Death
and Grief
Sekeles, Chava (2007). Music Therapy: Death
and Grief. Gilsum, NH: Barcelona Publishers.
Reviewed by Ruth Bright,
Dr. mus., Member of the Order
of Australia. RMT, Adjunct Lecturer, School of Health,
University of New
england, Australia.
The 150 pages of this book are divided
into 10 Chapters, with a Foreword by the Director of
an Israeli medical
centre and
an Introduction by the author. Each chapter ends with
notes, and (where appropriate) a discography; extensive
references
are used in the text and listed at the end of the book.
This
publication tells us much of the author’s own empathic
approach to her clients and her therapeutic
skills in
the use of music to meet their needs. In preparing
to review it, I
have read the book in detail many times – but each
reading has brought new thoughts. In today’s world,
in which
evidence-based medicine has become the sine qua non
of all treatment, it is
reassuring to see that intuition and (inspired!)
guess-work are still seen as having value in our work. (See
discussion
on p.40)
Contents
The Introduction lists and summarises the contents
of the various chapters and explains some of the
terminology that is used.
(The chapters describing case studies are interspersed
with others which discuss the music that has been
used in therapy.)
Surprisingly, the book has no
index, only a Table of Contents. (Perhaps, in a second
edition, this
may be
rectified?) The
references are clearly set out, each chapter
ends with detailed notes, and the book is comparatively
short,
so the lack of
indexing is perhaps of only minor importance.
The
author, Chava Sekeles, adopts a broad approach – using
graphic arts, painting and other modalities;
(some
of the paintings
created by clients are reproduced in colour).
She also mentions the personal responses of
the therapist
to
death, but deals
with these at greater length at the end of
the book.
The case histories she describes are not merely
of academic interest but inspire us with new
ideas, different approaches.
The interventions are all related in some way
to death and dying, and the associated psychological
and emotional
challenges.
Only one described therapy which addresses
a child’s
fear of death, all the other studies focus
on bereavement as such.
Yet each of those case studies differs markedly
from
the others, in the needs which were recognised,
and the interventions used
to meet those needs.
The book is not a hard-line
research text, in which similar or identical needs are
addressed using
the same approaches,
and the results then analysed statistically.
But it is highly realistic, and shows us
that the author
brings
to her work
a deep sensitivity to, and understanding
of each
individual’s needs. She also has insight
into both helpful and harmful
family relationships, and creates music therapy
interventions through
which relationships, in most instances, may
be healed, improved.
Although no extended
family therapy is described, the author recognises and
empathises with
the needs of
family members,
even when working with only one or two
individuals. (She comments, for example (p.15) on the
benefit of having
a parent present
during therapy for a child, in order to
reduce the likelihood of the child developing a
dependency upon
the therapist.)
The losses presented in the case studies,
and the ages of individuals,
are varied; all the studies are valuable,
but it would have been helpful to learn
about interventions
with
extended family
groups.
Chapters 1, 6 and 7 describes
work with young children, the first of these was
traumatised
by the violent
death of her
mother and brother and her own injury
in a "human bomb" incident.
Israeli songs were crucial in the child’s
therapy, which included a closure visit
to the cemetery with her supportive
father;
the author emphasises here the importance
of sharing in that visit as therapist
and not as a mother figure.
The third case history about
work with
children is also linked with terrorism,
and describes
a boy with
multiple
handicaps
who was terrified by his long daily
bus journey to a special school, and the
problems arising
from his
parent’s
requirement
that he remain brave in this ordeal.
The second case study, however, is very different in that
the boy’s difficulty
in coping with
the death of his beloved grandfather
was, the therapist found, a consequence
of his parents’ behaviour and attitudes.
In chapter 7, the stages of grief are mentioned. Although
these emotional
states are as
valid today as when presented
by Elizabeth
Kubler Ross in 1969, we now know that
they may not necessarily occur in the
sequence
originally set
out. (Bright, 1985,
pp. 49-50) We also find that, because
of circumstances, one may
revert to an earlier stage – as when
someone with leukaemia goes into remission
and
his/her doubts
recur (even
if only momentarily) as to the diagnosis.
And, even when
close to death,
and appearing to accept this peacefully,
one may inwardly revert to anger and
bargaining!
In Chapter 2, there is
extensive discussion of Israeli music, its imagery, symbolism
and therapeutic
use,
in which the author
touches on some interesting questions.
In
this chapter (p.28) there is a reference to an "enclosed
disc" of Israeli music but
I learned later that (due to Copyright
problems) this was not available
at
the time
of publication.
It is a pity that readers are not
warned of this by an Erratum slip
pasted into the book. (I spent
an
anxious
time wondering
whether I had lost it!)
