PRACTITIONER PERSPECTIVES ON SPIRITUALITY:

A Pilot Study for Interdisciplinary Potential of Music Therapy and Spiritual Care
Nathan Thorpe
Wilfrid Laurier University
Faculty of Music
Music Therapy Department
Supervisor:
Dr. Heidi Ahonen, PhD, MTA
Methodological key words:
Qualitative research, Hermeneutic phenomenology, Ricoeur, Foundational professional
research, Constructivist methodology, NVivo qualitative data analysis software, Clinical
resources, Professional development, Education, Spiritually informed epistemology
Content key words:
Music therapy, Spiritual care, Pastoral counseling, Palliative care, Holistic care, Spiritual health,
The other, Journey, Story, Witnessing, Connection, Embodiment, Cultural sensitivity

Biography
Nathan Thorpe holds a Bachelor of Science in health studies from the University of Waterloo,
and a Master's degree in music centred psychotherapy from Wilfrid Laurier University. He is
inspired by people who persist in overcoming challenges to personal and community health.
Nathan has engaged in music therapy with stroke survivors, and in mental health and palliative
contexts. His approach in music therapy is informed by both Mary Priestly and Michael White.
In his present work and life, Nathan creates opportunities for life-sharing, grows in service to a
global community, and encourages others to do the same.

i
Abstract
This hermeneutic phenomenological pilot study sought insight and possibilities regarding
intersections of music therapy and spiritual care. By interviewing music therapists and spiritual
care practitioners about their experiences, themes were sought which could inform a spiritual
focus and process for music therapy in palliative care. Articulate language was also sought
regarding how music therapists might provide palliative care in a spiritually informed manner.
Qualitative analysis of participants responses led to the development of three themes: Self with
"other", Life-Journeying and Life-storying, and Witnessed spiritual needs. Other topics like
humanity, religion, tradition, ritual, life, and death were also shown to be relevant to spiritually
informed palliative care. Insights emerged regarding the value of the following in the context of
palliative care: journeying and storying life together, relating with the spiritual, and considering
spiritual needs both within and beyond life. Foundational support was provided for the inclusion
of spirituality within music therapy in the context of palliative care, and some applications were
proposed. Future research questions were also proposed.

ii
Expressions of Gratitude
I pour out my thanks to my redeemer Jesus, borrowing from Paul's description of Jesus
in his letter to the church in Colossae (1:15 ff). I am grateful to Jesus for His being the image of
the invisible G-d1, the firstborn of all creation, in whom all things hold together. And to the
heavenly Father for the pleasure he took in indwelling His fullness in Jesus, and, through Him,
reconciling all things on earth and in heaven to Himself through Jesus, establishing peace
through the self-sacrificial blood of His cross.
To my Love and Joy, my wife, for your daily sacrifice of love, daily practical support,
and daily words of encouragement. For your help with understanding qualitative research and
structuring my paper and thoughts. For believing in me, inspiring me to pursue what I love and
reminding me to rest in Papa's Spirit.
To my parents and grandparents for the honour of being known as your child. To my
mom for loving me through everything and for showing it by teaching me for the (fundamental)
first half of my education. To my dad for wrestling with me physically as a kid, and spiritually as
an adult.
To my siblings for all the amazing things we've helped each other do, and all the stupid
things you forgive me for. Don't ever stop chasing the full life.
To my teachers and supervisors in every school: Wilfrid Laurier, Canadian Mennonite
University, Waterloo, Forest Heights, Raymond Yundt and Louise Jarvis. Thank you for every
challenge and grace you placed before me. Thank you Heidi Ahonen for knowing how to bring
out the best of my process in class, research, and writing. Thank you Colin Lee for sharing
yourself so deeply every class, you were an inspiration. Thank you Carolyn Arnason for showing
1

G-d is one spelling of the name of the deity of the Abrahamic religions. This spelling signifies reverence of the
deity's request that His name not be used in vain. The tradition of not including vowels in spelling the deity's name
renders it unpronounceable, and thus unable to be used in vain.

iii
me the beauty of balance, and the prevalence of both and possibilities. Thank you Deb
Seabrook for knowing how to get me to work through so much. Thank you Debra MartzMelanson for all the unexpected conversations - you made the institution feel welcoming to me.
To my classmates, friends: and siblings in Christ for your amazing examples of what it
means to be loving humans in school and in the rest of life. For your honesty, empathy, and
camaraderie in work, in play and in celebration. To every friend with whom I've musicked,
prayed, served, and lived.
Now to Him who is able to do far more abundantly beyond all that we ask or think,
according to the power that works within us, to Him be the glory in the church and in Christ
Jesus to all generations forever and ever. Amen. (Ephesians 3:19,20)

