Care for Music - an ethnography of music in late life and end of life settings

Lead Research Organisation: University of Exeter
Department Name: Sociology, Philosophy, Anthropology

Abstract

The project focuses on music-making in situations of modern dying and in relation to both (i) end-of-life (time-limited illnesses or conditions) and (ii) late life (more lengthy 'dwindling' and/or long-term disability). The research begins with a basic question which in our view has not yet been answered adequately: how does music work in situations of care? Behind this question is an assumption that musical care is more complex than models in music therapy and community music might imply. These models have tended to prioritise the activities and agencies of specialist music providers through a notion of music 'for' 'care recipients' and in individualistic and pathologised ways. But looking at music 'for care' (as opposed to 'care for' music) sidesteps the complex collaborative practices, and forms of agency, on the part of all the people involved (musicians, music therapists, carers, health professionals, family and so-called 'care-receivers'), that make music helpful (and meaningful) within scenes of care. A focus on this practice brings to the surface three otherwise implicit problems in the music and care literatures. These are perceptual, ontological and methodological. Processes of musical engagement are often tacit, fleeting and socially-spatially distributed and therefore difficult to perceive. They are also tied to a language of 'music' as an object and therefore to an ontology of stimulus-response rather than music as a joint activity. They are difficult to document unless they are observed in temporal and spatial contexts and in terms of their evolving histories - and for this specialist methods are required.

The methodological perspective to be employed is ethnographic, to trace connections and relationships between people as they are crafted from moment to moment in real time through music and in ways that may be consequential for action opportunities within settings of care. The project will produce four interlinked ethnographic case studies:
(1) A longitudinal study of community music therapy in a care facility (with specialty in neuro-disability), tracking the micro-detail and developing connections within and between individual and collective musical-communicative work (2) and (3) Studies of music/music therapy across the milieu of two flagship hospices, one in the UK, one in Norway. (4) A study of a novel approach to working relationally with people with memory loss by cueing pre-chosen sounds and memories using simple digital resources.

In each case, the project will examine the subtle, adaptive, and often unnoticed practices of managing to make and attend to music under constrained circumstances - how mutual orientation takes shape, how allowances are made, how musical gestures and acts are supported, by whom, with what and how. This focus will in turn support a second key task which will be to map the diversity of musical practices to be found and to follow these practices as they are connected (by participants) to other practices, activities, situations, and events that develop concurrently within the setting and in ways that inform future events. Ultimately, the project will address the question of how making music together may open new opportunities for caring understood in its widest sense, for example, fostering musicalised situations within which clients and carers may discover new forms of relation, empathy, activity, and mutual understanding.

Planned Impact

Four interlinked groups will benefit:

(1) Music Therapists, Community Musicians, Music & Health Practitioners
Increasingly Music therapists, community musicians and music & health practitioners are working in late and end-of-life settings, as individual specialists or as part of large-scale initiatives. Practitioners and service organizations speak of the need to develop effective techniques for 'reaching' the various groups with whom they work. But the current framework for thinking about their role and musical relationship with those groups (care recipients, families of care recipients, care staff) often portrays musical activity as specialist 'intervention' in ways that emphasize the 'delivery' aspect of music to people - through performances or more interactive work. The project will raise awareness of musicking in scenes of care as mutual, reciprocal and 'ecological' in ways currently under-appreciated. It will work with musicians and music therapists in bespoke workshops and symposia to highlight the often-subtle activities, practices and contributions to on-going musicking made by care recipients.

Our aim will be to enrich curricular resources for both expanded theoretical perspectives and fine-grained practical coaching in music therapy training. We will run workshops with music therapy and community music trainers, presenting a novel perspective on what counts as 'music', and how care and music interleave in practice. (We have experience of running a highly successful Masterclass on Ethnography for early career music therapists in 2017 at Exeter.) In these events, Ansdell, Schmid and Simpson will provide participant workshops specifically to present perspectives and techniques and to mentor practitioners. DeNora will contribute a wider perspective linking alternative music aesthetics and ontologies within a sociology of health and illness perspective. Rolvjord will offer specialist commentary on eliciting client perspectives and our partners from Earl Mountbatten will share their flagship practices for community-hospice interchange (as part of a wider education project musically-led about cultures of death and dying).

(2) Care givers, Care recipients, Family members and friends of care recipients
The introduction of a new form of client-centered approach that explicitly highlights how music can encompass and enhance the whole 'scene of care' will help shift the balance in care settings where music is happening in ways that should empower clients, carers and others involved, drawing to the fore their interests, talents and musical needs and thereby improve quality of care. But all this need sensitizing musicians and music therapists to really attend to how care-receivers themselves 'care for music' and how this can be worked with and extended.

