This article provides a promised update on the Muses. It also discusses the HOPES program’s survey of reactions by MGH patients, families/friends, and staff to our work. The results indicate that our live harp music contributes to a calming, relaxing ambience in the locations in which we play.
The Gentle Muses currently play in eight areas of MGH’s Cancer Center: the lobby, a two-story space with excellent acoustics, from which the harp is audible; also in the waiting area of the Gillette Center for Women’s Cancers; the radiation oncology waiting area, from which the harp is audible in the radiation treatment area; the infusion units for chemotherapy treatment, and outside of inpatient rooms in the hallways of adult cancer units.
The radiation oncology and infusion units are outpatient facilities. In the infusion units, in particular, treatments may require patients and their families and friends to spend long hours per visit, either in bay-like areas with approximately six recliners for patients being treated, or in adjacent private rooms from which the harp maybe hear if the doors stay open. Thus, as many as one or two dozen people may be near the music any time an MGH muse is playing.
Recently, we Muses expanded our playing into the pediatric and neonatal intensive care units, as well as into two inpatient pediatric units and the outpatient pediatric hematology/oncology clinics. These units, however, were not part of the current survey.
We do not, at this time, play individualized bedside music for patients. Because we play for groups, we can not synchronize our playing with a patients’ rate of respiration in an attempt to ease torturous or labored breathing, or use other patient –specific techniques of bedside therapeutic musicians.
We offer our music to MGH listeners with the intent of benefiting them but with no intent to elicit a certain response, participation or action on their part. What we do, therefore, qualifies as “passive harp therapy” under the taxonomy developed by harpist Ronald Price, Ph.D., Professor of Music Education at Northern Illinois University and founder of Healing Harps (www.healingharps.org.)
Muses play at MGH singly, not as an ensemble. Each month most of us play two MGH volunteer gigs, of two hours each, dividing that time typically between two MGH Cancer Center locations. Thus, we ordinarily play for about 50 minutes in each location.
When playing as Muses, we are neither entertainers nor performers. Rather, we play as a service, with the intention of creating a healing environment for our listeners. Accordingly, we try to choose music not for self-expression, but for its likely therapeutic effects. In a hospital setting, furthermore, people are ordinarily under one or another kind of stress. Less complex music tends to work better under such circumstances. As Certified Music practitioner and therapeutic harper Stella Benson has observed, “For healing music,… less is more,” (Benson, Stella, The Healing Musician, Seattle: NewGrail media, 1999, pp 100-01, ISBN 0-9675453). Muse co-founder, Cynthia Price-Glynn, Director of the Harp Department at The Boston Conservatory and Principal Harpist, The Boston Ballet, concurs. “Sound musicianship of course is essential. In this work, however, virtuosity gets in the way,”
We Muses have some repertoires in common. One example is Sue Raimonds’ magically calming “Melissa’ Circle” which she taught us at one of our workshops. It has almost become our leitmotiv. But most of what we play consists of appropriate selections from our personal repertoires. These, for instance, may include Celtic slow aires, music of the great 18th century Irish composer O’Carolan, modal music, Scottish and American traditional pieces, some spicier South American music, medieval, Renaissance, and classical selections; improvisations; and some music that is probably unclassifiable. Recently, and thus out of the survey period, one surprised but versatile Muse found herself accompanying an impromptu hospital sing-along that included “The Battle Hymn of the Republic.”
This range of repertoire provides variety for MGH staff members, who are on duty frequently when a Muse is scheduled to play. It does the same for the many patients, and their accompanying families and friends, who hear us repeatedly when at MGH for chemotherapy or radiation treatments.
Everything we play, by the way, is from memory. Even with our handy cart, carrying sheet music and music stand around the hospital, in addition to harp and stool, does not work. In addition, playing without sheet music frees us up to make eye contact with people near us, smile at them, and on occasion even chat a bit.
Some muses are primarily concert harpists, others are lever harpers. All have had an orientation and additional background in playing therapeutically, some have further training and considerable experience elsewhere in therapeutic music.
