Complementary Therapies in Clinical Practice 23 (2016) 125e129

Contents lists available at ScienceDirect

Complementary Therapies in Clinical Practice

journal homepage: www.elsevier.com/locate/ctcp

Development and efficacy of music therapy techniques within

palliative care
s
Amy Clements-Corte
University of Toronto, Music and Health Research Collaboratory, 80 Queen's Park Circle, Toronto, Canada

a r t i c l e i n f o a b s t r a c t

Article history: Music therapy is increasingly becoming an intervention used in palliative care settings around the globe.
Received 15 March 2015 While the specialty of palliative care music therapy is relatively young having emerged in the late 1980s,
Accepted 26 April 2015 there is a strong and growing body of evidence demonstrating its efficacy in assisting a variety of issues
common at end-of-life. There are multiple music therapy techniques that are implemented with clients
Keywords: in palliative care and they can be categorized in four broad areas: receptive, creative, recreative and
Efficacy
combined. These techniques will be presented with respect to their development by clinicians as sup-
Grief
ported by the descriptive and research literature. Information is also provided on the use of music
Music therapy
Palliative care
therapy in facilitating the grieving and bereavement process.
Techniques © 2015 Elsevier Ltd. All rights reserved.

1. Introduction and emotion in palliative care [11].

Music and medicine have enjoyed linkages throughout history
Davis, Gfeller and Thaut [1] noted a few such examples which
include: music being played in Cairo hospitals in the middle ages;
Renaissance physicians using music as preventative medicine;
Baroque musicians writing about the curative effects of music; and
in the 17th century, the surfacing of writings on the psychological
benefits of music. Music therapy as a discipline has a relatively
young but growing history. As a formalized profession, it came into
existence after World War II when music educators and musicians
were playing music in the veteran hospitals in an attempt to boost
morale.
With respect to palliative care music therapy, the Royal Victoria
hospital in Montreal, Canada emerged as the pioneering facility
that provided this type of therapy [2]. A landmark event in
launching palliative care music therapy was a symposium held in
New York city where 40 music therapists who were working with
the terminally ill came together to discuss their work. The subse-
quent proceedings served as an important initial grounding of the
work, as well as a launching point for research studies in the 1980s
and 1990s [3]. Early research and descriptive palliative care music
therapy articles primarily came out of Australia, the United States,
Canada and the United Kingdom [4e11]. Such articles addressed a
number of topics including: lyrical themes written by palliative
care patients [10]; pain and symptom management [6]; and music
E-mail address: notesbyamy2@yahoo.ca.
This paper will provide an overview of the development of
music therapy techniques used in palliative care, and will also take
a look at research demonstrating the efficacy of music therapy with
this population within the framework of said music therapy tech-
niques. Lastly, it will also provide additional information on the use
of music therapy to facilitate grieving and bereavement.
2. Development of music therapy techniques in palliative
care
Palliative care music therapy techniques have primarily devel-
oped from therapists describing their work and approaches/tech-
niques in the literature Peters [12] states: “as they have worked
with dying patients and their families, music therapists have
discovered many ways in which various music activities can help
meet the physical, psychological, emotional, social, and spiritual
needs of terminally ill clients” (p. 111). These early depictions of
useful and appropriate techniques have informed the practices of
today's music therapists.
The ways that music approaches are used in therapy are helpful
in providing a framework for understanding how techniques have
developed over time. For example three principles that guide how
music is used in therapy were outlined by music therapy pioneer
Gaston [13] as:
(1) the establishment or reestablishment of interpersonal
relationships,

http://dx.doi.org/10.1016/j.ctcp.2015.04.004
1744-3881/© 2015 Elsevier Ltd. All rights reserved.
126 A. Clements-Cortes / Complementary Therapies in Clinical Practice 23 (2016) 125e129
(2) the bringing about of self-esteem through self-actualization,
and
(3) the utilization of the unique potential of rhythm to engage
and bring order (p. v).
