Abstract
This is a beautiful and moving account of 20 years’ work in end-of-life care. Described as a memoir, it is a very personal book detailing a series of encounters Heath has experienced with people in his practice within palliative care. Heath describes himself as a singer–songwriter who came relatively late to music therapy. While it is evident that he engages in a range of musical activities with his clients, songwriting is a large part of his practice and the focus of this book.
Although Music Therapists have probably been writing songs with (and certainly for) their clients for many years, it is arguably not as mainstream a practice in the United Kingdom as, for example, improvisation. In other countries, such as Australia, songwriting is more central. This book is therefore a welcome and timely addition to the music therapy literature.
It does not refer to other writing that exists on the subject of songwriting, music therapy and palliative care. However, it is no less powerful for this, as it allows the impact of the stories to dominate. Heath shares how his own life experiences of cancer inform his work. Palliative care is an area in which the therapist is likely to have had personal experiences relating to the client group; the loss or serious illness of loved ones, friends or family and death is something that we will all face ourselves.
Heath begins by situating his work, stating that he views music as being ‘at the very heart of being human’ (p. 3) and that songs are central to this. ‘the world is full of songs’ and, he says, these relate to our individual and group identities, and are used to mark significant events and celebrations. We have deep associations to words and songs.
In this book, we are introduced to 10 people’s stories, mostly taken from the author’s music therapy practice based in a hospice. These mainly outpatient encounters range from a single session to well over a year’s work. Some clients create several songs which are included in the book, and others just one.
Heath has a gift for story-telling and he brings these encounters alive in his writing. The way he recounts dialogue and musical interactions enable us to feel as if we are in the room with him; we learn about the client at the same pace as Heath. He is honest about his own thinking and responses, his self-doubts and reasons for the choices he makes, all of which help the reader to understand the process of songwriting more deeply. The stories are all quite different and very engaging. How the songs come about varies for each client. Something I found fascinating is how songwriting emerges and evolves within a session as a natural development, whether from client and therapist talking together, improvising at the piano, singing another song or listening to a piece of music. While Heath does not present songwriting techniques in a didactic manner (for this, see, for example, Baker, 2015; Baker & Wigram, 2005), one can learn much about different methods through reading how the songs were created in their contexts. This provides a broad overview of possibilities and shows how one can move into songwriting naturally within the session. While specific techniques such as the use of acrostics are mentioned (p. 112, and also see Heath, 2014), Heath also describes the origins of songs as a mysterious process, with words and melodies appearing ‘as if from nowhere, surprising us, revealing things that we hadn’t anticipated (or, indeed, thought we’d known)’ (p. 3). One could view this as the unconscious becoming conscious through the songwriting process.
What makes this book unique is the inclusion of the lyrics of all the songs described in the stories. Recordings of some of these are available to listen to on Heath’s website. I found it fascinating to be able to listen to a song while reflecting on the story which accompanies it. Also interesting was the fact that the song I heard in my head while reading the text was so different to the one I heard on the recording. While many are sung by Heath, several are session recordings of the patients themselves, which brings a different emotional quality to them and to the impact on the listener. For example, Oskar sings some of his songs, and his lullaby for his baby daughter is made all the more poignant for hearing it through his voice.
Some of the recorded songs have been given additional vocal harmonies, strings and percussion. It is not clear whether these were also in the recordings that the patients received at the end of a session or were added for the website versions. Other recordings are taken from live concerts where a band contributes to the music. It would have been helpful to know more about these concerts that featured clients’ songs and voices, the thinking behind them, ethical considerations explored, and how clients or their families felt about their songs being performed publicly.
There are no common themes to the songs, instead Heath demonstrates how he works with something in the moment that the client is dealing with or trying to process. Songwriting is presented not as an end in itself, rather as a process of co-creation through which material is explored and emotions expressed. Some of his clients wish to reflect on past unresolved relationships, express their rage at their situation or their fears for the family they are leaving behind. Other topics are more prosaic. One of my favourite songs was ‘Lunch’ written initially as a poem by Ray. In this, he describes how in the midst of all the struggles and illnesses he is dealing with, the one thing he can always rely on is that lunch will be ready on the table in the Day Centre at 12.15. This is a useful reminder that palliative patients do not necessarily wish to write about dying; songwriting can address many needs, it is not for us to decide what is important.
