streams of living waters flow
My ransomed soul He leadeth.
And where the verdant pastures grow
With food celestial feedeth.

In death’s dark vale I fear no ill
With Thee, dear Lord, beside me.
And on His shoulder comfort still,
Thy cross before to guide me.

And so through all the length of days
Thy goodness faileth never;
Good shepherd may I sing Thy praise
Within Thy house forever.

While I was singing that hymn Edward’s wife, sobbing uncontrollably, reached out to me and held my hand. I held hers firmly to convey the support of the Psalmist’s words.

In such ways music therapy can make a valuable contribution to traditional pastoral care. Pastoral music therapy and spiritual care are natural allies - as my Spanish patients have often told me, “él que canta ora dos veces” - “The one who sings, prays twice.”

As I have written in my music therapy thesis (available on this web site):

“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.”

The need for this type of music therapy will increase as our health care system becomes more strained and impersonal and the number of people living in hospitals, nursing homes, and other institutions continues to swell. When I have worked in such settings it has been my job to act as a buffer between the patients and their depersonalized surroundings, and to help make their experience, with all its attendant fear, more endurable. By finding music that reflects their culture, or that brings back familiar and pleasant memories, I try to bring a little bit of home to them when they are far from home. And for those to whom faith is important, music can revive that faith and strengthen it.

Especially when both one’s illness and one’s environment can so easily lead to feelings of isolation and abandonment, not just the body but the soul as well needs our attention and care.