Similarly Sears [14], identified the following classification sys-
tem for processes occurring in music therapy as: “(1) experience
within structure, (2) experience in self-organization, and (3)
experience in relating to others” (p. 31). These principles and
classification systems shed light on how goals are accomplished
using music, and how they are exhibited and demonstrated in the
techniques.
Music is one modality that provides a large number of expres-
sive and learning experiences ranging from singing, to moving to
music, to discussing music, etcetera [12]. As with other clinical
populations, music therapy techniques in palliative care may be
categorized in one of four categories: receptive, creative, recreative,
and combined [15]. Receptive methods are common at end-of-life
considering the patient may have decreased energy levels and
involve more passive responses on the part of the client; typically
involving the patient listening to music. Approaches that fit in the
creative category include things such as: music and lyric compo-
sition, and other music creation on voice or instruments. Per-
forming previously composed music either on instruments or by
singing are considered recreative approaches, and combined ap-
proaches involve various fusions of music with other modalities
such as movement, art or drama.
Clements-Cortes [16] categorized various techniques that were
useful to her participants in examining relationship completion at
end-of-life (see Table 1).
Brief definitions of the techniques, which require further
description, are provided below. The receptive technique of song
choice is where the therapist invites the client to select a piece of
music based on certain criteria, or to freely choose any song that
might be important, present or preferred. Song choice which often
involves verbal processing of the selections, may help uncover and
reveal various aspects of the patient such as their feelings, and
present or enduring thoughts. Lyric analysis is the choice of songs
by either the patient or the therapist followed by listening to said
song and the having a verbal discussion of the lyrics.
Entrainment is another common technique in palliative care and
involves the therapist playing music to facilitate changing a pa-
tient's heart rate, brain waves and breathing pattern. The therapist
often includes this technique to help slow down rapid breathing or
to calm a racing heart rate. The therapist begins by matching the
heart rate of the patient musically and gradually changes and slows
the tempo so that the patient's heart rate and breathing will
resonate and change to the slower tempo. This is known as the iso-
principle.
Music and imagery involves the therapist providing either live,
improvised or recorded music accompanied by descriptions of
scenery, a journey, or other imagery. A specialized approach that
involves music and imagery implemented by a trained practitioner
in the approach is known as The Bonny Method of Guided Imagery
Table 1
Music therapy techniques for relationship completion.a
Receptive Creative
Music listening Songwriting
Song choice Instrumental improvisation
Lyric analysis Vocal improvisation
Entrainment Toning
Music and imagery Song dedications
Music/song legacies
a s.
Reprinted with permission from Dr. Amy Clements-Corte
and Music (BMGIM). The BMGIM involves the use of a detailed
protocol and specifically designed music programs to assist a client
in reaching a deep relaxed state in order to access their unconscious
and work through ‘material’ (issues, feelings) they may or may not
be acutely aware of. When this method is used at end-of-life it can
produce powerful results quickly.
Songwriting remains a highly effective and important technique
in palliative care. Refs. [17e19] first described songwriting for
persons with emotional and psychiatric problems; and songwriting
in palliative care has its roots in these early writings. O'Callaghan
[20] who has written extensively on songwriting in palliative care
provided early guidelines in the form of 10 therapeutic opportu-
nities associated with music and songwriting in palliative care,
which are:
(1) Songwriting offers patients opportunities to express crea-
tively through both the words and music.
(2) Songwriting may be less threatening than other forms of
creative writing.
(3) Songwriting offers varied opportunities to promote physical
and social well-being.
(4) The music accompaniment may enhance one's learning of
the lyrics.
(5) Songwriting allows people to make creative choices that
encompass both musical and verbal dimensions.
(6) Songwriting may offer opportunities for counseling.
(7) The song melodies may inadvertently offer comfort.
(8) Songwriting verbally and musically validates emotional
expression.
(9) Helping patients to create new lyrics for well-known music
may encourage their expression of thoughts and feelings.
