Rachel’s Blog

Sometimes working independently can be hard. I’ve recently finished a few projects with a number of organisations, and whilst the Occupational Therapists, Dementia Support Workers, Community Psychiatric Nurses etc continue their work with the clients in different contexts, it can sometimes be difficult to know how to properly digest the experience of the project and lay it down, especially when there may have been difficult emotions or situations. I have found that reflecting on the project while it is going helps enormously, not just for notes to look back on week by week, but to read back at the end. This can be particularly helpful when preparing a report. Not every organisation will want a report but it can be a good way of getting down on paper what happened so the project exists within the organisational memory, even if individual workers move on. Sometimes it may be appropriate to write several reports with different slants. I might write one for myself which contains fairly personal stuff about how I felt about my development, where I struggled, what I want to improve on, what I was proud of; another report might be very short and suitable for the organisation’s newsletter; a third might be lengthier, more formal and useful as a shared document from which to learn and develop new projects. Leave-taking can be sad, especially where good relationships have been formed and a group feels comfortable. One participant said on leaving the project ‘I feel quite emotional. You’ve all been so kind and so accepting’. Where there have been difficult relationships or uneasy emotions this too can be hard – from my point of view as a practitioner I will always be asking myself ‘could I have done this better – what could I have done to help this person settle better’ – there is a sense at the end of a project of having missed a chance. Which is why putting it down on the page can help. In The Artists’ Way Julia Cameron suggests a technique called ‘morning pages‘. Stream of consciousness writing I find can help get at the nub of the issue, and be a powerful learning tool for next time.

I’ve reached a point in the year when several projects have come to an end, not to start again until September. So I find myself with a little extra time on my hands. Which is great because I get to do a bit more ‘minstrelsie’ – that is, traveling around the county doing more one-off sessions, and hopefully developing some new work and meeting lots of new lovely people.

Download: Rachel M Smith Singing for Wellbeing Flier (pdf)

Age Concern (Age UK) Singing for Fun and Wellbeing Groups are for people aged 50 or older. We meet weekly in term time and all the groups vary depending on who comes along. Many people say to me ‘I can’t sing’ but whether this is true or not, it doesn’t seem to affect their enjoyment of the sessions.

We sing a variety of songs; hymns, songs from shows, popular favourites, folk songs, songs from around the world, gospel, jazz….. We sing unaccompanied; in unison, or in parts. In particular we sing a lot of rounds as they are a fun and straightforward way of getting everyone singing together in harmony. We also sing songs accompanied by the guitar, and sometimes we use percussion instruments. We learn songs by ear, and from song sheets.

All sessions cost £2.50, except for your first session which is free. Sessions will start week commencing Monday 7th June 2010 and run to the end of July 2010.

Banbury, Monday 4pm – 5pm, Age Concern Cafe, White Lion Walk

Witney,Wednesday 10.15am – 11.15am, Lower Hall, Witney Methodist Centre, High Street

North Leigh, Thursday 12.30pm – 1.30pm, North Leigh Youth Centre (at the back of the memorial hall)

Carterton, Friday 4pm – 5pm Brownes Social Club, Brownes Lane (no session Friday 2nd July)

On Sunday I attended a training day for people involved with Singing for the Brain. There were facilitators, volunteers, dementia support workers and fundraisers – over 60 in all. Great fun and it was useful to meet other people working in a similar field. Below are some reflections I wrote on the train on the way home…

Reflections

It was exciting to arrive this morning and be greeted by a number of familiar faces. Facilitators who I had met when visiting their sessions, and at the recent meet-up at Old Basing.

Watching Sue Shapland go through the session structure was incredibly useful. As I’m now more familiar with some of the material she uses (I have previously visited the Old Basing group), I was able to focus on some of the subtleties: small gestures such as putting her hand to her ear to indicate she is listening and that it’s our turn to sing – the use of a recorder – for months I have been struggling with a tuning fork to pitch songs – brilliant! The pace of the warm-up was also great – taking time to focus on one sound. Previously I have felt anxious about this aspect: is it too childish? Is everyone bored?