(3) The General Public
We aim to increase public empathy with groups of people who are typically sequestered and conceptualized as 'disabled' and lacking social and cultural resources by highlighting 'alternate forms of musical ability and sociability' and the ways in which musicalizing activities associated with 'care' may help to eclipse some of the barriers to shared meaning making in music. Calling attention to the sounds of musical care and to music in scenes of care will help to make those scenes less 'strange' to families and visitors who have loved ones in care facilities. At the same time we aim to raise public awareness of how to use music for wellbeing in daily contexts.

(4) Policy makers
We will aim to influence policy by contributing new perspectives for thinking about evidence and music's role in scenes of care through briefing documents, website entries and alignment with the All Party Parliamentary Group on Arts/Health as well as with Clinical Commissioning Groups. The aim will be to improve quality of care in care facilities.

Publications

10 25 50
 
Title Poetry of Departures 
Description The project team has a strong interest (amateur) in poetry and poetry writing. While DeNora has a strong hobby interest in formal poetry (and has written many villanelles about and around dementia - prompted by a close relative and 'drawn out' through engagement with a strict, highly repetitive formal structure, the Co-I, Ansdell, has used short, ethnographic poetry as a way of engaging in reflexive practice. The poems, short, anonymous, and mostly written quickly on a hand-held device, happened initially as a way of making sense of his own feelings/responses to events and interactions. Together they have been exploring the place (and placement of) poetry within an otherwise strictly research-based focus and in ways that add a component (not initially planned in the research proposal but linked to the aim of developing 'gentle' methods for examining music and care). We view the poem is for this project not as an end in itself, or even a medium or resource for public engagement (at least not so far) but rather as part of the research process. We are exploring how poetic representation can call out, or bring to mind, features of events in the field sites that otherwise might get lost, forgotten or suppressed, cognitively speaking. These features include the practitioner's emotions (engaging with people who are near end of life is inevitably imbued with a rich field of emotions and responses) and emotion regulation, but they also include issues that our project wishes to explore methodologically and substantively, namely, what 'is' ambience/atmosphere and for whom, and how is it brought into being as an object of awareness, and how can attempting to explore the emotional content of interaction in scenes of care (musical interaction specially but always as intwined with many other features of the care setting) be enriched, enhanced, or - conversely - traduced - by attempts to engage with that content through explicitly aesthetic means. We are sharing some of these on our website and presenting a special session on this topic at the Last Chapter Festival this summer in Bergen. 
Type Of Art Creative Writing 
Year Produced 2019 
Impact Any impact is nascent at this stage but we hope to be able to report on impact after the Festival appearance in June 2020. 
URL https://careformusic212434243.wordpress.com
 
Description One of our project aims is to develop nuanced methods for exploring music therapy and musical engagement 'in action'. We speak of these methods as 'gentle'. They include traditional ethnographic methods but also seek to develop methods for split-second musical/social interaction. We have begun to discuss these issues on our website and we have found, in our practice analysis and calibration workshops, that the things that seem to make music 'work' are often exceptionally 'small', micro-particicles of music/social/gestural interaction (e.g., how a note is sung in unison combined with eye contact) and that these small things are in fact often 'large' in terms of their follow-on consequences (relationships, topics of conversation, musical memories). We are exploring also the importance of person-centred,singular, biographical matters that frame music perception and music engagement. So far, we think that we are developing a new understanding of how people engage with music and how this engagement can be understood as a series of micro-practices.
Exploitation Route There are direct lessons for, and conversations still to be had, with music therapists and care providers.
Sectors Education,Healthcare,Culture, Heritage, Museums and Collections

 
Description It is still relatively early in the project but our findings are, as they emerge (slowly), being integrated into training for music therapists in London and in Bergen - both major centres for training practitioners. We're holding a special roundtable to produce the first of what we hope will be several Briefing Notes for policy makers and care providers in May at the British Academy.
First Year Of Impact 2019
Sector Education,Healthcare,Culture, Heritage, Museums and Collections
Impact Types Cultural,Societal

 
Description Training for professional music therapists: Ansdell, DeNora and Schmid have run or contributed to training sessions on evidence and 'gentle methods' (a project aim is to develop what we describe as 'gentle methods' of analysis) at Nordoff Robbins PhD Seminar (practicing music therapists who are pursuing advanced training/research linked to their work) and at GAMUT, The Grieg Academy. We have led sessions on the importance of ethnographic and micro research methods in music therapy research and practice which have reached roughly 10 practitioners in London and 30 in Bergen.
Geographic Reach Europe 
Policy Influence Type Influenced training of practitioners or researchers
 