(10) When writing songs one may feel pride about both the lyrics
and musical setting (p. 13e15).
Improvisation of music can either be done by the therapist and
the client individually or together. O' Kelly [21] acknowledges the
importance of this technique in facilitating therapist support,
reflection and encouragement of patient expression in music rather
than in verbal discussion and processing. Song dedications and the
creation of music or song legacies involve the patient selecting and/
or writing a song that expresses a thought, feeling or sentiment to
another person, and when these are recorded individually or as part
of a group of songs they are known as song legacies.
To conduct a music life review the therapist may help the pa-
tient to identify music from various time periods in their life to
stimulate discussion about their life story. However, assembling
music that the patient identifies as representative of important life
events or times is categorized as a musical autobiography.
3. The role of music therapists within palliative care
interdisciplinary health care teams
Around the world music therapists are increasingly being
included in palliative care interdisciplinary health care teams. This
Recreative Combined
Instrument playing Music and movement
Singing pre-composed songs Music and other arts experiences
Conducting music Musical life review
Musical Autobiography
 A. Clements-Cortes / Complementary Therapies in Clinical Practice 23 (2016) 125e129
growth in inclusion is primarily due to the increased research and
documented efficacy of music therapy as well an overall increase
and desire for holistic and comprehensive care. For example
Clements-Cortes [16], found music therapy was a valued inter-
vention in working towards common palliative care goals; and
others such as Refs. [22,23] describe its success in addressing a
variety of emotional, physical and spiritual issues in palliative care.
Specifically, the literature has discussed: reducing emotional
suffering that includes anxiety, anger, depression and fear [24],
reducing feelings of loneliness and social isolation [25], patient
perceived improvements in physical comfort, reduced pain
perception and enhanced relaxation [4,26e28] and attending to
spiritual distress [29].
4. Research efficacy evidence
Up until 2005 most studies on palliative care music therapy
were qualitative in nature. Hilliard [30] analyzed 11 published
quantitative studies summarizing that results were promising but
lacked generalization to the broader palliative care population. One
of the main issues with the quantitative studies to date surrounds
small sample sizes and an intensified need for studies with
increased control and randomization of participants as well as
meta-analyses. A Cochrane review of the literature that included
1891 participants and 30 trials was undertaken by Bradt et al. [31].
The authors concluded that music therapy may have benefits to-
wards reducing anxiety, improving mood, reducing pain percep-
tion, enhancing quality of life, and reducing heart, respiratory and
blood pressure rates in persons with cancer. This review highlights
the importance of music therapy as an intervention with end-of-life
cancer patients and also identifies areas for further research in
palliative care music therapy. Here, I have organized important
research contributions to palliative care music therapy under the
headings of the four categories of techniques described earlier:
receptive techniques, creative techniques, recreative techniques,
and combined techniques.
4.1. Receptive techniques
A number of studies have focused on the use of music listening
to reduce pain perception. For instance Curtis [27], found that
participants in her study had an increase in scores for pain relief,
physical comfort, relaxation and contentment after listening to
music. Clements-Corte s [26] found that both live and recorded
music listening by palliative care patients resulted in statistically
significant reduced pain perception with the magnitude of the ef-
fect being much greater for live music. Other case studies have also
identified that listening to music helps reduce pain perception and
increases feelings of relaxation [2,6,7,32]. More specifically Kemper
and Danhauer [33], found that classical music listening resulted in
patients experiencing reduced tension and prescribed music had
patients commenting on feelings of improved mental clarity,
increased relaxation, as well as reduced feelings of sadness, tension
and fatigue.
With respect to persons receiving chemotherapy treatments
Troesch et al. [34], found guided imagery resulted in delayed
symptoms of the chemotherapy as compared to participants in the
study control group. Further benefits included feelings of relaxation,
feeling more prepared and in control prior to chemotherapy then
participants in the control group. Similarly, patients who listened to
their own preferred choice of music experienced reduced or delayed
symptoms of nausea following chemotherapy [35].