I feel watching the different leaders today gave me permission to go with my instincts more and embrace the session structure as something to be played with. Something I would like to experiment with is the breaking up of the warm-up. Feedback from dementia support workers at one of the Singing for the Brain groups I run suggests that the warm-up goes on for too long, especially when coupled with a lengthy (depending on numbers) welcome song. Perhaps a way around this is to place some of the warm-up activities such as tongue-twisters into the main body of the session? I can however see the arguments for the warm-up section to follow a particular pattern, not least to develop a consistency to the opening of sessions. Evidence based practice anyone?

One of the strengths of today’s training was undoubtedly the variety of the facilitators we saw demonstrating different aspects of a session. I loved the Samba and the Rumba and the Cha-Cha-Cha (which I have temporarily forgotten and hopefully will remember in time for my next group on Tuesday) demonstrated by Joni from Castle Cary. I also enjoyed Faye’s session in which she had, I felt, high expectations of the group. This was a real positive. Singing for the Brain is not just about spoon-feeding, but offering a challenge to people. Finding the balance between nurture and challenge is an important part of the continuing development of Singing for the Brain practice. I really hope to use Faye’s action songs and rounds, as they were straightforward, rewarding and not at all childish. I particularly liked the action song ‘Tony Chestnut‘, and can see that this is something that ticks so many boxes in terms of language, swapping sides when doing the actions, and the actions reminding us of the words.

I think what I will most take away with me is the content of Chreanne’s talk at the beginning, that it isn’t ‘miraculous’ when someone withdrawn due to dementia suddenly ‘wakes up’ and joins in – this is the effect that music has on the brain. She also pointed out that people with a dementia diagnosis do not get ‘a fair crack at neuro-rehabilitation’; this is what Singing for the Brain is, and it shows people with dementia can learn to do new things: learn new songs, new skills and make new friends.

In March I went to an inspiring concert in Iffley Village Church Hall organised by the music therapists of the Guide Posts Trust. It was simply wonderful. And packed out too! Great to see such support for music therapy and the value of music being recognised. The music therapists themselves played and sang beautifully, but what stuck out for me was the performances of some of the clients – one performing his own composition ‘It’s Music’ which the whole audience joined in with.

The words which spring to my mind are: empowerment, visible, individual, truthful, creative, emotional… there are some things which can only be expressed through music.

This video is not directly relevant to my work, but I love this video and the ideas it expresses… Enjoy!

A couple of Fridays ago I visited the Singing for the Brain group in Old Basing – led by Sue, an experienced singing facilitator. It was a good opportunity to see some best practice in action in the area of singing with people living with dementia.

The group was quite large – over thirty, including visiting facilitators like me, carers, volunteers and Alzheimer’s Society employees. I particularly enjoyed the feeling of ‘expansiveness’ that the facilitator created; it was a space where anything was possible – and yet it was a safe space too. This is something I am looking to better achieve in my practice, and I think it will come as I gain in confidence and clarity.

Singing for the Brain is an idea which many facilitators and local Alzheimer’s Society branches have picked up and run with. It’s been so successful it is now becoming a core service of the charity and a new specification has been written to help guide the groups to have the most positive effect, leaving enough flexibility to take into account each groups’ uniqueness.

The main message I took from discussion with other facilitators is what Singing for the Brain is not: it’s not a sing-a-long! Trying to uncover what it actually is is more challenging as the framework has been developed through years of practice and research and includes complex ideas about emotional memory and something called neuroplasticity (I’ll let you know when I know!). At the simplest level, Singing for the Brain sessions must have a beginning, a middle and an end – this might sound obvious, but finding a good song to end on, or a way of rounding of or cooling down a session can be trickier than it first seems.  It is important to use movement, for a variety of reasons: for gentle aerobic exercise, and to keep joints moving, to help participants remember words, and evoke feelings and memories, and to encourage connections between both sides of the brain by using movements which cross the central line of the body – for example at Old Basing, the facilitator used small beanbags which the participants passed from hand to hand in time to a pulse.

