The Grand Orchestra: A Humanistic Conceptualization of Group Music Therapy in Dementia Care/Le Grand Orchestre : Conceptualisation Humaniste De Musicothérapie De Groupe En Soins Auprès Personnes Atteintes De Démence

Since 1998 I have specialized in working with older adults living in long-term care homes. I have learned so much and in turn have always striven to provide an experience that is meaningful for each group as a whole and for each individual within each group. In 2003 I completed a major research project in partial fulfilment of the Master of Music Therapy degree at Wilfrid Laurier University, Ontario, Canada. This was an important opportunity to better understand and articulate my own practice facilitating group music therapy sessions.Unfortunately, my enthusiasm for music therapy in geriatric and dementia care seems at odds with common negative stereotypes and misconceptions about what it means to work musically with older adults in long-term or extended care. Much of the music therapy literature in dementia care as comprehensively summarized by Brotons (2000] described cognitive, behavioural, social, and emotional treatment interventions without considering creativity. Ruud (2010] emphasized that respecting the dignity and musical identities of individuals involved in music therapy sessions is a priority. This important work is too often considered repetitive, boring, and uninspiring, largely because of the belief that working with the elderly involves singing the same songs day after day. But if singing old songs and thrusting instruments into frail hands to play along is believed to be the extent of the work, then I mourn a lost opportunity. It is possible to improvise with older adults: I have even used atonal music and observed great responses!The theoretical underpinnings of my music therapy clinical practice in dementia care have been informed by the work and writings of Australian music therapist, Ruth Bright (1972,1988,1997]. Bright's belief that persons with dementia possess the capacity to be creative inspired me and is the lens through which I have perceived and nurtured relationships with music therapy clients. Bright motivated me to hear, see, and cultivate the gems of musical creativity that are still present and accessible to persons with dementia.Much of the work done with the elderly focuses on who individuals were, which is echoed through theme and reminiscence-based programs intended to access and engage long-term memory. But I prefer to focus on individuals as who they are now. My approach is very much in the moment; I focus on the persons as they are that particular day. My goals have never been to a person with dementia, but to support the person in the best ways I can. For years now, my philosophy has been to assist persons to reach their fullest potential and improve their quality of life.Thus finding creative ways to engage older adults with dementia has been my mission, and as an advocate for music therapy in dementia care, my hope is that this paper will give music therapists a fresh perspective on a specialization that will only become more important-at least here in Canada (Milan, 2011)-as the population ages.BackgroundMy master's research was inspired by my passion to understand clinical observations and the ways in which persons with dementia were responding in the most extraordinary ways during music therapy sessions. I was witnessing individuals with moderate cognitive impairments spontaneously offering intentional verbal and non-verbal communication through vocal work and purposeful interactions with others using instruments; I was observing them demonstrating sophisticated physical movements like those of instrumentalists, conductors, and dancers; and I was seeing them responding musically in ways that may not be considered typical for this client group. In keeping with Maslow's (1943,1968,1973) theory of human motivation and his well-known hierarchy of basic needs, I believed that clients demonstrated a heightened human experience in group music therapy, which in fact could be described as being self-actualized. By modifying the concept of self-actualization to include music and musical relationships, I proposed a model of musical self-actualization (Jessop, 2003). …

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