Song choice has also been demonstrated in the efficacy literature
and is a useful technique in helping clients regain self-esteem,
reconnect to identity, provide opportunities to make choices, and
127
also help clients express feelings that are challenging to discuss [29].
Gallagher et al. [36] implemented song choice to facilitate goal
acquisition with respect to several concerns including: decreasing
anxiety and depression, enhancing mood, decreasing pain percep-
tion, providing enjoyment, distraction and support or coping skills.
Song choice and lyric analysis often trigger reminiscence and Jones
[37] acknowledges that patient self-identity can be strengthened
through music and reminiscence as specific songs might facilitate
discussion on stories from various time periods in a person's life such
as early adult years, childhood, marriage and school days.
4.2. Creative techniques
Songwriting is a powerful technique at end-of-life. O'Callaghan's
[38] early writings discussed how songwriting facilitates expres-
sion of suppressed feelings, instilling feelings of contributions to
the world, providing the client pleasure and contributing to
increased self-efficacy, all while helping the client to express
messages to important people in their lives. O'Callaghan [39]
studied the themes of 39 palliative care patients' songs (64 songs
total) concluding that songwriting provided diversion and a place
of refuge from their current illness, and it further provided a place
of safety and helped with symptom management. In more current
research, songwriting continues to be helpful for clients’ expression
of feelings [16], and further enables the discussions between the
client and their family and friends regarding their feelings and
experiences, with the song providing the framework within which
to share [40].
With respect to clinical improvisation common benefits noted
were release and resolution of painful emotions [41]; helping the
client build a deep therapeutic relationship with the therapist and
assisting the client to feel understood [25]; helping the client access
unconscious issues and process them including anger, fear, exis-
tential loneliness and jealousy [25]; and increasing comfort and
reducing anxiety [42]. Specifically, with respect to vocal improvi-
sation Batzner [43] noted that following music therapy sessions in-
patient hospice clients displayed decreased discomfort behaviors.
4.3. Recreative techniques
Halstead and Roscoe [44] found that enhanced mood, increased
expression of feeling, alongside contributing to feelings of
enhanced quality of life were benefits gained through instrument
playing; while Gauthier and Dallaire [45] found that it helped
facilitate communication between the client, their family and
friends as well as staff members. Singing was shown to lead to a
greater sense of self awareness and increased feelings of belonging
[46], while also helping boost mood, confidence, assist with
emotional release, and stimulate reminiscence and overall in-
teractions with family [47]. Toning and chanting were of specific
benefit as they were linked with emotional and physical relief and
reduced stress [48].
4.4. Combined techniques
Musical life review is a technique that allows clients to review
significant and unique aspects of their lives [49], while also
providing an avenue to celebrate or acknowledge accomplish-
ments, process regrets, and raise self-esteem. Duffey [50]
acknowledged that this technique may help clients to gain under-
standing on negative aspects of their life and even help the client to
revise or re-author those occurrences. For clients suffering from a
fear of death or those having existential concerns about life and
death this technique can also be important to work through some
of those issues. Halstead and Roscoe [44] noted the importance of
128 A. Clements-Cortes / Complementary Therapies in Clinical Practice 23 (2016) 125e129
musical life review to alleviate spiritual distress. The creation of
musical autobiographies are yet another way to highlight a person's
achievements and celebrate the important things a person has
done in their life. It can also be left as part of a legacy gift for family
and friends.
5. Music therapy grief and bereavement
At the end of life, music therapy is not only beneficial to patients
with anticipatory grief [23,51] but it is also valuable in supporting
grief and bereavement of family and friends. While the patient is
actively dying, music therapy sessions which focused on the patient
and caregivers were shown to have significant benefits in the grief
process for caregivers and even positively contributed to bereave-
ment [52]. In this incidence music provided an outlet to celebrate
and cherish moments of love, opened and renewed pathways for
communication between patients and caregivers, and helped create
memories that positively sustained caregivers during the
bereavement process. The spirituality of caregivers was also stud-
ied by Magill [53] who found that pre-death music therapy sessions
helped caregivers to feel a connection with themselves and others
while providing a space to reflect on the past, present and future.
