My practice is influenced by research in the following areas:
- Harp therapy
- Occupational therapy
- Person Centred Care
- Intensive Interaction
- Default Mode Network
Find out more about these influences on this page.
I completed the International Harp Therapy Programme in 2016 and am a certified therapeutic harp practitioner with the National Standards Board of Therapeutic Musicians.
Occupational therapy (OT)
I have an MSc in Occupation through Health. I am dual trained in physical and mental health and am a registered occupational therapist with the Health and Care Professions Council (HCPC) , no: OT68672.
As an occupational therapist I am guided by the Health and Care Professions Council Standards of Proficiency for Occupational Therapists, these standards are based around 15 competencies. You can read the competencies on the HCPC website –https://www.hcpc-uk.org/standards/standards-of-proficiency/occupational-therapists/
As an occupational therapist I believe that occupation and activity are necessary for human flourishing.
“Underpinning practice is the belief that occupation and activity are fundamental to a person’s health and wellbeing, within the context of their environment. A person’s ability to carry out the activities and roles that they need, want, or are expected to do in their daily life is seen as their occupational performance (RCOT 2017, p2)”.
Read more about occupational therapy in my blog post What is occupational therapy?
A person’s health and wellbeing affects, and is affected by, their occupational performance and participation. My practice is concerned with developing, maximising and / or maintaining my clients’ ability to engage in harp playing, by enabling them to achieve their musical goals through modification of my approach and adaptation of the environment (RCOT, 2017).
I constantly assess a clients strengths and difficulties, and conduct an activity analysis of tasks to understand what cognitive and physical skills are needed to achieve and set a just right level of challenge for them.
Person Centred Care
Tom Kitwood was a psychologist and a pioneer in the field of dementia care. He was a senior lecturer at Bradford University in the 1980s where he researched and wrote about ‘person centred’ dementia care. His aim was to understand, as far as is possible, what care is like from the point of view of the person with dementia.
His book ‘Dementia Reconsidered’ (1997) brought together much of his work and is still widely used today. He was very keen to challenge the way that people with dementia are treated and to move away from viewing dementia from purely a medical viewpoint.
As the ability to speak fades away, non-verbal communication becomes increasingly important for individuals with advanced dementia. This point was echoed by Tom Kitwood (1997):
‘In the course of dementia a person will try to use whatever (communicative) resources he or she still has available. If some of the more sophisticated means of action have dwindled away, it may be necessary to fall back on ways that are more basic, and more deeply learned; some of these were learned in early childhood’.
He identified a number of psychological and social factors which people need to have met in order to maintain wellbeing:
To practice person centred care it is necessary to focus on these needs by using responses and approaches that help to:
1. Uphold the person’s identity
- Respecting the person by addressing them by the name they wish to be called
- Seeking out opportunities to explore the life history of the person through talking to friends and family members.
2. Engage the person in occupation (supporting and encouraging the person to engage in meaningful tasks at whatever level they are able and comfortable to achieve)
3. Provide comfort (i.e. demonstrating warmth and acceptance of the person when talking with them)
4. Enable attachment. For example:
- Recognising the important feelings a person may have for past or present relationships.
- Being sensitive to recognition of the person’s sense of reality.
5. Include the person in what is happening. For example:
- Enabling a person to be involved both physically and psychologically.
Upholding these needs will have an effect on the person’s wellbeing. Not having these needs met could lead to ill being, that is, feelings of distress and discomfort.
Han et al (2011) recommend a person centred approach whereby clients could be actively assisted to participate in music in their preferred way. This could be singing, movement, tapping to the beat, or vocal and/ or percussion improvisation. This approach was found to produce a positive social effect especially with those who were initially reluctant. Clients were also found to be motivated by interaction with the facilitator.
I use a person centred approach to actively engage clients in music making. With live music making I am able to adjust my approach to the clients I am working with, and allow them to lead the session to an extent that is meaningful to them and motivates them to participate.
Intensive Interaction, developed in the 1980s, is a method of interacting with people with severe and profound learning disabilities and subsequent accompanying speech problems. This method appears to have great potential for improving communication between people with very advanced dementia and those who care for them. A number of researchers have shown that people with advanced dementia still have many identifiable communication skills (Orange and Purves 1996) and still want to communicate and interact with others (Ellis and Astell 2008).