At MGH, most Muses play a 34-string Blevins lever harp that the American Truths Foundation has generously provided. We also have use of a 23-string Westover therapy harp, which some of us play while strolling around a children’s inpatient cancer unit. When not in use the harps, a harp cart and accessories are stored in a closet near the MGH Chapel.
Like other harpists and harpers who play with therapeutic intent, the Gentle Muses have always received many appreciative comments form listeners. These responses were encouraging, but any program should be evaluated more systematically. In the fall of 2003, as one step in this evaluation, the HOPES program undertook a substantial (and unfounded) effort to survey our listeners for preliminary qualitative data on the Muses/ effectiveness.
Our Muse mentors, MGH oncology social worker Katie D. Binda, Director of the HOPES Program, and Cynthai Price-Glynn, coordinated development of a questionnaire for the purpose. We Muses all had input at our bimonthly MGH dinner meetings and by email. We also had the benefit of a survey format used in the San Diego Hospice in 1999-2000 and supplied by Christina Tourin, founder of the International harp Therapy program. Katie Binda shepherded our final version through the MGH review panel.
Our survey form was one page long and fairly simple. It asked for no information that could allow any individual respondent to be identified.
Besides space for the date, the first part included boxes that the respondent could check to indicate gender, age (under 35, 35-64, 65 & over), whether he or she was a patient, a family member/friend, or a staff member/volunteer, and the cancer center area in which the respondent heard the live harp music.
The second part had four questions.
The first of these said: “After listening to the live harp music today I feel….,” followed by a grid on which to check whether the respondent strongly agreed, agreed, was neutral, disagreed, or strongly disagreed that he or she was a) relaxed, b) calm, or c) energized.
The second question asked how the respondent would rate the volume of the live harp music: much too loud; a little loud; just right, a little soft; much too soft.
The third asked whether the respondent would like live harp music played in that location in the future.
The fourth asked whether the respondent would like live harp music played in other areas of MGH and if so, which areas.
The final part was an open-ended request for comments.
Stapled to the front of each survey form was a brief letter on the HOPES program stationery stating why we were making the survey. It explained that the Gentle MUSES were musician volunteers. It emphasized that taking part in the survey was voluntary.
Wanting a large enough sample for useful conclusions, we first set the ambitious goal of 200 completed survey responses within about a month. We wanted them from all eight areas of the Cancer Center in which Muses play. For several reasons, getting responses took longer than anticipated. The survey forms could be presented only when and where a Muses was playing. Some listeners declined. Some of the forms returned were incomplete. After nearly two months Katie Binda and the Hopes program manager Stacey Paiva decided to stop with the 182 survey forms obtained by that point.
It was particularly difficult to get survey forms filled out in inpatient cancer unit hallways in the evenings, the only time that Muses play there. Evening nurse managers tried to assign staff to help with the survey but could not always do so. To obtain the responses we wanted, it proved essential for Katie Binda or Stacey Paiva to personally administer the survey in those locations.
Katie and Stacey tried to make sure that no staff member was surveyed twice. As to patients and their families and friends, this was of course impossible. But there was little apparent duplication. We made no attempt to differentiate the responses of those hearing the larger harp from the responses of those hearing the smaller one. In addition, we made no attempt to get an approximately equal number of responses from men and women.
The findings have been worth the work involved. “Overall,” concluded Katie Binda, “the Gentle Muses program is doing what we hoped it would.”
Of the 182 respondents, 45% were patients; 29% were family and friends; and 265 were MGH staff and volunteers. 70% were women; 28% were men.
The age distribution of patients responding reflected approximately that of Cancer Center patients in general: 18% were under 35 years old; 57% were 35-64 years; and 19% were 65 and older.
Regardless of whether respondents were patients, family members and friends, or MGH staff and volunteers, and regardless of respondents’ age range, the data strongly indicate that most listeners responding found the live harp music both calming and relaxing.
A concern of some MGH staff before the Muses’ inception in 2002 had been that patients might be put off by harp music, associating it with angels and thus with death. The sole survey response mentioning this idea was from a patient whose husband had burst out laughing when she told him about the harp. He “wondered if MGH was preparing the chemo patients for entering the gates of heaven.” The patient herself said that she found the music “pleasant.” Our data, therefore, suggest that the concern does not appear to be widely held.