While there is a growing body of research with respect to music
therapy and bereavement support, it is not as extensive as the
palliative care music therapy literature at this time and has more so
been a focus since the turn of this century. The majority of writings
on this topic have focused on specific music therapy techniques and
child/adolescent populations. Two of the most important tech-
niques identified in the research were songwriting [54e59] and
clinical improvisation [60].
With respect to grieving children music therapy was imple-
mented by Hilliard [61] in a school setting, by Mayhew and Ryan
[62,63] within hospice, and by Roberts [64] in the home. A study
assessing the impact of social work and Orff-based music therapy,
using a wait list control group with bereaved children, found chil-
dren in the social work group experienced significant decreases in
behavioral problems, but not with respect to grief systems, the
control group had no significant changes in behavior or symptoms
and that the music therapy group showed a significant increase in
both areas [65].
An analysis of 123 song lyrics written by bereaved adolescent
gave light to five areas of grief processing including: feeling,
growing, integrating, remembering and understanding [55]. With
this information, a grief process scale (GPS) was developed to use
with bereaved adolescents participating in songwriting in a pilot
study [66]. Results indicated an improvement in the grief domains
for music therapy participants as compared to controls, and sug-
gests that songwriting facilitates positive growth in bereaved
adolescents.
With respect to bereaved adults, the use of the Mexican Corrido
song format was assessed by Schwantes et al. [59] for its benefits
with grief and sudden loss. In this study, the song format was
culturally relevant to the Mexican migrant farmworker partici-
pants, and results indicated that culturally centered approaches can
facilitate connections with group members and those who have
died when implemented with those experiencing grief.
Other writings on bereaved adults have been published as case
studies. The case of a bereaved woman looking to find personal
identity and work through grief with improvisational techniques
where the client vocalized and was supported by the therapist was
described by Smeijters and van den Hurk [67]. Lee [60] imple-
mented an Aesthetic Music Therapy (AeMT) approach with a client
processing the death of his mother. Lee stressed the importance of
the clinical improvisation, the creation of a musical relationship
and the presence of the therapist in supporting the bereavement
work.
With respect to efficacy Rosner et al. [68] conducted a meta-
analysis on the treatments for grief and bereavement in children,
adolescents and young persons. As a result, the authors indicate
two encouraging treatments that had demonstrated the most
success including: music therapy and trauma/grief based psycho-
therapy at school. Treatment was most effective for bereaved young
persons and they found further evidence that there was a larger
impact of the treatment with: longer treatment times, an increased
time period between the loss and the treatment, and the incidence
of complicated grief.
6. Conclusion
Music therapy is becoming increasingly common place within
the holistic care provided to persons at end-of-life, and a growing
body of research points to the many benefits of music therapy that
said persons may be exposed to throughout their dying process. A
variety of music therapy techniques are utilized with persons
receiving palliative care, ranging from passive to more active in-
terventions and can be categorized as receptive, creative, recreative
or combined. A number of innovative techniques were discussed in
the above paper including songwriting, improvisation, musical life
review, and guided imagery and music. While the body of evidence
continues to grow regarding the efficacy of music therapy palliative
care treatments, there is a call for increased sample sizes in studies
and further meta-analyses of existing studies. Some of the areas
where music therapy has been demonstrated to have an impact on
persons receiving palliative care include: reducing pain perception;
enhancing comfort, relaxation and quality of life; reducing anxiety
and depressive symptoms; enhancing mood; reducing heart and
respiratory rates’ improving and/or facilitating communication
with others; enhancing self-esteem; and reconnecting to identity.
In the end, the continued progress we have made within the
collaborative history of music and medicine can be seen in the
plethora of ways in which music therapy helps persons receiving
palliative care in a way that not only provides comfort and reduced
symptoms, but also allows them to face end-of-life with continued
dignity.
