Snapshot: Amy Clements-Cortes

Our Snapshot article series features Q&As with key pioneers, innovators and emerging practitioners across the multidisciplinary and multi-dimensional arts and health field in Canada, who are part of the Arts Health Network Canada community.

Interview by: Zara Contractor

Amy Clements-Cortes is Assistant Professor, Music and Health Research Collaboratory, University of Toronto; Senior Music Therapist/Practice Advisor, Baycrest; Instructor and Supervisor, Wilfrid Laurier University & Registered Psychotherapist. Amy has extensive clinical experience working with clients across the lifespan with a specialty in work with older adults and end-of-life care. She has given over 90 conference and/or invited academic presentations, is published in peer reviewed journals and books, and has supervised over 36 music therapy internships, 30 undergraduate research studies, and 3 Masters students Major Research papers. She is the President of the WFMT, Managing Editor of the Music and Medicine journal, a former President of the CAMT,  and serves on the editorial review board of the Journal of Music Therapy, Music Therapy Perspectives and Voices.

1. You wear many hats today: Music Therapist, Performer, Vocal Instructor, Educator, Researcher, etc. At what point did you first recognize and start to take an interest in the connection between the arts (music) and health, healing and wellbeing?

I think I first took an interest in Music and Health in high school. I was a dancer from a very young age and I was involved in Church music, singing and plays, so I naturally thought that as an adult I would perhaps be a dancer or a dance teacher.

But there was something calling me to help people, so I considered a career in social work as well. I was lucky because in high school I did a co-op placement with a Music Therapist who I was observing once a week. I also led a hymn-sing at a nursing home by myself, and once a week I taught music to adults who were learning English as a Second Language.

Right away I knew that that is what I wanted to do. I saw how people with dementia couldn't remember me from week to week, but they were be able to sing songs and use music as a way to participate. I knew that I could help people and use my gift.

In high school I researched Music Therapy programs in Canada. The discipline was still fairly young in the country. I decided to do my undergraduate degree at the University of Windsor and as a part of that we did practical placements. After graduation I came to Toronto for a clinical internship at Baycrest.

I was fortunate that after my internship there was a part-time job doing Music Recreation at Baycrest, so I started there and in the same year I opened my own business called Notes by Amy, where I was teaching music and also offering private music therapy.

After I was at Baycrest for a year I got a different job at the same hospital doing Program Coordination in the Adult Day Centre and I worked there for about 2 1/2 years and absolutely loved it. I was working with participants coming for a day program, there were some that were cognitively intact, and others with Dementia and other health issues. During that time I coordinated all of the Therapeutic Recreation programs and provided some of them along with Music Therapy. I continued my private practice and my performing which is also very important to me. After that I became the Music Therapist for Baycrest I went back to school to get my Masters and PhD from University of Toronto. As soon as I graduated I became interested in advancing our profession and so I've always had a role in Music Therapy organizations because I believe that is really important. 

2. In what ways have you seen music impact your clients’ health and wellbeing?

In so many ways it is hard to restrict myself to only a few. Music therapy helps clients with so many goals including: cognitive, social, emotional, physical, spiritual and so on. It can help someone to reduce pain perception while it might be implemented to help another person express challenging emotions. I think it might help to hear an example.

The needs of clients in palliative care vary but there are common issues which clients might present, including pain management, symptom control, anxiety, maintaining dignity, and cultural, spiritual and emotional needs (Halpin, Seamark, & Seamark, 2009; Higginson, Wade, & McCarthy, 1990; McKinnon, & Miller, 2002). Common emotional/psychological needs consist of adjusting to fear, sadness, perplexity, and anger. If these issues are not addressed, they may lead to serious psychiatric disorders, including depression, anxiety, and confusion (Lloyd-Williams, 2008).

Music therapy is a recognized treatment in palliative care that offers an innovative approach benefiting clients throughout the dying process. Music therapy interventions range from passive to active techniques and include music listening, lyric discussion and analysis, Guided Imagery and Music, improvisation, songwriting, musical life review, production of legacy gifts, relaxation, and singing/playing instruments. Music therapy can help clients going through the dying process to improve communication with family and friends and gain a sense of legacy and finality near the end of life. Music therapy has proven effects on anxiety, pain, mood, quality of life, heart and respiratory rates just to name a few areas.