The following charts set forth the data on whether respondents found the harp music calming or relaxing, respectively, The charts combine the categories for “strongly agree” (SA) and “agree” (A), as well as those for “disagree”(D) and “strongly disagree” (SD). Where (D) or (SD) appears after a figure, however, all responses to that item were either “disagree” or “strongly disagree.” “Unknown” figures lack of response to the relevant item.
By Category of Respondent
By Age Range of Respondent
Category of Respondent
By Age Range of Respondent
The results suggest that there may be a difference in the extent to which those 65 and over (70%), and those younger than 65 (35-64, 86%, under 35, 87%), find the harp music calming. However, an unusually high percentage (22%) of listeners 65 and up omitted this item completely. So it is unclear whether age may be a factor in response to the harp music or to the survey form, or whether something else is involved. It would be worthwhile investigating whether simplifying the form by presenting fewer choices, e.g. “agree,” “neutral,” “disagree,” would elicit more responses from listeners 65 and up.
As the charts above show, a few respondents in most categories disagreed, or even strongly disagreed, that harp music was calming or relaxing. The survey forms, however, lack identifying personal data. So we could not go back and ask those disagreeing whether they liked the music but just did not find it calming or relaxing, or whether they experienced negative reactions to the music.
This point is important. As is well known, a basic tenet of playing therapeutically is that every patient have (and be told at the outset that he or she has) the option of declining the music or of ending it at any time. Cf. Benson, The Healing Musician, p. 164.
Where a musician offers to play live music therapeutically at an individual patient’s bedside, the musician can easily make sure that the patient assents, or at the least, is told that he or she can stop the music at any time. When a musician plays for a number of patients and other as a group, however, it is impractical to get all potential hearer’s prior consent. Furthermore, once the musician starts playing, listeners may not feel free to tell the musician if they find the music unpleasant, or if they are just “not up to it at the moment.” Benson, The Healing Musician, p. 164. In a group situation, however, it might be feasible to make ear protectors available for any who may prefer not to hear.
This concern about the assent of the listener may be of particular relevance to hospital staff. They usually cannot move away from their stations and are therefore stuck with whatever music is being played. For what it is worth, however, no MGH patients, visitors or staff members have contacted the HOIPES program and asked that harp music be terminated in a given location, or that a particular Muse not play harp in the area The response typically is the opposite. As an MGH physician said to me during the survey, “Anything to keep you guys coming!”
The survey’s query about live harp music’s energizing effect had 38% of respondents reporting feeling more energized, and 31% feeling “neutral.” As the charts above make clear, this was by far the largest “neutral” category. In retrospect, “energizing” seems a less than useful category for evaluating music intended to decrease stress and promote relaxation. Revision of this survey would probably omit it. Substitution of a query about the effect of harp music on anxiety level, or if applicable, on the level of pain, might make more sense.
Other areas of MGH in which respondents would like live harp music played including a waiting room for family and friends of patients undergoing surgery. The respondent who wrote this reported having twice in the previous year waited anxiously in one of these rooms. Though praising MGH and its staff, the writer found the waiting room “busy and distracting, while there is so much anxiety at this time for family and friends.” Another respondent wanted live harp music “anywhere where people are apt to feel low.” Yet another wanted it “[e]verywhere because everyone should experience the heavenly sound of the harp.”
Of the responses under “Comments,” not all were positive. One respondent “Can not hear the news. Please have it turned down.” Another said, “It’s a nice touch, but not worth spending hospital money on live music. Maybe a record.” We always wear the distinctive salmon volunteer jackets when playing as Muses. It is unclear whether this respondent was in an inpatient room and thus could not see the Muse, or whether he did not connect that famous jacket with the Muse’s volunteer status.