References
[1] Davis WB, Gfeller KE, Thaut MH. An Introduction to Music Therapy: Theory &
Practice. 3rd ed. Silver Spring, Maryland: American Music Therapy Associa-
tion; 2008.
[2] Munro S, Mount B. Music therapy in palliative care. Can. Med. Assoc. J.
1978;119:1029e34.
[3] Martin J. Music therapy in palliative care. In: Martin J, editor. The Next Step
Forward: Music Therapy with the Terminally Ill. Proceedings from a Sympo-
sium for Music Therapists Working in Palliative Care. Bronx, NY: Calvary
Hospital; 1989. iiieviii.
[4] Bailey LM. The use of songs in music therapy with cancer patients and their
families. Music Ther 1984;4(1):5e17.
[5] Forinash M. A Phenomenology of Music Therapy with the Terminally Ill
(Doctoral dissertation). Dissertations Abstracts International; 1990. 51(09),
2915A.
[6] Magill-Levreault L. Music therapy in pain and symptom management.
J. Palliat. Care 1993;9(4):42e8.
[7] Munro S. Music Therapy in Palliative/Hospice Care. Saint Louis, MO: Magna
Music Baton, Inc; 1984.
[8] Munro S. Music therapy perspectives in palliative care education. J. Palliat.
Care 1993;9(4):39e42.
[9] Munro S. Music therapy perspectives in palliative care education. In: Lonely
Waters Proceedings of the International Conference, Music Therapy in Palli-
ative Care. Oxford: Sobell Publications; 1995.
[10] O'Callaghan C. Pain, music creativity and music therapy in palliative care. Am.
J. Hospice Palliat. Med. 1996;13(2):43e9.
[11] Salmon D. Music and emotion in palliative care. J. Palliat. Care 1993;9:42e8.
[12] Peters JS. Music Therapy: An Introduction. Springfield, IL: Charles C. Thomas;
1987.
[13] Gaston ET. Music in Therapy. New York, NY: Macmillan; 1968.
[14] Sears WW. Processes in music therapy. In: Gaston ET, editor. Music in
 A. Clements-Cortes / Complementary Therapies in Clinical Practice 23 (2016) 125e129
Therapy. New York: Macmillan; 1968. p. 30e44.
[15] Dileo C, Dneaster D. Introduction: state of the art. In: Dileo C, Loewy JV, ed-
itors. Music therapy at the End of Life. Cherry Hill, NJ: Jeffrey Books; 2005.
xixexxvii.
[16] Clements-Corte s A. Episodes of Relationship Completion through Song in
Palliative Care (Doctoral thesis). Toronto, Canada: University of Toronto; 2009.
[17] Castellano JA. Music composition in a music therapy program. J. Music Ther.
1969;6:12e4.
[18] Crocker D. Techniques in the use of music as therapy for the emotionally
maladjusted child. Music Ther. 1952;2:175e80.
[19] Rupenthal W. Scribbling in music therapy. J. Music Ther. 1965;2:8e9.
[20] O'Callaghan C. Therapeutic opportunities associated with the music when
using songwriting in palliative care. Music Ther. Perspect. 1997;15:32e8.
[21] O'Kelly J. Music therapy in palliative care: current perspectives. Int. J. Palliat.
Nurs. 2002;8(3):130e6.
[22] Hilliard. The use of music therapy in meeting the multidimensional needs of
hospice patients and families. J. Palliat. Care 2001a;17:161e6.
[23] O'Callaghan C. Bringing music to life: a study of music therapy and palliative
care experiences in a cancer hospital. J. Palliat. Care 2001;17(3):155e60.
[24] Hogan B. The experience of music therapy for terminally ill patients: a
phenomenological research project. In: Pratt RR, Grocke DE, editors. Music
Medicine 3: Music Medicine and Music Therapy. Australia Expanding Hori-
zons, Faculty of Music, University of Melbourne; 1999. p. 242e54.
[25] Lee CA. Music at the Edge. London: Routledge; 1996.