Working in palliative care I find it exceedingly important to learn about the lives of each of my clients in helping them face death. Walking down that road with each of them and their significant relationships has been an honour and privilege that has changed me. Facing one’s own death can be a time of significant growth and transformation. Reflecting and reassessing accomplishments and regrets often brings numerous emotions to the surface which may be difficult to deal with and process. At times clients prefer to keep emotions buried because they may be complex to work through. Fortunately, music is a powerful tool in being able to both bring those emotions to the surface and successively process them.

On a daily basis I see the importance of dying persons’ need to express sentiments and final thoughts to loved ones. This often involves the expression of key sentiments such as “I love you” and “thank you”. One might not think these words are challenging to express but they can be; and music is one way that helps patients to express these emotions while also providing an avenue to leave behind a legacy gift such as a musical recording for their family and friends.

Reminiscence is another important area of clinical focus in palliative care. Jonas (2005) states music for reminiscence can reinforce the patient's self-identity and promote communication between patient and family, and particular songs used for reminiscence may evoke memories of childhood, teenage, and adult years. Re-connecting to identity is important for many clients at end-of-life when so many changes have taken place affecting their independence, physical appearance and ability to make choices due to impairments in cognition. Another key indicator for using music for reminiscence is if the client shows signs that he/she could benefit from life review. Creating a musical life review can bring different generations together in interactive, meaning-making ways, as well as aid in emotional connection, remembrance, and creating meaning for one’s life (Berger, 2006).

I use music with my clients in various ways at the end-of-life. For example, I had a 40-year-old client who wanted to create a scrapbook for her children but did not have the energy in her last weeks to complete this project. Together we wrote a song which I recorded for them and we shared it at a family music therapy session together before she died. The song became significant to her family, was played at her funeral and is the theme song on her tribute website.

Another client I worked with wanted to express sincere gratitude to her husband for the care and support he provided to her in her last months of life. She knew he understood she loved him, but it was imperative for her to express this gratitude and love in a unique way that he could treasure once she passed. Together over several weeks, we selected pre-composed songs and also wrote songs to express gratitude and love for their life journey together. We performed these songs for her husband at a “mini-concert” in her hospital room. Her husband was so moved that his wife had written songs for him. I recorded these songs and gave them to her husband after she passed away.

Over my years of work I have witnessed clients who gain insight in their last days by opening themselves up to expressing emotions and thoughts through clinical improvisation and I have sung at the bedside with family members who are accompanying their loved ones as they let go of this world. These are two examples of the work I am privileged to be a part of. I never underestimate the power of music when implemented in conjunction with a therapeutic relationship to bring healing. I am so honoured to be a music therapist!

3. What are some of your favorite books or resources on music therapy?

That's a great question! There are so many fantastic resources.

In terms of journals, definitely the Journal of Music Therapy which comes out of the United States; it is probably one of the longest running journals of Music Therapy. Music Therapy Perspectives is another excellent one, as are The Canadian Journal of Music Therapy, Music Therapy Today which is the free journal of the World Federation of Music Therapy, and Music and Medicine-for which I'm the managing editor.

There’s also an online journal called Voices which is a great resource, not only for music therapists, but also many people interested in music, education, community music, because it publishes a diverse group of articles.

I am not sure if you would consider instruments as a resource, but the ocean drum has been key in working with so many populations. It is a drum put out by Remo®. It has lots of colours and it produces a sound like the ocean or the rain. It is a great instrument for sensory stimulation and an excellent tool for relaxation.

One of the most relevant texts in my work is edited by Joanne V. Loewy, called Music Therapy at the End of Life. This text offers rich chapters which on Palliative Care Work in Music Therapy.

I am a Fellow in the Association of Music and Imagery and in this role we use recorded Classical music programs, as I am a BMGIM (The Bonny Method of Guided Imagery and Music) practitioner, the music programs designed by Helen Bonny are a valuable resource for myself.

4. What are some of the challenges you’ve faced and continue dealing with in your work and how have you responded to those?

I think one of the biggest challenges that affects music therapists around the globe is advocacy for the profession and educating the public on Music Therapy. While our profession is not that young, we are still young relatively speaking compared to other disciplines. The arts sadly are always one of the first things that gets cut when finances are at the forefront. The more research, presentations and writings that we contribute the more our profession will grow…

What is pretty cool is that people often become music therapy converts when they see it in action.

