By Al Neale, MusicWorx Intern

During my recent music therapy experiences in medical settings, I have been working with many cancer patients, which has exposed me to the stress, anxiety, and struggles with pain and nausea that cancer patients have to endure while in the hospital. I’ve observed these patients undergo changes in diagnosis, levels of health, and life circumstances. When I began working with this population, I thought I would be largely using music to help these patients manage their physical symptoms, but I found that medical interventions such as drug therapies often had those well under control.  Once I began engaging patients, I discovered that the most prevalent issues that music therapy could address were anxiety, stress, and emotional processing. After I introduced myself and explained who I was and what music therapy could do, patients often requested relaxation exercises and receptive music. Multiple sessions built a rapport with these patients and revealed that the music was a great aid to the resolution of negative feelings of their care.

The sessions that I’ve done so far have used verbal processing, relaxation techniques, and receptive music listening. I was intrigued to discover how songwriting could be an aid for cancer patients to process their emotions in the medical setting because of the complexity of the emotional changes that cancer patients are experiencing. Songwriting allowed the patient to express complicated feelings in a more emotive way than through simply talking them through. Creating their own songs gave the patients space to synthesize their thoughts and feelings, and to fully express them using musical elements.

Songwriting in music therapy is one of the three most common music therapy interventions, along with music and relaxation and active music-making (Lin 2019). Songwriting interventions facilitate deep emotional expression, decrease depression symptoms, and increase their sense of identity in patients. Songwriting is an expressive technique that can address patients’ psychological, emotional, and psychosocial needs by promoting self-esteem and reducing stress (Lin, 2019). Songs written in music therapy interventions hold personal historic significance to the client or patient and maintain an ongoing presence outside of music therapy sessions (Cermak, 2005).

Guiding Original Lyrics and Music

While many methods of songwriting are used in music therapy, such as parody songwriting, fill in the blank, and others, writing a totally original song is the most meaningful and beneficial technique, when working with cancer patients. One method of fully original songwriting with a client is Guiding Original Lyrics and Music (GOLM). Developed by Felicity Baker, this method guides patients through the songwriting process in a way that is progressive, making the task of writing a song approachable. GOLM requires that the music therapist be stylistically flexible and be knowledgeable of the patient’s music preferences and creative intention. The five steps of GOLM are:

• Brainstorming
• Structural reframing
• Determining style and key
• Setting melody and accompaniment, and
• Settling on a finished song.

GOLM songwriting offers many avenues for therapeutic intervention. The brainstorming phase allows the client to freely express ideas as the therapist guides and encourages their self-exploration. The structural reframing phase helps to organize the patient’s thoughts, create or reframe the patient’s narrative, and allow the patient to use the song structure to express their transitions, accomplishments, or hardships (Baker, 2005).

The phase of the songwriting process that non-musicians find the most intimidating (and need the most direct involvement from the music therapist) is the creation of the song’s musical elements. When doing song parody or lyric rewrites this portion is already done, which is why these methods of songwriting are used more frequently. To create a completely original song, the style, harmony, and melody are created from scratch. For a person who has little or no musical experience, this can be very difficult and daunting. The therapist becomes a surrogate composer for the patient’s intentions with their song.

The music therapist may be the expert in these circumstances, but the patient must be the one making the final decisions in these aspects of their song in order to solidify their ownership of the song. If the music therapist disagrees with the patient’s decisions, they must remain neutral and support and validate the patient’s choices. The therapist can guide their patient through this process of choosing the style and arrangement by asking them how they want the song to feel, or by showing the patient an array of genres that are very different in order to give them an idea of the range of their choices. To choose the melody and key of the song, the therapist can explore how to express the patient’s ideas more completely in the song by using dynamic changes, melodic movement, key modulation, and melodic texture. This phase of the songwriting process offers the patient the opportunity to cathartically express thoughts and ideas more fully than by simply saying the words aloud or writing them down. For example, a lyric line of “I am strong” can be musically expressed by an increase in volume, an ascending melodic line, and drawn legato that crescendos on “strong”, allowing the patient to embody the idea of strength in their choices of melody (Baker, 2005).

Songwriting and Culture

When songwriting with patients, take different cultural factors into account. For example, many Western cultures have very individualistic values, while other cultures often have more collectivist values. Taking cultural different cultures’ different values into consideration can impact songwriting in the lyrical content that the patient develops. Individualist cultures may pursue self-reflection and legacy building, while those with collectivist values would be more inclined to write about the well-being of others and their relationships with people. The different spiritual needs of different cultures should be noted. The therapist should keep in mind that some cultures are more inclined to use family and religion as a support system rather than therapy. In these cases, patients won’t confront difficult emotions with a therapist and will be more reserved in what they are willing to share and address with someone from outside of their family.

Songwriting and Structure

Along with more broad cultural considerations, the musical and song forms should also be taken into consideration. When working with patients with collectivist values, consider using songs that involve participation from other people through dialogue or collaboration. Songwriting that uses improvisation can be a gateway for deeper levels of self-expression and the use of call and response with friends and family can also be useful.

Culturally specific song structures are also a great way to build rapport with a patient by using their preferred musical style to write songs. For example, with Mexican patients, it can be good to use the “ranchera” music form which uses an I-IV-V progression in double or triple meter and often expresses deep emotion through a combination of sung and spoken lyrics. For Cuban patients, the rumba or son structures consist of rhythmically strong and repetitive accompaniment that is useful for improvised lyrics. The Hebrew tradition of Klezmer music, which is usually in a minor key, has strong emotional content and commonly has the theme of lament. In Eastern Indian music traditions, chanting is a common song form. Having a wide knowledge of different musical styles and song structures to serve the diverse cultural needs of patients is essential for this form of therapy.

Original songwriting can seem like a large undertaking in the medical setting. The therapist sometimes feels like there isn’t enough time to write an original song, but the benefits of these sessions are worthwhile. Music therapists should put more emphasis on original songwriting practices to make the intervention more readily accessible and accomplishable. The songs don’t have to be perfect because they are a significant step in the patient’s recovery and provide something they can hold on to beyond the music therapy session.