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Table of Contents
Abstract.............................................................................................................................................i
Expressions of Gratitude..................................................................................................................ii
Table of Contents............................................................................................................................iv
List of Figures.................................................................................................................................vi
Chapter 1: Introduction....................................................................................................................1
1.1 Research Questions........................................................................................................2
1.2 Stance of Researcher......................................................................................................4
Chapter 2: Literature Review...........................................................................................................7
Chapter 3: Methodology................................................................................................................13
3.1 Purpose of the Study....................................................................................................13
3.2 Research Design...........................................................................................................13
3.3 Research Process..........................................................................................................15
3.4 Ethical Issues...............................................................................................................19
3.5 Trustworthiness............................................................................................................20
Chapter 4: Results..........................................................................................................................23
4.1 Introduction..................................................................................................................23
4.2 Theme 1: Self With Other.........................................................................................25
4.3 Theme 2: Life-Journeying and Life-Storying..............................................................32
4.4 Theme 3: Witnessed Spiritual Needs...........................................................................38
Chapter 5: Synthesis and Application............................................................................................45
5.1 Introduction..................................................................................................................45
5.2 Journeying and Storying Life Together.......................................................................45

v
5.3 Relating with The Spiritual..........................................................................................47
5.4 Spiritual Needs Within and Beyond Life.....................................................................48
5.5 Summary of Synthesis.................................................................................................49
Chapter 6: Conclusion....................................................................................................................51
6.1 Summary......................................................................................................................51
6.2 Opening the Way for Future Research.........................................................................53
6.3 Closing Remarks..........................................................................................................53
References......................................................................................................................................55
Appendices.....................................................................................................................................61
Appendix A: Letter of Recruitment...................................................................................62
Appendix B: Informed Consent Statement........................................................................63
Appendix C: Participant's Personal Spiritual Positions.....................................................67

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List of Figures
Figure 1: Conceptual diagram of research method
Figure 2: Disciplines related to music and therapy
Figure 3: Venn diagram of main results
Figure 4: Self with other theme
Figure 5: Life-journeying and life-storying theme
Figure 6: Witnessed spiritual needs theme

1
Chapter 1: Introduction
The thing in itself expresses itself. Expression manifests the presence of being,
but not by simply drawing aside the veil of the phenomenon. It is of itself
presence of a face, and hence appeal and teaching, entry into relation with me
the ethical relation. And expression does not manifest the presence of being by
referring from the sign to the signified; it presents the signifier. The signifier, he
who gives a sign, is not signified. It is necessary to have already been in the
society of signifiers for the sign to be able to appear as a sign. Hence the
signifier must present himself before every sign, by himselfpresent a face.
(Lvinas, 1991/1961, p. 181-182)
About to embark on my first clinical internship for my music therapy degree, I found
myself drawn to palliative care by a commonly cited word: spirituality. This word and its
derivatives were repeatedly presented to me in conversations and in the palliative care literature.
For example, Lee (2005) offered the following definition of music therapy in palliative care:
...the clinical use of both active and receptive music to assist persons diagnosed with a
life threatening illness encountering physiological, psychological, emotional and
spiritual distress. Music therapy is a primary intervention, working alongside
conventional treatment approaches... The qualities of the music therapy
relationship enable the patient to face and transcend the realities of their living
and dying. (p.151)
Statements like these developed in me a perception that spirituality was strongly linked with the
provision of palliative care. Because of my personal desire to pursue an ever-deepening spiritual
life, I accepted an internship working as a music therapist on a palliative care ward. Over four
months, I practiced music therapy in palliative care and kept all my senses open to enriching
encounters with spirituality. None occurred.
I was somewhat disillusioned by a lack of experiences that I could classify as spiritual.
I considered factors which may have precluded me from such experiences. Perhaps I understood

2
spirituality in a way that was dissimilar to the way others understood it and, as a result, perhaps I
was not perceiving spiritual experiences where others would have. Perhaps a language barrier
existed regarding spirituality, and led me to misunderstand the connection between spirituality
and palliative care. Perhaps I needed more training regarding how to access or work with client
spirituality. How were other therapists accessing this spiritual domain with clients in palliative
care? What did other therapists see as the spiritual significance of their work?
Major figures in music therapy research mention spiritual experiences and the therapeutic
significance of such experiences. Dorit Amir included spiritual experiences in a larger
discussion of meaningful moments (1992) and mysterious aspects of music therapy (2002).
David Aldridge (1999; 2003) wrote extensively about music therapy working on transcendental
levels. Mercds Pavlicevic (1988; 1991) pointed to supra-mutual intersubjectivity which is
reached at critical moments in some therapeutic musical interactions. Were these kinds of
experiences what my colleagues had mentioned as being associated with work in palliative care?
If so, why did I not perceive them during my work in palliative care? Were these types of
experiences simply not present? Did I fail to recognize them? I wanted to know where,
specifically, spirituality resided in palliative music therapy. These questions eventually led to
this pilot study which sought possibilities at the intersection of music therapy and spiritual care.
1.1 Research Questions
I wanted to know what language practitioners used to describe their experiences of
spirituality and learn more about how client and therapist could work with spirituality in music
therapy. When I first started to ask such questions, some colleagues pointed me to Jungian depth
psychology and Helen Bonny's method of Guided Imagery and Music (GIM) which Bruscia and
Erdonmez Grocke (2002) described as group or individual imaging while in altered states of