Personally since I began working I have seen the growth of music therapy in Canada. So for me this is what prompted me to go back to school in some respects. I wanted to learn more about helping my clients and conducting clinical research. I have also been actively involved in board work on music therapy associations since I graduated with my undergrad degree. For example, I served as the Clinical Commission for the World Federation of Music Therapy (WFMT) and am now the President of the WFMT, and I served the Canadian Association for Music Therapy as the Internship chair for years and was also president for a term. I also am a member of a number of Editorial review boards for journals and am the Managing Editor of the Music and Medicine journal.

One global challenge is persons understanding the differences in music experiences. Some people still think that putting headphones on a person and playing their favorite music is music therapy. This is an experience indeed and has value, but it is not Music Therapy. It feels like we have come a long way, but still must educate on a daily basis about the continuum of music experiences that exist.

Now as the current President of the WFMT, some challenges are helping other countries to build music therapy associations and become recognized in their countries and regions. Further helping establish training programs in countries where music therapists are not yet working and also establishing some kind of equivalencies so people can move around as they begin working. Setting standards for education and accreditation procedures and processes is a huge job and so vital to the growth of the profession. One challenge of course is that people who do this work, like myself are volunteers sitting on boards such as the WFMT council.

5. What do you think is needed to continue developing the connections between arts and health in Canada?

I think partnerships with various arts health care practitioners is extremely important, as is interdisciplinary collaborative research. I also think we need more opportunities to workshop and have conferences together, as opposed to those that only focus on an individual discipline. Conferences on individual disciplines have specific benefits, of course, but having opportunities to engage with a variety of healthcare professionals and arts-based practitioners, allows us to advance collaboratively. 

6. Are there any questions you wish we had asked you? Feel free to ask and answer it.

I would like to take this opportunity to tell you a little bit more about my research. The following are a few research projects that I am currently involved with.

I. Buddy’s Glee Club: Singing for Health and Wellness, Multi-Phase Studies

The purpose of this study is to examine the effects of choral singing with residents of a long-term care facility, diagnosed with Alzheimer’s disease, dementia, or cognitive impairment, and their caregivers. 

Buddy’s Glee Club One: took place with cognitively intact and cognitively impaired older adults attending an adult day care program. Five main themes emerged from this study: friendship and companionship; simplicity; happiness and uplifting and positive feelings; relaxing and reduced anxiety; and fun. This study has been published.

Clements-Cortes, A. (2013) Buddy's Glee Club: Singing for Life, Activities, Adaptation & Aging, 37, 4, 273-290, DOI: 10.1080/01924788.2013.845716

Research Questions

1)    What if any are the changes in pain, mood, and energy from the beginning of the session to the end of each session for the significant others/companions and residents singing in the choir?

2)    Can singing in a choir facilitate the acquisition of therapeutic goals including: reducing pain, improving mood and energy, increasing social interaction, and improving quality of life?

3)    What specific aspects of the choir do the residents and significant others find beneficial?

4)    What are the perceived effects of the choir on residents as described by caregivers/ significant others of the residents?

Buddy's Glee Club Two: examined physical, social, and emotional dimensions of wellness for older adults participating in a singing program facilitated by two music therapists. The participants included 16 older adults who were cognitively intact and those diagnosed with dementia. Self-report, observational, and interview data were collected: Likert scale ratings of mood, pain, anxiety, happiness, and energy were completed at the beginning and end of each choral session; participant behaviour and interactions were recorded in weekly observation notes; and semi-structured interviews about the choir were completed with participants as well as staff and volunteers who assisted with the choir. For all participants, average weekly pre- and post-session scores for happiness and mood increased each session; energy increased for 14 of 16 sessions; pain decreased for 14 of 16 sessions, and anxiety decreased for 11 of 16 sessions. T-test analyses, two-tailed with aggregated sessions data, indicated that changes were statistically significant (p < .01) for four indicators: increases in mood, energy, and happiness, and a decrease in pain. The observed decrease in anxiety did not reach statistical significance at conventional levels (p = .06) but is noteworthy given the small sample. Qualitative data led to the identification of nine major themes (community building/making friends; special moments; climate of positivity; music is therapy; singing makes me feel well/keeps me going; no anxiety at Glee; increased mood, energy and alertness; I can do it; and I love to sing) as well as recommendations for music therapists facilitating choral programs with this population.  This study has been published. Clements-Cortes, A. (2014). Buddy’s Glee Club two: Choral singing benefits for older adults. Canadian Journal of Music Therapy, 20(1), 85-109.