A couple of comments noted that an announcement or explanation before the harp music started would have helped listeners know what was going on. We do have a lovely informative Gentle Muse poster that we sometimes display while we play. Furthermore, the completely public process of unstrapping the harp from the cart, taking the dust cover off the harp, setting the levers, and unfolding the harps tool ordinarily provides sufficient of notice that there’s going to be harp music. (It also provides onlookers with an intriguing diversion.)
Neither the poster nor the harp set-up spectacle would however, help a room-bound patient who could not see them. In this case, it could be useful for a staff person or the Muse to briefly visit the rooms of nearby patients to mention that soothing harp music will be played shortly I the hall for a half an hour or more, and to offer to close the door if that patient prefers to shut the music out.
As to the type of music we play, two comments out of the 182 responses noted that it “needs to be more upbeat,” and that it “is not upbeat enough.” These appeared to be isolated reactions. Any muse to whom a listened mentioned this at the time, however, would undoubtedly be glad to segue into something more spirited. A related though more approving comment was by a patient who found it “Good as long as it doesn’t get too much like ‘new age’ music.”
The other comments from patients, staff, and visitors were overwhelmingly positive. That so many responses to the open-ended comments item were positive seem to indicate that our choice or repertoire, focus on how our music may affect our listeners, and intent to create a healing environment for them are effective means to our ends.
Many comments mentioned the music’s effects, in particular, its effects in diminishing stress and anxiety, and in calming listeners. This seems particularly noteworthy since the words “stress” and “anxiety “ did not appear either in the HOPES program cover letter, or in the survey form itself,
Although the survey concerned only the effect of the music on each respondent, a number of MGH staff comments also mentioned the music’s effects on patients as well,
“I think having harp music helps to relieve stress in patients and staff on a hectic day. It helps me relax and I can re-focus. We need to have harpists here more often.” “This is very lovely and it relaxes the patients so that they are not so anxious.” The harp music…relaxes and calms patients. I work for an infusion unit and have heard lots of great comments from patients.” It relaxes patients so that they are not so anxious.”
“As a staff RN on this busy unit,... I find it extremely relaxing, it can very much take the edge off the stress of the demands of a busy area. I have always heard positive feed back from patients as well, Thank you.” It’s very relaxing for our patients to have something to calm them down... I think it should be played every day!” “Very calm and soothing for the patients.” The Gentle MUSES come to [an inpatient unit] at a very hectic time of day [3-7pm] so it is a nice break from this chaotic pace.”
Comments from patients themselves, and from their family members and friends, bear out the MGH staff’s observations.
“Absolutely wonderful! I have chemotherapy today and I was anxious until I sat and listened to the music.” “It helped make our first time more peaceful.” “It has a soothing effect on me and on my friend who is undergoing chemotherapy.” “I think it’s very soothing and my daughter here almost fell asleep.” “We had been here once before and when we… heard the music today it was so pleasant and…reassuring that there was a sort of familiarity and order to what seemed so jarring and chaotic (i.e. chemo treatment).” “It was very soothing and a great comfort to me. I enjoyed this harp music immensely. [I] heard it once before and look forward for it again.”
Some other comments are also worth quoting. “This is my second day here so I’m pretty tense. Thought it took my mind off me.” “What a blessing in a stressful situation.” “I was feeling very ‘blue’ today and this really was relaxing!” “A pleasant surprise.” “It makes me feel good.” “Love the sound.” I feel calm and centered and great.” “Would like the harpists to play more frequently.” “I find it wonderful to have this kind of music in such a hectic environment, it is a moment of peace and serenity. “
From the HOPES program survey, it accordingly seems fair to draw several conclusions.
The Gentle Muses are grateful to Bruce Chabner, MD, Clinical Director of the MGH Cancer Center and Chief of Hematology and Medical Oncology and to Katie D Binda, LISCW; Director of the HOPES program, for their imaginative foresight in establishing the Gentle Muses and for their unstinting support of it. We are also grateful to Katie Binda and Stacey Paiva, Program manager of the HOPES program, for their dedicated efforts (including those on their personal time) in conducting this survey, doing the analysis, and advising on this article. Our sincere thanks also the 182 MGH patients, family members, friends, staff and volunteers whose generous participation made this survey possible.