Music Therapy in the Moment

Updated: May 22, 2019

by Jennifer L. Cossman, MT-BC, AC-BC


One of the most powerful aspects of music therapy is the fact that people are usually so motivated to interact with music that the therapy happens in the background. Many times, clients are so engaged in the music experience presented by the therapist that they don’t realize that they are receiving non-musical therapeutic benefit! Unfortunately, that can lead to confusion as to the purpose of music therapy since it frequently looks like people having a “jam session”.


It is very difficult to observe an interaction and truly know what is going on. Many times, music therapists are thought of as entertainment simply because the session they are leading looks like leading a sing-a-long. Entertainment musicians, harp therapists, music volunteers, and music thanatologists provide a valuable service to our community. What makes sessions music therapy is when they’re being led by a board certified music therapist (MT-BC) and non-musical goals are being addressed.


Hospice music therapists are able to address a wide variety of goals through music interactions, including:

  • Symptom management (i.e., managing anxiety, pain, and/or dyspnea)

  • Reality orientation

  • Emotional expression

  • Improving family communication

  • Life review

  • Grief support

What does music therapy look like “in the moment”? Music therapy services are individualized for each patient, so the same goal may look like five different things with five different patients. Following are examples of what the above goals might look like.


Symptom Management

  • What might it look like? The therapist playing continuous live music, possibly over extensive periods of time, while the patient is listening, frequently with their eyes closed. Occasionally, the patient will appear very agitated and not aware of the music.

  • What is actually happening? Using the process of entrainment, the music therapist matches the intensity of the patient’s symptoms with the intensity of the music using dynamic, rhythm, tempo, timbre. The therapist is closely observing the patient’s responses for cues that their body is responding to the music (changes in vocalizations, respiratory rate, movements, eye tracking, etc.). Over a period of time, the therapist alters the qualities of the music while providing a steady pulse and the patient’s heart rate, pain level, and respiratory rate will sense the change and adjust to synchronize with the therapist’s music. The patient will occasionally fall asleep by the end of the session.

Reality Orientation

  • What might it look like? The therapist singing and playing live music for the patient. The patient may be singing along or simply listening.

  • What is actually happening? Patients with confusion or dementia will frequently talk about events from their past, believing that they are happening now, or will speak about things that don’t appear to relate to anything at all. The therapist is presenting music that incorporates the patient’s verbalizations. The music may be either improvised by the therapist or music the patient is familiar with and enjoys. Providing an environment that incorporates these seemingly unrelated verbalizations immediately gives the patient’s interactions meaning and context in the current situation. This can decrease the patient’s anxiety over their confusion. Occasionally, the patient and therapist can then engage in reminiscence about the music and patient verbalizations.

Emotional Expression

  • What might it look like? The therapist and patient playing drums together while singing a popular song.

  • What is actually happening? The patient may be experiencing anxiety about their health and may not have an appropriate outlet for those emotions. The therapist assesses what emotions the patient may be feeling and selects a song the patient enjoys. The song lyrics may discuss the emotions the patient is feeling. While singing the song with the therapist, the patient plays the drums. The physical activity of beating a drum with as much force and energy as the patient wants provides an appropriate physical outlet for anxiety. Singing words that express the emotion provides a verbal outlet for the emotion.

Improving Family Communication

  • What might it look like?  The therapist singing music for the family. The family may or may not be singing along.

  • What is actually happening? Patients and families in hospice are experiencing a great deal of stress which can make interacting with each other strained. Finding a pre-composed song that discusses the topics or emotions you are currently feeling lets you project your emotions on the song rather than feeling the pressure of having to come up with the right words on your own. When working with families who are experiencing strained communication, the therapist can ask each family member to choose a song to have sung to their family. Having the therapist sing the song for the whole family removes the potential stress and pressure of needing to sing and hearing your voice say the words you’re feeling.

Life Review

  • What might it look like? The patient and therapist making a list of favorite music to record on a CD.

  • What is actually happening? Listening to music that was popular earlier in your life can bring memories to mind. Patients in hospice frequently benefit from reviewing the experiences of their life to help provide a sense of meaning and purpose. The patient and therapist discuss events from the patient’s past and find music that matches either the event or the year the event happened. Occasionally, the patient and therapist write original songs to correlate with specific events. Creating a musical timeline not only allows the patient to engage in meaningful life review, but provides a tangible legacy project for the patient to give their family.

Grief Support

  • What might it look like? The surviving family member and therapist singing hymns together.

  • What is actually happening? Many patients and families rely on their faith and spirituality to support them through the process of dying. Following the patient’s death, the surviving family member may rely even more strongly on their faith to help them begin the process of grieving. Singing or listening to hymns that address the family member’s current emotional and grief state can help reinforce their spiritual support. Frequently, family members may get emotional while singing or listening to hymns. The therapist observes the emotional response and will stop the music if necessary. Discussion about the hymn’s message and the family member’s thoughts or feelings about the music help move the person in and through the grieving process.

Music therapy in the moment can look like a lot of different things, many of which may not seem overtly therapeutic. All board certified music therapists are trained to provide therapeutic experiences through the highly motivating medium of music, allowing the music experience to come to the forefront. The only way to truly know what is going on in any music therapy session is to ask! Don’t just assume every person carrying a guitar in the hospital or assisted living facility is there to provide entertainment – ask if they’re a board certified music therapist and what they will be working on today.

© 2020 by Blue Ridge

Music Therapy, LLC

Proudly serving the Lynchburg, Virginia community since 2006

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