As in Chapter
2, the author focuses in Chapter
5 on therapeutic uses
of music
as such, and
here she
uses
the term "Art
music" in her discussion of
different genres of compositions.
(The term "classical" is
often used to differentiate ‘"serious" music
from ephemeral "pop" music,
but "art music" refers
to serious music which sets a scene,
portrays an emotion.)
Music therapy
with adult clients is described
in Chapters 3, 4,
8 and 9.
Chapter 3 gives an account of music
therapy (which included the use
of poetry) with
a man facing
death from cancer.
Chapter 4 .describes
two stages of complex therapy with a mother
and
(separately) with her son,
grieving over
the war-related
death of the older son - killed
by what
is ironically called ‘friendly
fire’, so that
the aura of heroism
about his death
was lacking. Help was also needed
later in order to cope with the
death of
her husband.
Chapter 8 focuses on
eclectic work with a bereaved young man, whose
borderline personality
disorder
affected the
processes
of dealing with the death of
his mother, who had died after a long
struggle
with
cancer. Although therapy
was not completed,
we read of the young man’s increasing
insight as
a result of therapy.
Chapter
9 differs from the rest of the book in that it takes
place within
a
psychiatric institution,
describing work with
a forensic patient in his late
20s who had
been diagnosed
as having schizoaffective disorder,
and who had killed his mother.
He had been an active folk
musician and enjoyed playing the instruments
in the
hospital’s
music room, gradually
working
toward greater insight.
Chapter
10, which focuses on the grief of the therapist
over the
death of
clients, is moving
and valuable
to all readers.
It can be difficult to deal
with one’s own
emotional trauma, yet there
are potential risks to our
own emotional health
if we "sweep it under
the mat" - leave it
unresolved.
Termination of
therapy can be complex: ideally
(p. 58),
it
is by mutual
consent, which improves
the
prospect for independent
decision-making by the client.
But therapy may be left unfinished
for
various reasons
(as with
suicide,
as
mentioned
above),
but also if the decision
is made (as with Bobby’s
parents
(chapter
6) because
of
difficulties in coping with
change, and this
too can be painful for the
therapist.
When the termination
is by suicide, the difficulties
are of major
proportions. Although Edwin
(chapter 8) killed himself,
this occurred several years
after his 5 years of music
therapy
had ended,
and
there
is
no specific discussion
about the impact
upon the therapist of suicide
by a current client.
General Comments
In this publication we
read of the constant threats
to
life
and safety
which are
engendered by the
conflict between Israel
and its Arab neighbours,
but the book is not a political
manifesto – we are
reminded
that
people
on both sides
of this conflict
are suffering. (p. 20)
.Discussing the varied
cultural backgrounds
of its citizens,
Sekeles
uses the image
(p.130)
of Israel as
the melting pot because
it consists of people from
all
over the world,
speaking
different
languages, and having
different
cultural traditions, etc.
Israeli
songs, semi-folk songs
and other national
items are
mentioned throughout
the book, and
it is clear
that Israeli
people place far greater
importance - politically,
religiously,
emotionally – upon their
national music than is
commonly seen in countries
such as
UK,
USA, Canada
and Australia. Nevertheless,
these discussions have
especial implications
for therapists in countries
to
which Jewish people came
for refuge, and for all
of us who
work with
migrants
and refugees
from other countries
where the folk tradition
is important.
We know that
songs originating in someone’s
country of
origin are not
necessarily
appropriate in
meeting the
needs of that
individual: any one item
may have particular associations
– happy,
tragic - or even
humorous. But these associations
help
a client to externalise
hidden feelings, and the
value of
this comes through
strongly in
this book.
Eclectic Interactions
Throughout the book, the
author demonstrates her
awareness that music
can externalise
complex matters
which require
resolution by various
means, such as graphic art, poetry,
verbal
discussion and psychotherapeutic
techniques
linked
with music, rather than
through music alone.
" Process" and "Product"
Some readers may question the comments on these concepts
(p.127): the end product is indeed
important – the song which a dying individual gives to someone who has
been significant
in
his
or her life, or the
satisfaction of someone
with a severe mental illness when he looks at a song
or a poem he has written about this experience. But, in the journey towards
healing
(for which the therapist is the guide) the
process of doing something is equally important, giving opportunities
for
growth in the on-going creative acts, whether working
on
a collage, improvising or anything else.
Perhaps we can compromise
by agreeing that creativity is important,
however we use the word!
References
Bright, R. (1985). Grieving: A handbook
for those who care.
St Louis, MMB.
This bookreview
was released August
20 ©2007 Nordic
Journal of Music
Therapy
