A Survey of Music Therapy Students' Practica Experiences in Hospice and Palliative Care Settings

Abstract

When students begin a new clinical placement, they often take time to become familiar with the skills, repertoire, and interventions necessary to implement effective music therapy in that particular setting. Sometimes there is very little information on what to expect or what to do as a music therapy student and there is not a music therapist or an opportunity to shadow a music therapist before working with a specific population for the first time. Some practica are structured in a similar way as internships in which students move from observing to co-leading and finally to leading sessions. Other universities have students leading indepen- dently from the first session onward. Beginning a practica with no information or experience could potentially set a student up for failure or a negative experience.At times students tend to dislike or avoid clinical populations with whom they are not familiar and which require them to think outside of their comfort zone. This is might occur in emotional and intense settings, such as hospice and palliative care (HPC). Working in HPC settings can involve aspects of music therapy, such as counseling and working with grieving families, that students are not comfort- able facilitating. Furthermore, the possibility of having a patient actively die can be a stressful and frightening experience for students who are not emotionally prepared.The primary researcher of this study was a student music therapist preparing for practicum in a HPC setting. During the preparation process, she found little to no information on what songs were useful to know or what to expect during session. This made it difficult for her to prepare adequately as she had for previous practica in other settings. Thus, she participated in many informal conversations with her professor, as well as other student music therapists, regarding what information students might want or need before beginning a HPC practicum. This dilemma sparked the questions on both surveys in this research study. Other questions were pulled from previous studies on students' responses regarding their clinical work (Grant & McCarty, 1990; McClain, 1993; Wheeler, 2002).The purpose of this study was to provide further information on student music therapists' views on the dying process and professional neutrality, two central yet complex issues in HPC. Also of importance was how student music therapists prepared for their HPC clinical placement, experiences they had in this setting, and other insights that might benefit student music therapists. Researchers wanted to provide information and data for both students and their clinical supervisors on working in a HPC setting.Literature ReviewHospice facilities in the United States have grown substantially in the last 20 years. In 2007, hospice services, both in-patient and home care, provided medical care to 1,400,000 patients. This is 56 times the number of patients served in 1982 when the hospice movement began (National Hospice & Palliative Care Organization [NHPCO], 2009). As the need for hospice facilities increased, so did the need for music therapists (Krout, 2000). Researchers have previously indicated that patients and their families can benefit from music therapy (Gilbert, 1977; Hilliard, 2001, 2005; West, 1994). Music therapists not only provided patients distractions from pain, anxiety, and physical discomfort, they also used music to give patients and families a medium to express emotions, reminisce about previous life events, and find closure (Gilbert, 1977; Hilliard, 2001; West, 1994).The multidimensional needs of the hospice patient brought up the question of whether student music therapists and interns in this particular setting needed to learn additional skills and competencies besides those identified by the American Music Therapy Association (AMTA) (AMTA, 2008; Krout, 2000). Music therapists must adapt interventions for patients' changing emotional, spiritual, physical, and medical needs as well as work around interdisciplinary teams' schedules (Krout, 2004; Mandel, 1993). …