Glee 3: Singing Together was the third part of a multi-phase investigation examining the benefits of singing for older adults with and without cognitive impairment in an adult daycare program (phase one) and in a long-term care facility (phase two and three). Phase three focused on residents of a long-term care facility diagnosed with mild to moderate cognitive impairment and Alzheimer’s disease, and was unique in its extended scope of examining their choral participation with caregivers, or significant others. Pain, energy, and mood were assessed using multiple objective and self-reported tools. Results of 16 weeks of choir sessions indicate statistically significant reduced perceptions of pain and increased energy and mood for both residents and significant others. Qualitative themes in this study included: encourages maximized participation; facilitates interaction and bonding; promotes enjoyment and fun; encourages improved mood and attitude; facilitates energy and motivation; promotes stress release and relaxation, and singing is recognized as therapy.

II. Taking Flight: Music Therapy Internship Experiences from the Eyes of the Pre-Professional

Background

There is limited research to date on the clinical music therapy internship experience from the perspective of the pre-professional. Further study is required to advance this significant stage in clinician development as it is an intense period when pre-professionals apply and integrate theoretical knowledge about music therapy into their clinical practice.

Objective

This study aimed to: 1) assess the skills, competence, comfort, concerns, issues, challenges, and anxieties of Canadian undergraduate students at two stages in the internship process (pre- and post-internship); and 2) examine whether these perceptions are consistent with published research on internship.

Methods

Thirty-five pre-professionals, from a pool of 50 eligible respondents (70% response rate), completed a 57-question survey using a five-point Likert scale ranking pre- and post- internship experience and participated in an interview post study. 
Results

Survey results indicate a statistically significant increase in pre-professional’s perceived clinical, music and personal skill development from pre- to post-internship. Areas of desired skill development included: counselling, functional guitar, and clinical improvisation. 
Conclusions

Recommendations for educators and supervisors are provided with respect to areas of focus in undergraduate education and during clinical internship.

III. Getting Your Groove on with the Tenori-On

The purpose of this study was to assess the use of the Yamaha Tenori-on instrument in clinical music therapy sessions with a variety of clients across the lifespan ranging from children with ADHD and learning disabilities to older adults with cognitive impairment. In addition, the study sought to evaluate if the accompanying written guide for music therapists on the Tenori-on authored by the P.I. and Dr. Lee Bartel was helpful and useful in implementing musical interventions and working towards goals with a variety of populations. The Tenori-on is a digital instrument on which persons can play or compose music. Participants in the study included music therapists and music therapy interns/students who received a Tenori-on to assess its application in their clinical work. Feedback was obtained through interviews and surveys  on their experiences using the Tenori-on with a variety of populations and their assessments of the instrument’s ability to address communication, emotional, social, and motor goals in individual and group settings. Participants described the instrument as fun, engaging, motivating, having sensory appeal, being well suited for improvisation and easy for non-musicians, but also complicated to master. The study has been published. Clements-Cortes, A. (2014). Getting your groove on with the Tenori-on. Music Technology  and Education 7(1), 59–74, doi: 10.1386/ jmte.7.1.59_1

I. Sing-A-Long of the 1930s.

This study investigated the utilization of an original sing-a-long DVD and activity package titled Sing-A-Long of the 1930’s to engage older adults’ participation in singing and therapeutic recreation activities. The method included the participation of 25 nursing or retirement homes and adult day care centres across Canada in a DVD sing-a-long and activity program for 5 weeks, followed by individual interviews with participants and/or focus groups. The results focused on participant, caregiver, and DVD facilitator’s perceived benefits and indicate the DVD was successful in engaging older adults with cognitive impairment in social interaction and discussion, participation in meaningful activity, reminiscence, sensory stimulation, and quality of life in aging.