But how does it work? One researcher, Phoebe Caldwell (2005), described Intensive Interaction as a way of ‘learning the language’ of non-verbal people. Intensive Interaction involves the caregiver becoming familiar with the the non-verbal behaviours, such as sounds or movements, of the client they want to communicate with. The caregiver then chooses one of these behaviours and uses it to start a ‘conversation’ with the person, by copying or mirroring these behaviours – in the same way that a parent imitates their child’s attempts at communicating.
For example, those persistent body movements (such as tapping a finger or pulling at a piece of fabric) could be used as a basis of communication between people with advanced dementia and their caregivers. By responding in ways that are familiar and meaningful to a person without speech, initially imitating and then developing non-verbal communication into a shared ‘language’, it is possible to build and sustain close relationships (Caldwell 2005).
Researchers Maggie Ellis and Arlene Astell have pioneered the use of Intensive Interaction with people with advanced dementia and have developed a programme which teaches caregivers how to engage in this type of communication. The aim of focusing on non-verbal communication is to encourage the emotional message in the interaction that becomes hidden by our dependence on speech as a sign of connection. It is important to note that engaging in this type of communication is not intended to infantilise the person with dementia (SCIE).
I wrote my MSc dissertation about my experience of Flow when I played the harp.
Csikszentmihalyi coined the term flow in the 1970s and Flow has been researched extensively since then (Csikszentmihalyi 1998). There is no room to be judgemental when in flow, as our consciousness is full of positive harmonious feelings. Flow occurs when skills are suitable for the challenge, goals are clear, immediate feedback is available and the sense of time is lost. Happiness can be felt in retrospect when reflecting on the experience, but not at the time as this would require a conscious effort to focus on inner feelings (Csikszentmihalyi 1997). Read more about the Flow state on the BBC: The Flow state where creative work thrives
I often see clients in what looks like Flow to me; some clients lean there head into the harp, close their eyes and feel and hear the music they create through vibration and sound.
“Flow – the state in which people are so involved in an activity that nothing else seems to matter; the experience itself is so enjoyable that people will do it even at great cost, for the sheer sake of doing it” (Csikszentmihalyi 1992, p4).
Default mode network (DMN) AKA monkey mind or negative self talk
At From the Harp we believe engaging in activity, either passively, say by listening in a gong bath, or actively by playing a harp, is good for physical and mental health. When we become absorbed in an activity we can forget our troubles.
Research in neuroscience shows that neural development occurs when we are deeply engaged in an activity that takes all of our attention; more and faster neural connections are made (cell, dendrties and axons) and blood supply becomes richer. When we are not deeply engaged the Default Mode Network (DMN) – negative self talk or the monkey mind – may become active. These self generating thoughts can be useful, but also have a social-threat response side to it. When we are thinking about our own lives and problems etc it can be rather threatening (“will they like me?” “can I do a good job on this?”,”did I say the right thing to Mary?”) and so the stress-response is easily activated when thinking about ourselves. So, we can long for a short period of respite from our extreme self-awareness – a time when we can ‘forget ourselves’.
We can all relate to just dwelling on our symptoms when there is nothing else to do, and fretting. Our DMN can naturally become very active in worrying situations. Studies have now revealed that depression is linked to over activity in the DMN. So, forgetting ourselves using sound or music may be a good way to reduce stress (Sadlo 2016, Reybrouck et al 2018).
Relaxation is an important occupation that we don’t seem to dedicate enough time to these days. Everybody is so busy, waiting for incoming social media stimulus on our smart phone or tablet that we’re seldom present, in the moment, or even day dreaming any more.
Playing the harp or coming along to a gong bath is an ideal time to put your virtual life aside, put yourself at the top of your to do list and be in the moment.
The potential therapeutic effects of music listening have been largely attributed to its ability to reduce stress and modulate arousal levels. Listening to ‘relaxing music’ (generally considered to have slow tempo, low pitch, and no lyrics) has been shown to reduce stress and anxiety in healthy subjects (Dileo and Bradt 2007, Knight and Rickard, 2001). Music listening following painful medical procedures (e.g., surgery) has also been found to reduce the need for sedation or pain relief. These effects are conventionally considered to be owing to the ability of music to distract or modulate mood (Chanda and Levitin 2013).
