Using Artistic Advanced Accurate Empathy to Assist a Client to Deal with Death and Dying

1. Using Artistic Advanced Accurate Empathy to Assist a Client to Deal with Death and Dying Client Reflections on Death and Dying Wilfred Gallant. Ed.D., M.S.W. I. C. A. D. C. Michael Holosko, Ph.D., M.S.W. Melanie Gallant, B.A. , M. A. (Doctoral Candidate)

2. I Purpose of Presentation • To Report on The Use of Artistic Accurate Empathy and Artistic Advanced Accurate Empathy • Using Client Identified Themes to Develop a Stage Specific Model of Music Intervention with Clients Confronted with Death and Dying

3. I Purpose of Presentation • To Demonstrate the Practical Use of the Music Impact Inventory Scale (MIIS) to Measure Artistic Accurate Empathy and Artistic Advanced Accurate Empathy and and as a Tool of Professional Accountabity

4. I Purpose of Presentation • To Demonstrate the Use of Music Intervention With a Client Who Has a Life-Threatening, Inoperable Brain Tumor

5. I Purpose of Presentation • Using a single system design and anecdotal data , the article describes how music therapists may use artistic interventions e.g. prose, songs, poems, movies, videos, reflective journals etc. to reach the spiritual souls of clients at higher level of empathy.

6. I Purpose of Presentation • Our experiences with such clients have revealed that actualizing deeper levels of empathy are the keys to unlocking specific stages that typically house very complex, difficult and troublesome issues that such clients face.

7. II Method (Sample) • This study presents a case of a middle age woman, Elena, 55, who was diagnosed four years ago with a life threatening brain tumour.

8. II Method (Sample) • Following the surgery, I made regular bi-weekly visits with Elena and her husband over a two year period as surgeons were only able to remove 80% of the malignant growth.

9. II Method (Sample) • The work in Stage 1 consisted in helping 1) Elena come to peace with her predicament and finding an inner strength within herself and

10. II Method (Sample) • 2) aiding her husband with his denial of the seriousness of her condition and Elena’s discernment over her impeding loss of life(Therapeutic Artistic Entry Point) with the song: “Don’t Give Up” I Hear You Crying.

11. II Method (Sample) • “In Stage 3 I helping Elena to accept affirmation and support from others through the (Therapeutic Artistic Entry Point) with the song:open to her higher power with the song: “For This I Pray.”

12. II Method (Sample) • The work in Stage 1 consisted in helping 1) Elena come to peace with her predicament and finding an inner strength within herself and

13. Using the Stages of Death and Dying to Demonstrate AAE and AAAE Three client themes: 1. Facing death and dying in the “here and now” 2. Spiritual self-discovery 3. Saying: “good-bye”

14. A Using the Stages of Death and Dying to Demonstrate AAE and AAAE Three stages: • Seeking an Inner Peace Within the Self

15. A Using the Stages of Death and Dying to Demonstrate AAE and AAAE • Acknowledging the Need of Others Outside Oneself • Accepting Affirmation and Support From Others

16. Therapeutic Artistic Entry Points Dealing with Blind Spots, Denial and Discerning One’s Loss Worker Composed Song “Don’t Give Up” I Hear You Crying Client Composed Poem “Tears Amidst Laughter”

17. Therapeutic Artistic Entry Points Renewing An Interest in Others and Becoming “Part Of” Worker Composed Song “Music Maker” Client Composed Poem “Whisper Softly Whisper”

18. Therapeutic Artistic Entry Points Reminiscing About Friendships and Relationships and Opening to Communion With a Power Greater Than Oneself Worker Composed Song “For This I Pray” Client Composed Poem “Ode To This I Pray”

19. Empathy • Definition • Unconditional acceptance or agape • Involves active engagement in the inner self of another in order to affirm the person's humanness. Tillich (1962)

20. Accurate Empathy Accurate empathy entails “being there” for a client in a reflective and facilitative way and capturing the substance of the client’s verbal and non-verbal communication.

21. Artistic Accurate Empathy The worker’s ability to clearly denote and convey through the use of prose,poetry, drama or music the quality, texture and varied nuances of the client’s expression and the manner in which such individuals experience their world at the cognitive, affective, behavioural and experiential level.

22. Artistic Accurate Empathy (AAE) Reflects the worker’s awareness of the content, feeling, meaning, behaviour and experience of the client’s life situation. AAE or acceptance of self and of others is closely paralleled to love or ‘agape’ which enters the dark, repulsive ravishes of the human condition in order to elevate it to a place of dignity, value and respect (Tillich, 1962).

23. Artistic Accurate Empathy (AAE) • An “act of loving imagination” • Enables clients, by means of the worker internalizing their message • To feel a sense of competence, efficacy, and responsibility in achieving their own goals (Miley, O’Melia, & DuBois, 2001)

24. Comparison of Empathic Communication Scale and the Music Impact Inventory Scale Empathic Communication Scale • Level 1 Low Level • Level 2Moderately Low Level • Level 3Interchangeable Or Reciprocal • Level 4Moderately High Level • Level 5High Level

25. Measuring Therapeutic AAE and AAAE Using The Music Impact Inventory Scale The Music Impact Inventory Scale (Part II) (Facilitative) (Worker) • Level1Not At All (Detracts Significantly • Level 2A Little (Subtracts Noticeably) • Level 3Somewhat (AAE)(Interchangeable) • Level 4Moderately (AAE) (Adds Noticeably) • Level 5Considerably (AAAE)(Adds Significantly) • Level 6Very Much(AAAE)(Captures Full (Expression)

26. Scoring MIIS (Likert Scale) 1. Level 1 - 2 score = 1 - 29 2. Level 3 - 5 score = 20 - 59 3. Level 5 - 6 score = 60 - 90

27. Artistic Empathic Assumptions that a spiritual framework for wellness-directed music intervention provides counsellors with an effective venue to assist clients in putting a sense ofmeaning and closure to their experience

28. Generalizability of the Model • Although, our work was primarily developed and ‘field-tested’ with addictive clients in recovery • We have generalized the approach successfully to clients challenged with a life threatening illness who are not addicted

29. Facing Death and Dying in the ‘Here and Now’: A Case Example • Elena’s brain tumour was tenaciously lodged behind her eye and in her jaw bones. She was warned of the seriousness of a life-threatening operation.