This study was published. Clements-Cortes, A. (2014). Sing-a-long DVD and activity package pilot study with older adults. Music Technology and Education, 7(2), 123-139

Published Referred Articles

Clements-Cortés, A. (2015). Development and efficacy of music therapy techniques within palliative care. Complementary Therapies in Clinical Practice, 10.1016/j.ctcp.2015.04.004

Clements-Cortés, A. (2015). A survey study of Pre-professionals’ understanding of the Canadian music therapy internship experience. Journal of Music Therapy, 52(2), 221-257.

Clements-Cortés, A. & Bartel, L. (2015). Sound stimulation in patients with Alzheimer’s disease. Annals of Long Term Care, 23(5), 10-16.

Clements-Cortés, A. (2014). Breaking free: Healing physical, verbal and sexual abuse through the Bonny Method of Guided Imagery and Music. Association for Music and Imagery Journal, 14, 39-60.

Clements-Cortés, A. (2014). Sing-a-long DVD and activity package pilot study with older adults. Music Technology and Education, 7(2), 123-139.

Lee, C. A. & Clements-Cortés, A. (2014). Applications of clinical improvisation and aesthetic music therapy in medical settings: An analysis of Debussy’s ‘L’isle joyeuse’. Music and Medicine, 6(2), 61-69.

Clements-Cortés, A. (2014). Getting your groove on with the Tenori-on. Music Technology and Education 7(1), 59–74, doi: 10.1386/ jmte.7.1.59_1

Clements-Cortés, A. (2014). Buddy’s Glee Club two: Choral singing benefits for older adults. Canadian Journal of Music Therapy, 20(1), 85-109.

Clements-Cortés, A. & Pearson, S. (2014). Discovering community music therapy in practice: Case reports from two Ontario hospitals. International Journal of Community Music, 7(1), 93-111.

Clements-Cortés, A. (2013). Burnout in music therapists: Work, individual, and social factors, Music Therapy Perspectives, 31(2), 166-174.

Clements-Cortés, A. (2013) Buddy's Glee Club: Singing for Life, Activities, Adaptation & Aging, 37(4), 273-290, DOI: 10.1080/01924788.2013.845716

Gordon, M., & Clements-Cortés, A.  (2013). Music at the end of life: bringing comfort and saying goodbye through song and story. Annals of Long-Term Care: Clinical Care and Aging, 21(11), 24-29. http://www.annalsoflongtermcare.com/content/music-end-life-song-story#sthash.H5Muf5JG.dpuf

Clements-Cortés, A. (2013). Freeing the voice within. Canadian Music Educators Journal, 55(1), 19-24.

Clements-Cortés, A. (2013). Luba’s theme. Imagine, 40(1), 70-73.

Clements-Cortés, (2013) A. healing water: Assessing trauma, abuse and loss via guided imagery and music. Kavod Journal (3). http://kavod.claimscon.org/

Clements-Cortés, A. (2012). Music therapy to sever the silence of a childhood holocaust survivor. Kavod Journal,(2). http://kavod.claimscon.org/

Clements-Cortés, A. (2011). Designing an effective music teacher evaluation system: Part two. Canadian Music Educators Journal,53(2), 22-24.

Clements-Cortés, A. (2011). Designing an effective music teacher evaluation system: Part one. Canadian Music Educators Journal,53(1), 13-17.

Clements-Cortés, A. (2011). The effect of live music vs. taped music on pain and comfort in palliative care. Korean Journal of Music Therapy, 13(1), 105-121.

Clements-Cortés, A. (2011). Portraits of music therapy in facilitating relationship completion at the end of Life. Music and Medicine, 3(1), 31-39, DOI: 10.1177/1943862110388181.

Clements-Cortés, A. (2010). The role of music therapy in facilitating relationship completion in end-of-life care. Canadian Journal of Music Therapy, 16(1), 112-136.

Clements-Cortés, A. (2010). The role of pop music and pop singers in the construction of a singer’s identity in three early adolescent females. Canadian Music Educators Journal, 51(4), 17-23.

Clements-Cortés, A. (2008). Music to shatter the silence: A case study on music therapy, trauma, and the Holocaust. Canadian Journal of Music Therapy, 14(1), 9-20.

Clements-Cortés, A. (2006).  Occupational stressors among music therapists working in palliative care. Canadian Association for Music Therapy Journal, 12(1), 30-60.

Clements-Cortés, A. (2004).  The use of music in facilitating emotional expression in the terminally ill. American Journal of Hospice and Palliative Medicine, 21(4), 255-260.