Striking a Chord: Music therapy in session

Kirsten Wells helps bring music therapy to mainstream in Montana

kirsten wells music therapist montana living lakeview  care center

By DAVID REESE/Montana Health Journal

The small group of residents at Lakeview Care Center sat in a circle around Kirsten Wells as she strummed a familiar melody on her guitar.

The residents sang to their hearts’ delight a song from the 1940s that talked about love and marriage. Most of the residents joined in, except for a couple of men who sat quietly, observing the others. But when it came time to sing a song about cars, the two men who had held out before were now fully part of the group music experience.

After singing the song, the entire group of people in the memory-care wing of the care center laughed and chatted about what the songs meant to them, with Wells leading the discussion. This may sound like an afternoon music session at a nursing home, but it was music therapy. Music therapy is not musical performance with an audience.

Music therapy is the planned and structured use of musical experiences to increase emotional expression, life review, socialization and memory exercise, and that's what was happening at Lakeview Care Center that day. Wells is a board-certified music therapist who provides individual and group music therapy in the Flathead Valley. She and her husband, Garth, moved to the Flathead area in 2015 from Denver and she’s been busy building a music therapy practice ever since. Wells knew early in her life that music therapy was the path she wanted to take.

As a junior in high school in Billings, Montana, Wells discovered music therapy when her mother clipped out an article from the local newspaper. Wells wrote an essay about music therapy in high school, and she forged an education and a career around music therapy. “I never looked back, and I never turned back after that,” she said. “I just did it. I wanted to stay in the music field, but I didn’t want the lifestyle as a performer, and I wasn’t drawn to teaching. I wanted to be of service.” Wells attended a four-year college for music therapy, and worked fulltime professionally in Denver as a music therapist before moving to Montana.

She is one of about 12 board certified music therapists in Montana. She has worked in music therapy with children with disabilities to adults with dementia — from pediatrics to hospice care. With so few music therapists in Montana, getting the practice into schools, nursing homes and hospitals is taking time, Wells said, since it is generally not covered by insurance. But there is momentum. Healthcare administrators are seeing the benefits of group music therapy, and families are using music therapy for their loved ones. Wells is on the frontier of a business model that has not been fully tried in Montana. “I want to provide music therapy to an area that hasn’t had music therapy available,” she said. “I’m looking forward to showing the medical community how music therapy can be utilized.”

WELLS REMEMBERS working with one man in a care facility. For over a year the man sat detached from the group, smiling pleasantly as Wells led the music therapy sessions. Then she sang “Make the World Go Away,” the Eddy Arnold song from 1966. “That song was the switch,” Wells said. She remembers another example of how music improved a stroke victim’s verbal communication. The woman had never been able to speak after her stroke, “She’d never been able to tell her husband that she loved him,” Wells said.

Using what is called melodic intonation therapy, where a simple phrase like “I love you” is combined with a music melody, Wells helped the woman re-learn how to say those three words to her husband. That same kind of music therapy was used with Gabrielle Giffords, the Arizona congresswoman who was injured in a shooting several years ago, Wells said. Wells often works in conjunction with other care team members, such as speech therapists and teachers. “I have the same goals as everyone else, I just use music as the modality,” Wells said.

When working with older clients, the therapeutic approach tends to be broader and less structured, while working with younger people involves setting very specific outcomes with the care team, Wells said. Music therapy works well with neonatal intensive care, early intervention, children with diabetes, at-risk youth, adults with disabilities, traumatic brain injury, dementia, hospice, mental health, and other situations, Wells said. The field is growing more clinical, which will help get music therapy into mainstream healthcare treatment. “We have to have proof something is doing what it says it’s going to do,” Wells said.

Often there is a misconception about what music therapy does. A certified music practitioner is allowed to play music for a patient, but the practice is not outcome-based, Wells said, while music therapy is. “There’s a big difference,” she said. Funding is often an issue in getting music therapy into a reimbursed, insurance-covered, organizational setting. Wells currently does music therapy in group settings around the Flathead Valley, including the Montana Veterans Home in Columbia Falls and The Springs in Whitefish.

Group sessions help bring the cost per patient down. A medical referral from a physician can also help persuade insurance companies to cover it, but that takes quite a bit of background work and is often not worth it financially, Wells said. However, that process may be exactly what is needed. “It’s a lot of work, but it’s where Montana and the nation need to go with it until insurance companies recognize us,” she said. Other states are finding success in getting music therapy reimbursed, Wells said, but with only about 13 board certified music therapists in Montana, Montana is a long way from having music therapy considered for reimbursement at the legislative level. “It’s going to be a hard push,” Wells said. Music therapists are trained to know what music is appropriate and when it should be used, and the situations that can arise during therapy, Wells said. “You have to know how to recognize the different situations. Sometimes my sessions are mostly talking. Sometimes the music is emotional support. Every day is different.” A bachelor's degree and board certification are basic requirements for music therapy accreditation.

The training for a music therapy certification is often a music degree with a music therapy emphasis or bachelor of science degree in music therapy. Music therapists must become recertified every five years. In other areas of the country, institutions such as jail, school districts and assisted living facilities incorporate music therapy into their systems, Wells said. “Montana is behind the times,” she said.

Despite not having music therapy covered by insurance in Montana, Wells is pushing on with her own music therapy practice in the Flathead Valley, one group session, one family at a time, showing the public — and the healthcare community — how important this therapy is. “It’s a viable profession and a needed service,” Wells said. “I get the joy of making people happy. When you get to see someone do something they haven’t done in years, like talking or singing, it’s some of the best feelings to see them get to that point.” Lakeview Care Center, an assisted-living home in Bigfork, Montana, brought in music therapy in spring of 2016, and uses Wells as their music therapist. Karyn Jones, director of activities at Lakeview, said the therapy sessions help bring people out of their sometimes isolated environments, and helps keep patients' minds sharp. “They might not know their loved ones anymore, but they remember that song,” Jones said. Music is a keen motivator. When you see people running, they are usually listening to music. Music can help you run faster, stay motivated and on pace, Wells said. “Music often motivates us to do what we don't want to do,” she said. For patients with dementia, music is often the last part of their memory to fade away, she said.

JENNA JUSTICE is a board certified music therapist who provides services mainly in the hospice setting. Trained music therapists are skilled in verbal counseling. Music therapy is not just playing a guitar or tambourine in a group setting. During individual therapy sessions, the music is matched to the patient's physical state, Justice said. This practice is known as the isorhythmic principle. The style of music is matched to their emotional state; this is known as the isomoodic principle. Music has the potential in therapy to help re-orient a patient back to a safe place, so that dialogue may take place, Justice said. “Music is the door, or the key,” Justice, who has a master's degree in music therapy, said. “Sometimes it's just the key to get me into the dialogue that needs to follow.”

At a session at Lakeview Care Center, Wells started by checking in with each of the dozen or so people, then having them join her in songs that were appropriate for the age group — most of whom were over 75 years old. The songs they shared, like “Abadaba Honeymoon” and “Making Whoopie,” helped lead to conversations about each of the peoples' lives. One man in the group was reluctant to join in the conversations, until Wells brought out the song “My Merry Oldsmobile.”

That opened the man up to join the conversation, and he shared a story about how as a child he drove a Model T sitting on his dad’s lap. The session ended with “Happy Trails to You.”

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