In various studies meditative and relaxing music, when compared to silence or different types of music, has been found to reduce plasma levels of cortisol and norepinephrine, and prevent stress-induced increases in heart rate and systolic blood pressure. Relaxing music during the post-operative period was most effective, resulting in a significantly greater decrease in serum cortisol, compared to controls, following cardiac surgery (Chanda and Levitin 2013).
One proposed mechanism for the ability of music to regulate stress, arousal, and emotions is that it initiates reflexive brainstem responses. Music modulates brainstem- mediated measures, including heart rate, pulse, blood pressure, body temperature, skin conductance and muscle tension. Stimulating music produces increases in cardiovascular measures, whereas relaxing music produces decreases. These are patterns observed even in infants. These effects are largely mediated by tempo: slow music and musical pauses are associated with a decrease in heart rate, respiration and blood pressure, and faster music with increases in these parameters. This follows, given that brainstem neurons tend to fire synchronously with tempo. ‘Relaxing’ music mimics soothing natural sounds such as maternal vocalizations, purring and cooing (soft, low- pitched sounds with a gradual amplitude envelope), which decreases sympathetic arousal, in turn leading to relaxation (Chanda and Levitin 2013).
Caldwell, P. (2005) Finding you finding me: Using Intensive Interaction to get in touch with people whose severe learning disabilities are combined with autistic spectrum disorder. London: Jessica Kingsley Publisher.
M L Chanda, D J Levitin (2013) The neurochemistry of music, Trends in Cognitive Sciences 17 (4) 179 – 193.
Csikszentmihalyi M (1992) Flow: the psychology of happiness. London: Rider.
Csikszentmihalyi M (1996) Creativity: flow and the psychology of discovery and invention. New York: HarperCollins.
Csikszentmihalyi M (1997) Living well the psychology of everyday life. London: Weidenfeld & Nicolson.
Dileo, C. and Bradt, J. (2007) Music therapy: applications to stressmanagement. In Principles and Practice of Stress Management (Lehrer, P.M. et al., eds), pp. 519–544, Guilford Press
Ellis, M.P. and Astell, A.J. (2011) ‘Adaptive Interaction: a new approach to communication’,Journal of Dementia Carevol 19, no 3, pp 24–26.
Ellis, M.P. and Astell, A.J. (2008) ‘A case study of Adaptive Interaction: a new approach to communicating with people with advanced dementia’, in Zeedyk, M.S. (ed)Promoting social interaction for individuals with communicative impairments. London: Jessica Kingsley Publishers.
Han, P. et al (2011) A Controlled Naturalistic Study on a Weekly Music Therapy and Activity Program on Disruptive and Depressive Behaviors in Dementia. Dementia Geriatric Cognitive Disorders 30: 540–546.
Health and Care Professions Council (HCPC) 2013 Standards of Proficiency – occupational therapists.
Kitwood, T. (1997) Dementia reconsidered. The person comes first.www.dementiapartnerships.org.uk
Kitwood, T. (1997) Dementia reconsidered: The person comes first.Buckingham: Open University Press.
Knight, W.E.J. and Rickard, N.S. (2001) Relaxing music prevents stress-induced increases in subjective anxiety, systolic blood pressure, and heart rate in healthy males and females. J. Music Ther. 38, 254–272
Orange, J. and Purves, B. (1996) ‘Conversational discourse and cognitive impairment: Implications for Alzheimer’s disease’,Journal of Speech-Language Pathology and Audiology, vol 20, pp 139–150.
Reybrouck, M. Vuust, P. Brattico, E. (2018) Brain Connectivity Networks and the Aesthetic Experience of Music. Brain Sciences8, 107.
Royal College of Occuational Therapy (RCOT) 2017 Professional Standards for Occupational Therapy Practice.
Sadlo G. (2016) Threshold concepts for educating people about human engagement in occupation: The study of human systems that enable occupation. Journal of Occupational Science, Vol. 23, No. 4, 496–509
Social Care Institute for Excellence (SCIE) Advanced Dementia – Communication in Advanced Dementia.