It goes without saying that working with people with Alzheimer’s or dementia or significant mental health difficulties, require different types of approaches, if we are to reach them in terms of the compassionate, emotional and spiritual care. This is because many of these individuals have lost the ability to connect, engage, respond, make or sustain meaningful relationships.

In my experience of working in the Trust as a hospital chaplain, i found that one can make a relationship with a patient one day , seek to do great things eg contributing to the rehabilitation , then find that on your next ward visit they have been discharged somewhere back into the community, often without notice or recourse to us. We therefore as professionals in whatever capacity and wherever we are placed, have a very short time span/window to connect and show that we care.

One approach which is breaking ground , particularly in the field of dementia (but not exclusively)is the benefit of using music therapeutically and just ‘being there’ and holding the patient in the space , for the time allowed. (My italics and emphasis).

I attended a course recently by Guy Harrison at the Oxford University entitled ‘Radical Presence’ . It helped me as a Chaplain see the continued value of our role and also the need for cascading the learning, so that others become more intentional about their presence, when on the wards or when going about chaplaincy business. It also helped me see how to use and utilise music as a medium.

Being radically present is essentially ‘being there’. One author puts it as using ‘self’ as a resource (Ewan Kelly (2012).

Being radically present is an ‘approach’ rather than a ‘fixed’ model. It is about

• Being intentional
• Being conscious of the skills we are using any encounter
• Seeing ‘listening’ as a form of hospitality (and one can listen with eyes and heart)
• Being passionately interested
• Drawing from palliative care models (where appropriate)
• And my favourite phrase….. ‘letting our patient lead the dance’

I carried out an exercise of ‘letting the patient lead the dance’ and using music recently (Nov 2014) on one of our units. It was an unintentional happening, but I was still equipped. This is what happened:

I had not been able to get into the usual room to do my work as it was locked. I thought I would sit in the canteen area where I could see a trickle of patients coming in for their weekly injection and/or coffee. I quickly grabbed the non-intrusive beat box with flashing lights out of my handbag. It is the size of a can of coke and works via blue tooth and was intended for a session later that day on the Edward Street unit.
I selected some well-known music from my iphone with words which I thought were apt and would perhaps match where most of the client group might be finding themselves at this time. I sat quietly, head down writing up notes so as not to look too obvious or intrusive.

I sensed the atmosphere changed in the room. One by one patients (who would not normally come up and speak) came and sat down with me or made eye contact and smiled. It was amazing. Music acted as a medium and had drawn the individual up side by side to me , clearly seeking further engagement.

When I was training to be a social worker in the late ‘80’s, I came across a quote which I have never forgotten. It said that ‘the environment we create controls us’. It was a comment made in relation to residential care for children and young people. I have found that it is relevant with adults and older adults , in a hospital institutional setting or anywhere we are purporting to offer care and services.

There is much we can do in breaking down the some time cold clinical environments which our client group come into. Using music as a medium is powerful and carthartic including the need to be ‘present’ (fully engaged and intentional) for the purpose of reaching our users. During the above encounter, I had some very interesting and useful conversations about the journey some had made into the Trust. With music as a medium (or cushion if you like), I found that patients begin to find their own rhythm and dance (my italics) in their personal journey and recovery.

Linda J Clifford-Hayes
May 2014

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