[26] Clements-Corte s A. The effect of live music vs. taped music on pain and
comfort in palliative care. Korean J. Music Ther. 2011;13(1):105e21.
[27] Curtis S. The effect of music on pain relief and relaxation of the terminally ill.
J. Music Ther. 1986;24(1):10e24.
[28] Krout RE. The effects of single-session music therapy interventions on the
observed and self-reported levels of pain control, physical comfort, and
relaxation of hospice patients. Am. J. Hospice Palliat. Care 2001;18:383e90.
[29] Clements-Corte s A. The use of music in facilitating emotional expression in
the terminally ill. Am. J. Hospice Palliat. Med. 2004;21(4):255e60.
[30] Hilliard RE. Music therapy in hospice and palliative care: a review of the
empirical data. Evid. Base Comp. Altern. Med. 2005;2(2):173e8.
[31] Bradt J, Dileo C, Grocke D, Magill L. Music interventions for improving psy-
chological and physical outcomes in cancer patients. Cochrane Database Syst.
Rev. 2011;2011(8). http://dx.doi.org/10.1002/14651858.CD006911.pub2.
Article. CD006911.
[32] Mandel SE. Music Therapy in the Hospice: “Musicalive.” Palliative Medicine.
5(2). 1991. p. 155e60.
[33] Kemper KJ, Danhauer SC. Music as therapy. South Med. J. 2005;98(3):282e8.
[34] Troesch LM, Rodehaver CB, Delaney EA, Yanes B. The influence of guided
imagery on chemotherapy-related nausea and vomiting. Oncol. Nurse Forum
1993;20(8):1179e85.
[35] Standley JM. Clinical applications of music and chemotherapy: the effects of
nausea and emesis'. Music Ther. Perspect. 1992;10(1):27e35.
[36] Gallagher LM, Lagman R, Walsh D, Davis MP, LeGrand SB. The clinical effects of
music therapy in palliative medicine. Support Care Cancer 2006;14:859e66.
[37] Jones JD. A comparison of songwriting and lyric analysis techniques to evoke
emotional change in a single session with people who are chemically
dependent. J. Music Ther. 2005;42:94e110.
[38] O'Callaghan C. Music therapy skills used in song-writing within a palliative
care setting. Aust. J. Music Ther. 1990;1:15e22.
[39] O'Callaghan C. Songwriting in Palliative Care. Master’s thesis. Australia: Uni-
versity of Melbourne; 1994.
[40] Blyth L, Miles L. We’re all in this together: inpatient and community based
music therapy for children and families experiencing terminal illness. Palliat.
Care. Aust. 2012 Online PDF retrieved from, http://www.palliativecare.org.au/
Portals/46/Together%20conference/C4%20Louise%20Miles.pdf.
[41] Bunt L. Music Therapy: An Art beyond Words. New York: Routledge; 1994.
[42] Lee CA, Clements-Corte s A. Applications of clinical improvisation and
aesthetic music therapy in medical settings: an analysis of Debussy's ‘L’isle
joyeuse’. Music Med. 2014;6(2):61e9.
[43] Batzner KW. The Effects of Therapist Vocal Improvisation on Discomfort
129
Behaviors of In-patient Hospice Clients (Unpublished master’s thesis). Law-
rence, KS: University of Kansas; 2003.
[44] Halstead MT, Roscoe ST. Restoring the spirit at the end-of-life: music as an
intervention for oncology nurses. Clin J Oncol Nurs 2007;6(6):332e6.
[45] Gauthier PA, Dallaire C. Music therapy. Can Nurse 1993;89(2):46e8.
[46] Clair AA. Therapeutic Uses of Music with Older Adults. Baltimore, MD: Health
Professions Press; 1996.
[47] Aldridge D. Music Therapy in Palliative Care: New Voices. London: Jessica
Kingsley Publishers; 1999.
[48] Dileo C. Music Therapy and Medicine: Theoretical and Clinical Approaches.
