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Music as therapy for O-day-old babies

"Music is life, and by doing music therapy, I feel that, as if with an invisible thread, my child is bound to the here and now"

...says one of the parents who participates in the music therapy program from the Angels of Joy which takes place in the Neonatal Intensive Care Unit (NICU) of the Panagiotis & Aglaia Kyriakou Athens Children's General Hospital.

We asked Christina Kalliodi and Dimitris Koukourakis, two of the organization's music therapists, to tell us about the music therapy programs implemented with support from the Stavros Niarchos Foundation (SNF) as part of its Global Health Initiative (GHI) through an SNF – Release Athens grant. The program is offered in the NICU and two of other departments at the hospital—the Child Psychiatric Department and the Pediatric Oncology Department—as well as at Aghia Sophia Children's Hospital in the unit where children with cancer are treated. Their responses reveal the importance of an unorthodox but by all accounts meaningfully beneficial intervention for young people, from newborns up to 18-year-olds, as well as their families.

How did the need for this intervention arise?

Dimitris Koukourakis: In the burdened and difficult environments we were visiting, there was clearly a need for a purely therapeutic program, in addition to the programs we already had in place, which were mainly of an artistic and educational nature.

As a recognized scientific field, music therapy complemented our programming within health facilities in a remarkable and important way. Scientific research supports the use of music as a therapeutic tool because of the positive changes it can cause in one’s mood and in the non-verbal expression of difficult emotions.

Christina Kalliodi: Hospitalization in the Neonatal Intensive Care Unit (NICU) is often a traumatic experience with difficulties for both premature and term infants and their parents, who are a high-risk group for development of postpartum depression, anxiety disorder, and post-traumatic stress disorder. For this reason, early intervention programs are now being developed internationally that focus on individualized support for the physical, developmental, and psychosocial needs of hospitalized infants and their families. Knowing the above, and in combination with my own experience as a music therapist specializing in this field, we contacted the NICU at Pan. & Aglaia Kyriakou Children’s Hospital (a hospital with which Angels of Joy had already established a successful, long-term partnership) to explore their needs and interest. The management of the NICU has been promoting and supporting this family-centered approach for years, so they felt that such an intervention would further enhance the quality of care offered to young patients and their families.

It is not often that one reminisces about moments from an intensive care unit. For this particular family, music therapy helped transform the hospital room into a warm home.
Christina Kalliodi
Music Therapist & Psychotherapist, Angels of Joy

What was the most difficult moment a music therapist was asked to face?

Ch.K.: For me, the hardest moment so far was when we were told that we would have to suspend the programming for a long period of time due to the protection measures for COVID-19.

D.K.: What constitutes a “difficult moment” is quite subjective in the case of art therapies—and in psychotherapy in general—and depends to some extent on the clinical experience of music therapists. At the beginning of my career, I was working abroad in a security ward where I was physically attacked by a patient. I believe that this is one of the most difficult situations one can face. It is of course extremely rare for something like this to happen in a hospital.

In music therapy, we are not here to just feel something pleasant but to stand and embrace the difficult parts together.
Dimitris Koukourakis
Music Therapist, Angels of Joy

What three words best describe the mission of this program?

D.K.: Music, interaction, connection

Ch.K.: Support, empowerment, hope

"The first time I held her in my arms and we listened to the guitar, she immediately fell asleep"
"Music therapy was a great motivation for my first child too, to visit the NICU together in a happy mood.”

What changes have you noticed in children and parents after music therapy? Are the changes immediate or long-term?

Ch.K.: What we observe is consistent with what is documented in the international research literature. We see both immediate changes, such as an improvement in a baby’s breathing function, and long-term changes, such as a change in a parent’s attitude. I would prefer to use the words of the parents themselves as they describe their experiences through the program evaluation forms:

“The first time I held her in my arms and we listened to the guitar, she immediately fell asleep.”

“When my baby is doing music therapy…

…It seems calm

…It is reacting

…I feel like I’m communicating with it.”

“After music therapy, I feel peace, contentment, relief.”

“Music therapy was a great motivation for my first child too, to visit the NICU together in a happy mood.”

“A significant moment was when I heard dad singing along with the music therapist. Dads appear more uptight and some may have a hard time bonding. I think the moment when you participate in music therapy is also the moment when you accept it as a means of bonding with the baby, of healing and support.”

“Music is life and by doing music therapy I feel that, as if with an invisible thread, the child is bound to the here and now.”

D.K.: The application of music therapy in the hospital context presents an important peculiarity. The frequency of case rotation is high, and, for this reason, we emphasize the present during meetings, without always being able to determine whether there will be a next time. The most obvious changes that we have seen are found in the before and after of music therapy sessions. A family may at first be reluctant to try this service, thinking that being in a difficult emotional state, it cannot possibly turn out to be a pleasant experience. When they understand that, in music therapy, we are not here just to feel something pleasant but to stand and embrace the difficult parts together, then an important change occurs. Contact with music through actively playing instruments has very often brought immediate changes. This can be seen in the change in the mood of the family, as well as in the children. Through the musical connection and the resonance that they experience, they seem to become emotionally activated and give new meaning to the family relationship. This is a change that happens immediately. Long-term changes have occurred at the level of the children's discovery of music, to the extent that it becomes important in their lives. We have heard from parents that after contact with music therapy at the children’s hospital, their child wanted to start piano lessons as a more permanent way of being in touch with music.  

Could you share a specific case in which music therapy has had a transformative effect on a child or a family?

D.K.: Once, when I entered a room in the oncology department, I saw a girl with her mother. The girl was having numerous difficulties due to multiple head surgeries. I suggested she choose an instrument she liked and she opted for the keyboard. As soon as her fingers touched the keys, she started creating some musical patterns, on which I improvised on the guitar. I encouraged her to improvise with me, using her voice without words, only with open vowels. Her face had changed, her expression seemed happier and more relaxed. We played like that for about 20 minutes, which surprised her mother because she usually got tired easily. From what she said afterwards, the vocal improvisation relaxed her a lot and she especially liked the fact that there were no words because that kind of thing makes it difficult and tires her. Both through her musical expression on the keyboard and by using her voice, she was given the opportunity to discover something she couldn’t access before—a space in which she could exist at her own pace, with her own capacity. And that was the most important thing.

Ch.K.: Sometimes, despite everyone’s best efforts, an infant’s life can be very short. And I think it is important to stress that this short duration should not affect either its value or its quality. I will not forget the case of X, who stayed with us for about 6 months and died shortly afterwards. We were able to support him and his family in many ways, helping them find ways of communication and contact beyond physical care, providing opportunities for play and interaction, contributing to warm family moments and beautiful memories but also facilitating the expression and sharing of fear, pain and grief. It is not often that one reminisces about moments spent in an intensive care unit. For this particular family, music therapy helped transform the hospital room into a warm home, where they lived and experienced beautiful moments that they now think back on with emotion.

Video Credits: Melina Boukouvala
Photo credits: Melina Boukouvala, Dimitris Koukourakis, Kostas Stamoulis