Beginning in my music therapy internship and continuing into my professional work with Connecticut Music Therapy Services, I have witnessed firsthand the benefits of music therapy in working with persons with dementia. The DSM-IV states that the essential feature of a dementia is the development of multiple cognitive deficits that include memory impairment and at least one of the following cognitive disturbances: aphasia, apraxia, agnosia, or a disturbance in executive functioning. It can be said that the majority of the goals addressed in music therapy with persons with dementia would fall under the cognitive domain. If we consider that many persons with dementia reside in assisted living or hospital settings it would be appropriate to also address goals that fall under the social, communication, and emotional domains in order to improve overall quality of life. In my experience I have found that these four domain areas could be addressed within one interactive vocal experience utilizing a 4-step process.
First, the therapist will address the cognitive needs of the client by playing only the melody of a chosen song. The therapist will then observe the client’s response (Is he/she humming or singing the melody?). I have found that songs which are short in length and have a simple melody (i.e. “You Are My Sunshine,” “Let Me Call You Sweetheart”) are most effective. If a song is too long, or its melody is too complex, the more difficult it would be for the client to recall the melody and/or lyrics. The next step would be for the therapist to sing the song with a simple chordal accompaniment providing the client with an opportunity to recall the song’s lyrics.
In order to provide the client with an emotional outlet, the therapist would then replay the song encouraging the client to sing on his/her own. It may be necessary to provide the client with vocal support by singing only the first words of each line and allowing him/her to complete the vocal line. Finally, to address the social and communicative needs of the client, the therapist and the client will sing the song together one last time. At this point the client has had the opportunity to recall the melody, lyrics, and rhythm of the song. The cooperative singing between the client and therapist provides a strong sense of accomplishment for the client and brings closure to the experience.