Silver Spring, MD: American Music Therapy Association; 1999.
[49] O'Callaghan C. Musical profiles of dying patients. Aust. Music. Ther. Assoc. Bull
1984;7(2):5e11.
[50] Duffey T. Using music and a musical chronology as a life review with the
aging. In: Rubin LC, editor. Popular Culture in Counseling, Psychotherapy, and
Play-Based Interventions. New York, NY: Springer Publishing Company, LLC;
2008. p. 81e92.
[51] Salmon D. Music therapy as psychospiritual process in palliative care. J. Palliat.
Care 2001;17(3):142e6.
[52] Magill LM. The meaning of the music: the role of music in palliative care
music therapy as perceived by bereaved caregivers of advanced cancer pa-
tients. Am. J. Hospice Palliat. Med. 2009a;26(1):33e9.
[53] Magill LM. The spiritual meaning of pre-loss music therapy to bereaved
caregivers of advanced cancer patients. Palliat Support. Care 2009b;7:97e108.
[54] Baker F, Wigram T. Songwriting Methods, Techniques and Clinical Applica-
tions for Music Therapy Clinicians, Educators and Students. London: Jessica
Kingsley Publishers; 2005.
[55] Dalton TA, Krout RE. The grief song-writing process with bereaved adoles-
cents: an integrated grief model and music therapy protocol. Music Ther.
Perspec. 2005a;24:94e106.
[56] Derrington P. Teenagers and songwriting: supporting students in a main-
stream secondary school. In: Baker F, Wigram T, editors. Songwriting:
Methods, Techniques and Clinical Applications for Music Therapy Clinicians,
Educators and Students. London: Jessica Kingsley Publishers; 2005. p. 66e81.
[57] Hara AF. Continuity through song. In: Loewy JV, Hara AF, editors. Caring for
the Caregiver: The Use of Music and Music Therapy in Grief and Trauma.
Silver Spring, MD: American Music Therapy Association; 2002. p. 63e70.
[58] Krout RE. The music therapist as singer/songwriter: applications with
bereaved teenagers. In: Baker F, Wigram T, editors. Songwriting Methods,
Techniques and Clinical Applications for Music Therapy Clinicians, Educators
and Students. London: Jessica Kingsley Publishers; 2005. p. 206e23.
[59] Schwantes M, Wigram T, McKinney C, Lipscomb A, Richards C. The Mexican
corrido and its use in a music therapy bereavement group. Aust. J. Music Ther.
2011;22:2e20.
[60] Lee CA. Architecture of Aesthetic Music Therapy. New Braunfels: Barcelona
Publishers; 2003.
[61] Hilliard. The effects of music therapy based bereavement groups on mood and
behaviour of grieving children. J. Music Ther. 2001b;37:291e306.
[62] Mayhew J. A creative response to loss: developing a music therapy group for
bereaved siblings. In: Pavlicevic M, editor. Music Therapy in Children’s Hos-
pices. London: Jessica Kingsley Publishers; 2005. p. 62e80.
[63] Ryan KL. Access to music in pediatric bereavement support groups. In: Lee C,
editor. Lonely Waters. Oxford: Sobell Publications; 1995. p. 41e59.
[64] Roberts M. “I want to play and sing my story”: Home-based songwriting for
bereaved children and adolescents. Aust. J. Music Ther. 2006;17:18e34.
[65] Hilliard. The effects of orff-based music therapy and social work groups on
childhood grief symptoms and behaviors. J. Music Ther. 2007;44(2):123e38.
[66] Dalton TA, Krout RE. Development of the grief process scale through music
therapy songwriting with bereaved adolescents. Arts Psychotherapy
2005b;32(2):131e43.
[67] Smeijters H, van den Hurk J. Music therapy helping to work through grief and
finding a personal identity: qualitative single case research. J. Music Ther.
1999;16(3):222e52.
[68] Rosner Kruse, Jagl. A meta analysis of interventions for bereaved children and
adolescents. Death Stud. 2010;34(2):99e136.