I don’t need to say that we are in unprecedented times, but I will say it because we are in the midst of a new, unknown territory in healthcare and the wider provision of health and care services. For a profession as ‘small’ as Music Therapy (at the time of writing the number of registered Music Therapists is approximately 800 (BAMT, 2020)) this type of scenario leaves us with many questions about how best to practise and continue our services. But it also provides us with an opportunity to unite as professionals and to, together, move forwards with the ways in which Music Therapy is offered during the times patients are no longer able to access our services face to face.
Can we consider the current situation as an opportunity to grow and develop the ways in which we offer sessions to patients remotely? This doesn’t have to end when the current Covid-19 pandemic and resulting lock-down ends. How can we start building robust foundations to build digital services on?
Getting it off the ground
The first challenge we face is ‘convincing’ (I’m sure there’s a better word here!) service providers that Music Therapy and Music Therapists are still just as effective and valuable when face to face sessions are not possible. To quote Chiltern Music Therapy: ‘In these unprecedented times, our commitment to our patients is ever more important. Many of our patients are in the high-risk categories and desperately rely on their weekly sessions.’ (Chiltern Music Therapy, 2020).
If we can still find a way to see our patients and continue their therapy input, we must.
Quality of service
The next challenge we face is the practical running of a remote session. Which platforms are safe and comply with GDPR? What is our patient comfortable using? How do we set up a space in our home that is able to feel and look clinical without revealing too much of our personal lives? How do we ensure audio quality is good enough to actually hear the music properly?
This is something I am currently coming up against in sessions: the impact of audio / video delays when using online platforms such as Skype or Zoom. There is undeniably a delay and this can impact the experience of being with the patient. One technique that I have found works, when playing a familiar song together, is to ask the patient to follow me (rather than me following them). Whilst this inevitably impacts my experience of the music – and having to focus on my timing rather than the patient’s delayed responses! – the patient’s experience of joining in with a piece of music is hopefully not too impaired. Whilst discussing and debriefing a NMT Oral Motor Respiratory Exercise (OMREX) with my patient this week, the patient’s partner reassured me they felt that the exercise had gone well for them and they had felt able to hear me and keep in time with me as required. For me: I had fought to keep focused on my own timing and not slip into the patient’s delayed timing on the computer screen…so much so, that I hadn’t felt able to observe the patient much at all!
Interestingly, in the ‘experiment’ performed by Jonathan Cousins-Booth and Marianne Rizkallah, they felt that musical improvisation could cope with the audio delay whereas trying to play the same piece together was challenging and disrupted by the delay (Rizkallah & Cousins-Booth, 2020). Several colleagues of mine at Chiltern Music Therapy have experimented with turning video off to minimise the delay, but have reported that this results in removing the visual cues from the session.
Therapist – Patient relationship
I believe that if the Therapist-Patient relationship is robust, safe and good-enough, there is no reason that there would be a detrimental impact on the therapy if sessions were digital for a period. The Therapist is still ‘being with’ the patient, still carries their best interests at the heart of the work and meets the patient with unconditional positive regard. As Music Therapists, we have so much more to offer than a musical experience. In our sessions we are supporting our patient through their journey of change, providing them with the best tools we have to meet their goals, and continuing to work with the wider network of the patient. Most importantly: we aim to make the patient feel heard and understood. We are still making patient experience the priority, regardless of if that is in person or via video call.
The opportunity for providing additional services
Whilst we are focusing on continuing to provide our patients with their therapy input, we are also needing to be creative and innovative with how we meet the changing needs of our communities. For example, families that would spend their week at work and at school are now all based at home, and still trying to reach previous targets. This places an incredible amount of stress and pressure on all individuals. How can we help reach people and offer them something invaluable in a new way? How do we provide services to the elderly and vulnerable without adding to the workload of carers? How do we support the carers and the incredible NHS staff working through this?
Looking to the future as one united profession
I have been so amazed when reading about the new ventures and adapted services of many Music Therapists on Twitter and during conversations with my colleagues. It seems that when the pressure is on, we rise to the challenge and we not only want to help our patients, but we want to protect Music Therapy.
I feel so strongly that the way forwards for us is through UNITY. We must journey together, listen to one another’s suggestions, work together to create and deliver new, adapted approaches. We should use each other as sounding boards, ask for thoughts and responses to suggestions. And most of all: we can support each other through this extremely difficult and stressful time.