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ehospice speaks to...Dr Giorgos Tsiris

Author: Leila Hawkins
02 March 2018

Dr Giorgos Tsiris has previously worked as a music therapist at St Christopher's Hospice in south London, and is currently a senior lecturer at Queen Margaret University in Edinburgh and head of research at the music therapy charity Nordoff Robbins Scotland. Here he tells ehospice about his work and the benefits of music therapy at the end of life.

What led you to become a music therapist?

When I was a teenager I knew I wanted to do music therapy. It brought together my love of music and my wish to use music for the service of humanity. Music therapy is not music for the sake of performing to people but making music with people, with the hope of making a positive change to their lives. There was a period in my life when I was a performing musician. I was also a special needs teacher, and I was always trying to enable students to access music as well as to learn how to play and interact through music. Then I came to London to study music therapy, I am originally from Greece.

What are the benefits of music therapy to patients at the end of life?

My experience has been that music can bypass the limits of language. This applies not only to people who may have lost the ability to engage in verbal dialogue because of degenerative conditions for example, but also to people who are able to verbalise their experience. In both cases language has its limits, and music can offer another path. For different people, of course, it works differently.

Often people come to music therapy with no experience of playing an instrument. The experience of making music can be something new and an ‘unknown’, and you can imagine what this might be like for some people when they face the end of life, which is often experienced as a big unknown. In some ways music therapy can be an invitation to do something you have never done before and also improvise – there is no script you have to follow. It welcomes you to face and experience an ‘unknown’ within a safe therapeutic environment: What could happen if I play this xylophone? Where can the music go? Where can I take the music?

You can also think of music as a metaphor for life and death. When a piece of music, or even a musical phrase, comes to an end you can think of this ending as a small ‘death’. Music does bring up this element of time. These are ‘small deaths’ if you like, that people can gently explore in music therapy.

Although such experiences can be tremendously empowering and meaningful to people at the end of life, they are not widely discussed when it comes to talking about music therapy’s ‘benefits’. People would often talk about music therapy improving mood, regulating heartbeat, increasing socialisation, and all of these are true, but I think sometimes when we ask this question - what the benefits are at the end of life - we also need to think of music as an artform. We also need to consider what music brings in everyday life, and how that might translate in an end of life care context.

In a typical session - if there is one - is there a degree of improvisation?

Improvisation is at the core of many music therapy approaches. During their music therapy course, people will often engage with music in different ways, and that would often involve some kind of music making, music listening, and/or songwriting. It really depends. Sometimes it feels appropriate to invite somebody to play an instrument, sometimes it is not appropriate, or a person may have no movement or capacity to engage in playing an instrument. 

But I think one of the things that music therapy can always bring is a musical awareness of a situation and of one’s presence. So, in the broader sense you always engage in music – even through your breathing.  For example people who are in a coma, can they engage in music? You have to observe what that person can do, and one of the things they can do is breath. So you would adapt your music to their breathing pace and very often you would see their breathing changing in response to your playing. So, did they engage in music? I would say yes.

Are there particular types of music that have particular effects, or is it very much up to the individual and their taste?

It is very much up to the individual. Research suggests that certain musical elements may have a certain impact, and that relates to our physiology.  For example, we all grew out of a womb environment where a main auditory stimulant was the heartbeat, and that is typically between 60 and 100 beats per minute. This early life experience, as well as one’s own heart beat seem to shape people’s typical perception of music as ‘relaxing’ when it is within that rate of beats per minute.  However, when it comes to thinking of genres of music like heavy metal, or classical, we always need to consider the cultural background and the experience of each particular person.

What projects are you currently involved in?

One of the projects I am currently involved with [at Nordoff Robbins Scotland] is a therapeutic songwriting project. This project was inspired by young adults who were accessing children's hospice services and had the opportunity to engage in music therapy. Given their positive experience of music therapy, they expressed their wish to carry on accessing music therapy after their discharge from children’s services and as they moved on to adult services. In response to this situation, the Children’s Hospices Across Scotland (CHAS) and Nordoff Robbins Scotland developed a songwriting project which is led by music therapist Jo Edgar.

This project supports young adults who may often experience isolation, and it brings a sense of community through music. As far as I know no similar project is happening anywhere else in the UK at the moment. Because of its innovative nature we are currently designing a research study where we will explore in greater depth people's experiences of participating in this project. We hope to learn from people’s experiences and understand music therapy’s role in supporting their transition from children to adult palliative care services.

What would you like to see more of? 

One area that is certainly underdeveloped is the use of the arts as a methodology, not necessarily as a research topic. For example, when you have a trial of a new painkiller, very often the methodology will focus on how to design a randomised control trial (RCT) and how to choose outcome measures. This kind of thinking is important and needs to be done, but we very often miss the personal experience of the patient being part of that study.  The arts as a methodology – and I am thinking here of arts-based research approaches – can offer a useful lens of understanding people's experiences in terms of being part of such studies and of receiving hospice care. I think this is an area that should be explored further.

In terms of emerging practice and research areas, I would like to see an increased focus on how music and other art therapies can support and contribute to the wellbeing of palliative care professionals. End of life care work can be emotionally demanding, and practitioners need to have access to appropriate support and opportunities for creative outlet. The arts can play a huge role in staff wellbeing as well as in expanding their horizons of how to engage meaningfully and creatively with dying people and their families.

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