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From Music Therapy – Intimate Notes – case studies compiled by Mercedes Pavlicevic

Based on an interview with Judith Nockolds who works with elderly people with advanced dementia

The Haven is run by an NHS Trust, and is a forty-five bed residential unit that admits elderly people when community or home care cannot cope anymore. The Haven is their last home: it has a policy of non-resuscitation, and avoids moving people to hospital if at all possible.

Most of the residents die there.

The atmosphere is generally fairly depressed, the staff are underpaid, and there is a huge turnover of staff because many are in-between jobs and are not skilled workers.

They have inadequate training so don't know how to get the best out of their working environments. . . lack of funding is the bottom line. There are also dedicated, inspiring people.

The building has a central area which is where the music therapy room is, and also the reception area. This is light with lots of windows, and there are three units placed in a circle around the central area. Each unit has fifteen beds, with its own staff, a sitting area, TV and dining room, and each resident has their own bedroom. It attempts not to be clinical but still ends up being that... the philosophy is to provide a more homely environment. . ..

When I first met Olive I was very struck by her presence. She was a good friend of Ethel's - and they used to walk around arm-in-arm. They were both walkers, Olive was very driven by her walking. She never slept, she catnapped for twenty minutes at a time and generally walked for up to twenty-two hours a day. And if you walked with her you could sort of have a dialogue with her but you had to walk. Any conversation was very much in the here-and-now and never developed beyond that. You could listen to what she said, answer her - there was no flow in the conversation, her flow was very much in her walking.

She was a tiny woman, with a shock of white hair, and very beautiful, piercing blue eyes which could really look into you. I always had a feeling of being looked into, by her. There was a liveliness about her - she was eighty and undeterred by her age. And so much energy!

When I met her she was walking with Ethel, telling her what to do, and Ethel would answer her, very earnestly. Olive would get fed-up with Ethel because Ethel would want to sit down and not walk. They had this rather wonderful relationship... sometimes Ethel would come into the music therapy sessions with Olive and usually sleep - but she'd be there.

Olive would come into the session and become very quickly anxious.

If I managed to engage her musically she would stay for a little while, but as soon as that engagement was gone, then she was off- walking.

Her aim was to get back home, to see her mother, or else her children would be waiting for her, she had a high level of anxiety. If I tried to distract her, this would just reinforce her anxiety so I would accept this and say 'well you can come back later'.  Sometimes she did come back again for another ten minutes. Music therapy offered Olive a respite from this driven, exhausting walking... I think she walked herself to death; she went very quickly, had a sudden heart attack.

At times she'd become very angry she would see people walking in and out the front door of the Haven, and would become very cross. Because she couldn't.

Olive was very insightful. Her short-term memory was immensely impaired, but in terms of her own situation I think there was a huge amount of insight... and a huge amount of anger and frustration. I saw the walking as a part of her dealing with that: there was a relentlessness about her walking which must have reflected her feelings of having lost so much.

I worked with her for about ten sessions, of varying lengths. I want to play you a bit of one session... so you can hear what she was able to offer, from her situation. You can hear her coming in and beginning to play the drum, and what I heard on the drum was the energy of her walking. And there is also an element of performance: Olive was a performer! There is a feeling of 'I'm going to play the drum' - she was tiny about 4ft 8in! I start to sing and she reflects the harmonies that I'm improvising at the piano and then starts her own song... we have this rather wonderful improvisation. Olive's voice is strong and lively. It is low, and bristles with energy. The words of her song are:

‘l’m forever waiting for the one I really love... never mind... soon go over... come back again... we're fine together... 'bye.'bye my darling ... want to see you soon again...'.

You can hear how astonishing her vocal freedom is:  her voice has wide contours, she is very free in her singing, with an interweaving of her and my phrases over the pedal point of the music.

And the emotional texture of the singing is warm, there is a real feeling of merging between us.

Then she wanted to go! I said 'Oh no, don't go now it was so lovely, I want to do some more...'so I start singing goodbye - you know the music therapy trick, the elongated goodbye... works perfectly. But on the whole, her preoccupation with walking, and her drivenness, inhibited other possibilities of communication. But listen to the emotional expression in her singing! I think the words were important to her... they were part of her expression - I reflected, I mirrored the words by singing them back to her, letting her lead with them.

I went to fetch Olive for a session one day and they said 'Oh no, Olive's died'. Nobody had told me, nobody prepared me - just like that - gone. I'm glad she went quickly. . .. Yes, I do form a strong attachment and we share... but to a certain extent part of me is relieved when someone dies - because I do feel that many of the residents are depressed. There is a theory of 'happy oblivion', but I don't share that idea, and that is not my experience. Maybe it makes it easier for us to bear, not having to face someone else's pain.