Heath describes his task as being to accompany his clients on their journey, to be alongside them during their time with him. This is demonstrated powerfully in his accounts. He often does not know much of their story, although mentions having access to their clinical notes which can help to fill in some gaps. Alice talks of needing to fly again, and, wondering how to interpret this, he discovers in the notes that she actually used to be a pilot. Alice brings poems and her own unique ‘notations’ for the music of the songs for Heath to interpret. Other clients bring poems, old songs they wrote in their youth, classical music pieces to add words to or just listen to, and several bring dreams. The creativity of the work is remarkable.
As described, many of the songs Heath and his clients write, although not all, end up as a ‘product’; a tangible artefact (a CD), which is taken home by the patient. It then becomes the patient’s property to do with as they wish. The boundaries between inside and outside the therapy space are opened at this point. I found it interesting to reflect on how something from the music therapy room takes on an after-life once it has left the room, and still has work to do. There are several stories of how the songs are used post-creation, for example, to be listened to by estranged family members to mend a relationship, or as a legacy for a child.
The story of Rick and his ‘A Song for Paddy’ is an example of this. In their first session together, Rick, a man in his late 50s with a prognosis of a few months, and Heath begin to write a song together. This is inspired by dreams Rick had been having about a man, Paddy, who had been a significant influence on him as a boy. Unexpectedly, at least for Heath, Rick died a few days later and they were unable to continue with the song. Heath describes well the feelings this evoked in him, probably feelings many of us who work in palliative can identify with; that we know our patients are going to die, but it is still a surprise when they do and we do not always feel ready. Unbeknownst to Heath, Rick had asked his family to complete the song after his death, and it is this encounter with the extended family in their home that demonstrates how the client’s song has work to do beyond its life in the music therapy room. In the course of one visit, the family talked and reminisced about Rick’s life, were able to cry, some for the first time, and eventually created the rest of the song which became ‘an opportunity for his family to grieve and celebrate together’ (p. 31).
In this story, taken from early in his music therapy career, Heath also questions whether going to the family home to complete Paddy’s song is the right thing to do and reflects on the profound effect this work has had on him personally. Heath appears to become very close to some of his patients, in one instance, he shares his own near-death experiences. From my own practice, I find that being alongside people near the end of life cannot help but be an intimate experience. Heath often voices concerns about whether he is overstepping boundaries in some of these relationships. Whether, as the reader, we agree with the decisions he comes to or not, he describes his rationale with honest self-reflection, which is arguably one of the most important qualities a therapist requires.
One aspect that specifically impressed me reading this book is how quickly Heath manages to suggest, co-create, perform and record a song in a single session. His long familiarity with the medium no doubt contributes to his skill and virtuosity with this, but it is a useful reminder that a song is not necessarily something that needs to be worked on for several sessions, refined and the music carefully composed. It can be a creation of the moment that is powerful just as it is. As a singer–songwriter, it is evident that this is a very natural form of music therapy for Heath. Other music therapists might struggle to work with such ease until they are more familiar with writing songs.
As an appendix item, I would have appreciated the inclusion of some technical information on how Heath records songs in sessions, and suggestions for the basic equipment and computer programmes needed for this type of work. Although technology changes quickly, the principles for recording and saving songs would be helpful for anyone wishing to engage in this practice.
This book will hopefully inspire music therapists to consider using songwriting in a range of settings, not only in palliative care and hospices. Through the stories recounted, Heath demonstrates that songwriting is both a possible and a powerful therapeutic endeavour, even at the end of life that can express and capture so much more than words alone. As he suggests, ‘we shouldn’t wait until we’re dying before we start to share our truth and our stories and write our songs’ (p. 168).