Description Partnership with Earl Mountbatten Hospice 
Organisation Earl Mountbatten Hospice
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution Access to research expertise and staff peer-to-peer training and data-analysis workshops
Collaborator Contribution access to facilities for planning data collection; expert advice on project and project advisory board membership
Impact At this stage outcomes are enriched research perspectives due to the interdisciplinary collaboration between sociology of music, music therapy and palliative care The project website, particularly the sections on engagement activities and gentle methods, reflects some of the anticipated directions that eventual publicaitons might take. There are events in the pipeline for spring/summer involving project partners, the first of which is a scheduled roundtable at teh British Academy with the aim of producing a briefing paper on care and music which will be circulated for discussion on the project web page.
Start Year 2019
 
Description Implementation of home-based music therapy for people living and dying at home 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Patients, carers and/or patient groups
Results and Impact Home-based music therapy with a patient associated to the Sunniva Senter for Palliative Care. First steps towards the implementation of home-based music therapy for persons in palliative care in Bergen/Norway.
Year(s) Of Engagement Activity 2019
 
Description Inservice training at the Sunniva Senter for palliative care, Haraldsplass Deaconess Hospital Bergen, Norway 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact 25 professionals (specialised nurses, physicians, a physiotherapist, a psychologist, a priest) attended an inservice training about music therapy and the Care for Music-research project at the Hospice Sunniva Senter for Palliative Care at Haraldsplass Deaconess Hospital in Bergen, Norway. The participating colleagues reported an enhanced and extended understanding of music therapy´s role in interdisciplinary care, as well as of the research project.
Year(s) Of Engagement Activity 2019
 
Description Keynote Lecture Art in Education Conference, Oslomet University, Oslo August 28-30 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Roughly 120 attendees, the keynote described the importance of 'legacy resources' (music in particular) in later life and for mental health and mentioned the MARCH project as a key project devoted to and promoting this topic and outlined the first phase of Care for Music.
Year(s) Of Engagement Activity 2019
URL https://www.oslomet.no/om/arrangement/art-in-education/programme-art-in-education
 
Description Lecture, University of Rome III on project themes, December 2019 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Schools
Results and Impact Postgraduates and Undergraduates plus ministerial employee and academics to discuss and debate issues around non-verbal communication and music's important role when speech is not available. Laid groundwork while there fore follow-on research in collaboration with specialist in memory studies.
Year(s) Of Engagement Activity 2019
 
Description Panel on Care and Arts for Nordic International Grieg Research School in Music Studies: presented our research program and led discussion as part of this summer school drawing together music therapists and music researchers, staff and postdoctoral researchers 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact Roughly 30 postgraduate researchers in music therapy and allied disciplines plus associated university staff and postdoctoral researchers plus music therapy practitioners took part in this conference event in June 2019. We hosted a panel on Care and the role of the arts in care and facilitated a general discussion. This was the 'launch' conference event for the project and coincided with the first Investigators' meeting in Bergen.
Year(s) Of Engagement Activity 2019
URL https://careformusic212434243.wordpress.com/what-counts-as-music-and-for-whom/
 
Description Presentation at Nordoff Robbins social value of music conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Varied audience of over 100 attended Nordoff Robbins Social Value of Music conference at Nordoff Robbins Music Therapy, London. My talk was 'When (exactly) is wellbeing? (What clues does music therapy give?)'.
Year(s) Of Engagement Activity 2019
 
Description Professional skills and research skills workshop 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact October 2019: 30 music therapy advanced practitioners attended a weekend workshop I led at Concordia University, Canada. There were two presentations: (i) 'Deep listening in music therapy practice - Care for music in later life settings' [open day workshop for students and alumni]; (ii) 'Designing ecologically valid research - towards an AHRC project' [MA students & alumni]
Year(s) Of Engagement Activity 2019
 
Description Research information workshop at music and care conference 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact 20 participants attended a research information workshop on music and care at a major conference on this theme - The power of music in health and social care conference, Nottingham University. My workshop (with Dr Orii McDermott, Nottingham University) helped music therapy and music & health practitioners orientate to the latest research on music and care.
Year(s) Of Engagement Activity 2019
 
Description keynote presentation at music and care conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact 200 people attended an international conference on music and care - The power of music in health and social care conference, Nottingham University. My Keynote was 'Taking an improvisational attitude to music's help'
Year(s) Of Engagement Activity 2019