Obviously singing is the central part of the session, and the majority of the time is taken up singing songs, either from memory or from song sheets, and also incorporating harmony through part-songs, rounds and partner songs (2 songs sung on top of each other). There is also a strong sense of pulse running throughout, which helps connect people (this makes me think about entrainment theory) and gives a backdrop to activities such as tongue-twisters and rhythmic ditties such as Hickory Dickory Dock.

I’m really excited about the possibilities of Singing for the Brain because of the improved social, physical and mental health of people living with dementia, a disease for which a medical cure seems a long way off, but for which social coping strategies are being put in place by the fantastic work of The Alzheimer’s Society.

If you want to join in the conversation about singing with people living with dementia please leave a comment or join the WellSing network where there is a new discussion thread on this topic.

I’m really keen on reflective practice – that reflecting and thinking about what I’ve already done impacts, and hopefully improves what I will do in the future. This falls into the lovely messiness of action research/action learning, it’s difficult to know which questions you are going to need to ask until you’re in the thick of it. This can be difficult sometimes, it’s not about being prepared or unprepared, but when in practice, unexpected things happen, which requires the practitioner to be flexible, but also to think about it all afterwards.

That’s what I want to do now (the Christmas break and the New Year seem a good time for reflection and resolution).

I have some questions about my practice. I’ve worked with a wide variety of groups, from tiny (just a couple of people) to large groups of over 50 people, and everything in between. Most of the time it’s in the 12-20 number range. Some groups are more diverse than others; some groups meld together well, and others don’t, or is it simply that some groups include people who find it harder to relate to others socially?  One of the fantastic things about group singing is it is very inclusive and is an activity that different people can share.

The facilitation of a singing group is very important to ensure everyone does feel included.

How do I feel about using the guitar? Does it get in the way?

How could I change my introductions/patter etc? Can I be clearer when giving instructions. I have an invitational style, and perhaps people need something more directive.

How do existing members of the group react to larger numbers? Generally people like being in a larger group if they are not confident singers, but in some settings, it can put people at a distance which limits the connection I can have with each person.

I spend a lot of time seated, especially when working with the older old who are often less able to stand up (I think it’s important to be on the same level, and not looking down on / talking down to participants) and I think this can give me a sense of being rooted to the spot (not in a good way!). How can I vary this?

How do I combine leadership with joint exploration of a song? I want participants to interpret the songs and music in their own way – I don’t have strongly developed ideas of exactly how I want something to sound. Perhaps I should develop this more!

I feel most comfortable when facilitating unaccompanied singing. I think it’s time to write arrangements of my own to cater to this need. Interestingly, the unaccompanied, harmony songs seem to be the most popular, the ones we keep coming back to, as opposed to the guitar-accompanied songs in strophic form.

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Reflective practice can be difficult. The questions I ask myself force me to acknowledge the truth of my practice, and sometimes the truth is hard to swallow. The important thing is that I am asking the questions, and if I don’t know the answers, then I am working towards them at least. By blogging them I hope the exploration can be shared with others practicing in these kinds of contexts, and help develop an honest community of (reflective) practice.

On Monday I took one of the community-based singing groups I facilitate into a residential care home. It was a bit of an experiment.

Participatory Singing in Residential Care Homes

I have done a lot of work in care homes. It can be a challenge – more of a challenge than I had expected compared to community-based work. The residents often have high support needs of varying types. For example, there may be people in different stages of dementia, with different physical disabilities and frailty, as well as other factors such as literacy, language (can they speak English?), and other mental health problems such as bi-polar disorder or depression.

Often I am left to lead a participatory singing session with groups like this with no support from care staff. This is, as you can imagine, quite difficult, as participants need help to find page numbers, follow the words and reminders to sing and/or use hand percussion. There may also be disruptive group members who might, for example, sing loudly and completely out of time with the group, which other residents find disruptive and mars their enjoyment, or even participation of the session. This means that sessions can feel a little disjointed as often the groups are as large as 20+.

The Community-Based Singing Group

Having a cup of tea with some of the participants of a community-based group in the autumn, it emerged that they felt they wanted to give something back. They enjoyed singing so much that they wanted to share it with others. After a conversation with the manager of the church centre we use, we got a contact at a local residential care home. This residential care home is brand new and as such has limited local connections. They had been unable to secure any activities or entertainment for Christmas.

