Using Artistic Empathy to Assist Clients with Death and Dying

1. Using Artistic Empathy (AAE) and the Music Impact Inventory Life-Threatening Issues Scale (MIIS) to Assist Clients in 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, Ph.D., M.A; B.Sc.)

2. A Using the Stages of Death and Dying to Demonstrate AAE and AAAE Three stages: • Seeking an Inner Peace Within the Self • Acknowledging the Need of Others Outside Oneself • Accepting Affirmation and Support Form Others

3. 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”

4. 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”

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

6. 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”

7. 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)

8. 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.

9. 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.

10. 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).

11. 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).

12. 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

13. Measuring Therapeutic AAE and AAAE Using The Music Impact Inventory Scale The Music Impact Inventory Scale (Part II) (Facilitative) (Worker) • Level 1 Not At All (Detracts Significantly • Level 2A Little (Subtracts Noticeably) • Level 3Somewhat (Interchangeable) • Level 4Moderately (Adds Noticeably) • Level 5Considerably (Adds Significantly) • Level 6Very Much (Captures Full (Expression)

14. Scoring MIIS (Likert Scale) 1. Level 1 - 2 Score = 15 - 40 2. Level 3 - 5 Score = 41 - 65 3. Level 5 - 6 Score = 66 - 90

15. 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.

16. 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

17. Facing Death and Dying in the ‘Here and Now’: A Case Example • Elena, a middle age woman, was recently diagnosed with a life threatening brain tumour, tenaciously lodged behind her eye and in her jaw bones. She was warned of the seriousness of a life-threatening operation.

18. 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.

19. 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.

20. 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’.

21. 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.

22. 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 Can Weather the Storm Through Prayer and Faith in God

23. Issues With Caring Husband • Husband in Denial about the impending death. • Husband in the “Doing” Phase as Opposed to the “Being” Phase • Husband Is Attempting to Inspire His Wife, Giving Her Hope in the Midst of Discouragement.

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

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

26. 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

27. 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.

28. “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)

29. “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)

30. 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

31. 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. ________________________________________

32. 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.

33. 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.

34. The words to this song and its music has really made us both aware of how much we do mean 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.

35. 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.

36. 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.

37. 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)

38. There are no "right" or "wrong" answers; your personal response is what is important. In order to ensure the anonymity of all responses, please do not put your name anywhere on the form. After you have completed all the items, please submit to the research associate. Thank you.

39. MIIS (Part II ) Husband & Wife Scores SONG TITLE:“Don’t Give Up,” I Hear You Crying 1. Not At All 2. A Little 3. Somewhat 4. Moderately 5. Considerably 6. Very Much Their response to this song was…

40. MIIS (Part II) Husband & Wife Scores (Continued) 1.(T-F-E) It made me consider certain (W) (H)thoughts, feelings and experiences in my own life (6 ) ( 6) 2.(B) It made me examine my personal behaviour(6 ) (6 ) 3. (B) It made me want to change my present behaviour( 5) (3 ) 4.(F-B) It made me become more relaxed(6 ) (6 ) 5.(T-E)It caused me to think about some things which are troubling in my life (4 ) (6 )

41. MIIS (Part II) Husband & Wife Scores (Continued) 6.(T-B) It reminded me about something I need(W) (H)to work on (6) (6 ) 7.(T-B) It made me aware of ways I can change my present day life situation (4 ) (6 ) 8.(T-B) It made me aware of ways I can change my life in the future (5 ) (6) 9.(B-E) It invited me to reflect upon instances/experiences which are important to me ( 6) (6) 10.(T-B) It reminded me of negative things (behaviour/s) I have done to myself and to others. (6 ) (6 )

42. MIIS (Part II) Husband & Wife Scores (Continued) 11. (F)It alerted me to my satisfaction with(W) (H)my lifetoday( 6) (4 ) 12. (F-B)It gave me hope in my ability to changethings in my life (6 ) (6 ) 13.(T-B-E) It reminded me with remnants of my ownstory and my own experiences ( 6) (6 ) 14.(T-B-E) It reminded me of stuck points in my lifetoday (5 ) (6 ) 15.(F-B)It provided me with hope for changing mypresent circumstances (6 ) (6 )

43. MIIS (Part III) Includes the first 15 Questions From Above and the The Remaining 3 Questions Below 16. If you were to examine your life five years down the road, what do you think it would look like? 17. What things would you be doing differently? 18. Are there any general comments you would like to make?

44. Assisting Clients, Caretakers and Family Members to Say “Good-bye” Wheredo we turn when real pain and suffering is beyond the limits of science or medicine? How can we brave the elements of discouragement and despair mid such uncertainty, convinced in our hearts that there has to be a power greater than us to whom we can have recourse?

45. Within a Christian context, the essential thing that changes the meaning of suffering for those on a faith journey is the intrinsic belief that Christ himself took on human flesh and undertook the pain of human suffering as an example of the path we too must dare to tread and the same passage we must risk tracing.

46. As images of God, we can give birth to that image - By seeing death as a birth to new life, life in its fullness in the spirit - By leaving the safe haven we have had on earth to enter a new world of meaning within the vast dimensions of the universe (Boros, 1973).

47. Dealing With Close Family Bonds By The Use of AAA During my continued visits with Elena and Ricardo, I was discovering that the greater the love has been between a couple, the more heartbreaking it is to part and the more difficult it is to sever the ties which have bound two human souls together.

48. Having loved God through a bond and fidelity to another person, it is extremely discomforting to “let go” and to give the other “permission” to go to their rest.

49. This is especially true when the dying person wants permission to part and pleads: “Please do not interfere with my dying.”

50. There’s an unquestionable silence which needs to be listened to in the hidden centre of their hearts and a hushed stillness that needs to be heard which speaks of memories and recollections, goals and achievements as well as prospects and expectations perhaps still unrealized which require an avenue of expression.