30. Facing Death and Dying in the ‘Here and Now’: A Case Example She recorded a tape for each of her children sharing her love for them should she not survive the surgery and she assured them that she was not afraid to die and that at the time of her surgery her faith was sustaining her.

31. Facing Death and Dying in the ‘Here and Now’: A Case Example • The aftermath of the surgery has left Elena at times in excruciating pain with severe muscle spasms, sharp piercing headaches and with agonizing nerve tremors which shake through her whole body.

32. The Husband in the Picture • Ricardo, a very caring husband, unwittingly, has attempted at times to minimize her actual anguish and distress by endeavouring to persuade her to ‘cheer up’ and ‘look and the brighter side of things’.

33. Elena’s Needs • Elena (wife) is troubled and feels that the seriousness of her condition is being undermined and somewhat diminished • She is pleading for him to be with her should these be her last moments of life and to not deny the immanent possibility of her impending demise

34. Elena’s Needs • Client is Feeling Helpless And Needs Someone to Feel the Depth of Her Pain • Client Is Willing To Submit to “God’s Will” • Client Is Confidant That Both of Them Can Weather the Storm Through Prayer and Faith in God

35. Issues With Caring Husband • Husband in Denial about the impending death • Husband in the “Doing” Phase as Opposed to the “Being” Phase

36. Issues With Caring Husband • Husband Is Attempting to Inspire His Wife, Giving Her Hope in the Midst of Discouragement

37. Issues With Caring Husband • Husband Further Aggravates His Wife’s By Ineffectively Trying To Boost Her Morale. • Husband Tormented With the Fear of Losing His Wife. • Husband Not Prepared To “Let Her Go.”

38. AAE Revisited • Bysensitively caringto the needs of the client and attentively listening to the insights provided, the worker

39. AAE Revisited • the thoughts, feelings, behaviours and experiencesthrough “Accurate Artistic Empathy” by means of the following composition: • Don’t Give Up, I Hear You Crying

40. REFRAIN • “Don’t give up”, I hear you crying. “Don’t give up”, I hear you say. Well intentioned are such promptings, when you can’t feel all this pain. Can you listen to my story. As I wipe tears from my eyes? Like a brave yet wounded soldier, my soul is stretched on bended knee. My soul is stretched, blessed lord so stretched, on bended knee.

41. “Don’t Give Up,” I Hear You Crying • I have so much to live for though I’m not afraid to die. But if god in whisper calls me, can you be here by my side? In a journey rough and ragged with questions, doubts and fears, we can make it faith is calling, as we join our hands in prayer, as we join our hands in prayer. (R)

42. “Don’t Give Up,” I Hear You Crying • Oh God what dreadful challenge, often times a crippling cross to simply grasp this suffering mystery, its valleys low and mountains high. You are bread of life that nurtures, the cup of peace and grace. Fill my soul and bring me comfort. Let your will on earth be done. Let your will on earth be done. (R)

43. The Music Impact Inventory Scale (MIIS) [Short Form] MIIS assesses the degree of “artistic accurate empathy” Part I a written response by the client of impact of the music Part II is composed of 15 questions that evokes client response at the cognitive, affective, behavioural and experiential level, measure on a 6 point Likert type Scale

44. The MIIS [Short Form] PART I Date: 10/12/01 Client: Elena\Ricardo Please indicate your immediate responses to the song: 1. ________________________________________ 2. ________________________________________ 3. ________________________________________ 4. ________________________________________

45. The following statements describe a variety of possible reactions by people. Some of the statements may represent your own experience in listening to the selected musical pieces, while others may not. For each of the items there are six possible choices.

46. Wife’s Written Response This song is truly beautiful. I know with the hassles involved in the slow recovery from my surgery that I am not always “a happy camper”. Ricardo, as good as he is, and as hard as he tries to be here for me, is often the butt of my anger and frustration. I can see from here the tears in his eyes and this is honestly the first time that I have seen him cry since my surgery.

47. The words to this song and its music has really made us both aware of how much we domean to each other and what hope there is for us if we work at this process with your continued support and encouragement. I know it is not going to be easy but I am prepared to make the effort to make it happen and to get us through this ordeal.

48. Husband’s Written Response Yes indeed, the whole composition has brought tears to my eyes. We have been married for 35 years and we have been through thick and thin. Elena means more to me than anything in the world and I know that even though I may have my shortcomings I am always willing to do my best and to be there for her.

49. Husband’s Written Response She is my love and my life. This song moves me to renew my commitment of love, for better or worse, for richer or poorer, in sickness or in health, until death. I too am prepared to work on those things which will strengthen our relationship one step at a time, one day at a time.

50. Please mark with the number 1, 2, or 3, 4, 5, or 6 in the appropriate ( ) space below the choice which most accurately describes your experience in listening to the following musical selection: Name of Song (“Don’t Give Up,” I Hear You Crying)