The Experiment

Around 12 participants of the community-based group came to a 1.5 hour session (with a break for tea and mince pies) at the resi care home. There were about 12 residents present and I think the enthusiasm of the visitors and the increased numbers of people around them helped them feel able to join in with the singing, especially with the actions. The residents were also assisted by the group to play hand percussion and the group were able to help find page numbers and amplify song requests on behalf of residents sitting near them.

From my point of view, I was able to concentrate on leading the music, secure in the knowledge that everyone was engaged in some way. This led to a more coherent session, with more singing, and smoother transitions between different activities. The increased numbers meant that although I couldn’t distinguish who was singing and who wasn’t from listening, I could relax a little and look around the room and see the different ways in which people were engaging. There was one resident who didn’t join in the singing until we sang Oh When The Saints.

Reflection

Taking the group into the residential care home has made me reflect a lot on my practice in residential settings. Yes it would be great to have enthusiastic singers assisting at a session, and I hope I can develop a regular relationship with this care home, as so many from the group enjoyed the visit. However, it is also helping me rethink the way I work in residential care homes.

• Am I placing too much expectation on the residents to be able to work with my resources? (song book, hand percussion) In some cases yes, in others, no. And usually all in the same room.
• I place a high value on participative sessions, yet many resi care homes describe me as ‘the entertainer’ (“she’s going to sing to you” is how I’m often introduced) – what value is there in performing in residential care homes? Or mixing up the session so there is a combination?
• I want to challenge care home residents to make their own decisions and to take a little responsibility for participating. If I work to the lowest common denominator then will I simply be complicit in the institutionalisation of older people?
• How can I be sure the residents want to be in a singing workshop? The descriptor ‘captive audience’ is sadly no over-statement.
• I want to find ways of encouraging care staff to be involved in participative singing.

It’s been such a long time since I last blogged, I wanted to pull together the many ideas and inspirations and anything else which has caught my attention or fed into my practice over the last few months and place them together in one post.

Telly

The first thing is to comment on the recent surge of interest in older peoples’ issues, for example the recent edition of Wonderland showing how the lives of those living with dementia can be improved through group singing. I have to confess to being frustrated by this programme as I felt they could have shown more of the singing – but could have used fewer clips of people singing ‘It’s a Long Way to Tipperary’. On an occassion when I was volunteering at an Alzheimer’s home we sang this song and a woman commented after the last line (‘and my heart’s right there’) “no it’s not, it’s here” whilst pointing to her chest. Always amazed at the humour found within people with this debilitating disease.

Another, two-part programme which has been on the telly (or iplayer in my case) is the Can Gerry Robinson Fix Dementia Care Homes? I really relished watching this programme. I see the inside of residential care homes at least weekly, and I work with older people daily. It was wonderful to see my world on the screen because the media in general doesn’t have much space for older people. It was also inspiring to see examples of good practice that show affordable, excellent dementia care is possible.

Yawn-Length Reports (which have lots of useful things in them)

There has been a report published by the Joseph Rowntree Foundation called Older People’s Vision for Long-Term Care. There has also been a large-scale consultation taking place called The Big Care Debate. This has now come to a close, but the goverment published a green paper – and you can listen to Andy Burnham talking about it here. Hopefully the systemic change the Joseph Rowntree Foundation is calling for will be matched in the green paper. But we’ll have to wait and see…

Books

There have been a number of books which have helped me think and reflect on my practice. One is Contented Dementia by Oliver James. I found it an overwhelmingly positive read and it helped me to see beyond the disease when working with people with dementia. Perhaps one criticism might be that it painted a picture that was a little too rosy. But I guess the important point is that just because someone has dementia, doesn’t mean they or their family will never have fun again. People have a right to fulfilling lives.

A few others are The Artist’s Way by Julia Cameron, Well-Tuned Women: Growing Strong Through Voicework by Frankie Armstrong et al and Community Music Therapy by Gary Ansdell et al.

Music

I have found the music of Chris Wood to be particularly inspirational this year. He has such integrity as an artist, telling stories without sentimentality. He has made me think about connection to place, tradition, nationality and community.