3
consciousness and guided by a therapist and music. Much of the literature presented GIM as an
approach which joined spirituality with music therapy (Lipe, 2002). Indeed, GIM used some
language and prioritized archetypal symbols similar to Jung's grand theories of psychology and
spirituality. However, my understanding of Jungian language was minimal, moreso when it was
extrapolated to GIM theory, Jungian psychology and Jungian spirituality. Jung's theory of the
soul utilizes highly formalized systems of thought and specialized terminologies (Stein, 1998)
which would have required more than a little contrivance for me to employ within music therapy
sessions. Moreover, as a music therapist seeking training, I lacked faith in Jungian training
because I was aware that Jungian Christianity may have been in opposition to my own views
(Payne & Perrotta, 1988).
Jung aside, I had language pertaining to spirituality, but had a minimal understanding of
its potential role in palliative care music therapy. I was led to another question, What sources of
understanding do other professionals in palliative care draw on to understand, describe and
address issues of spiritual wellness? I was particularly interested in the understandings of music
therapists (MTs) and spiritual care practitioners (SCPs) because I sensed potential for greater cooperation, in research and practice, between the field of music therapy and the fields of spiritual
musicology and spiritual care.
My research questions became: What new knowledge can be gained from other
professionals regarding the connections between music therapy, spiritual care, and palliative
care? and What do practitioners recognize as spiritual in palliative care? The data sought in
this study was visualized as a process of distillation, as shown in Figure 1:

Figure 1: Conceptual diagram of research method

Based on the research questions, this pilot study was designed to seek intersections between
music therapy and spiritual care by interviewing MTs and SCPs. The purposes of this study were
to provide new insights for MTs regarding spiritual aspects of providing palliative care, and the
spiritual processes therein. My hope was that the present study would facilitate more harmony
between MTs' spiritual experiences within and beyond sessions in palliative care by helping them
to locate themselves at the intersection of music therapy, palliative care and spiritual care.
1.2 Stance of Researcher
This section addresses contextual issues regarding my social location and impetus for the
study in order to help establish authenticity (Kenny, Jahn-Langenberg, & Loewy, 2005). My
personal experience as a MT in palliative care was that I found more spiritual significance
beyond sessions than within sessions. This was in contrast to the impression I had entering the
field that spiritual experiences were common within palliative care. I thought the reason
spirituality might be prominent in palliative care was that one's spiritual wellness need not wane

5
with one's physical wellness. Furthermore, I thought that part of a healthy dying process would
involve holding on to those positive things which can be retained up to the moment of death,
including one's spiritual wellness.
My prior work experiences inspired my pursuit of graduate music therapy training and
also contributed to my beliefs that work was one part of a wholly spiritual life, and that spiritual
awareness and reflection on day-to-day experiences could reveal lessons which supported a
deepening of my spiritual life. I am a white middle-class male, born and raised in Canada. My
social and cultural perspectives were shaped by my perceptions of my parents' priorities which
they communicated to me through nurturance and discipline. My father worked to support the
family while my mother homeschooled my three siblings and I until we transitioned to public
highschool. Although I was raised with a belief that G-d2 was part of my life, my knowledge of
how G-d was a part of my life was limited until my last year of undergraduate studies. At this
time, I believe I had a spiritual awakening. In the midst of a very socially, emotionally and
personally difficult season of my life, I believe that I began to perceive G-d's spirit sometimes in
dialogue with my conscious thought. I trust that this was more than a new cognitive process
because of the distinct personality expressed by the new thought voice, sometimes G-d's spirit
would even interrupt or speak over my thoughts. All the education I had received about G-d as a
child supported but paled in comparison to this dynamic relationship G-d was honouring me
with. The next years of my life, I began to learn rapidly what it meant to become mature in
relationship with G-d, to embody love in my actions and relationships, and so many other things.
Because of these experiences, my understanding of spirituality was heavily informed by those
who follow Jesus as the only begotten son of G-d (John 1:14 and John 3:16, New International
2

G-d is one spelling of the name of the deity of the Abrahamic religions. This spelling signifies reverence of the
deity's request that His name not be used in vain. The tradition of not including vowels in spelling the deity's name
renders it unpronounceable, and thus unable to be used in vain.

6
Version), by the power of the Holy Spirit (2 Timothy 1:14 and Titus 3:4-7). My spiritual beliefs
permeated my philosophical and epistemological views, which were similar to those of Paul
Ricoeur (1966, 2007), Jean Vanier (2008), Shane Claiborne (2006), and Albert B. Simpson
(1890) (to the extent that I understood their work). To combine spirituality with epistemology is
not a unique position, for example, confer with Phillips' (2011) summary of Classical Indian
philosophy and epistemology.
My experiences providing palliative care music therapy, my personal spiritual position
and my spiritual epistemology fundamentally influenced the impetus for this study, the data
collection and analysis thereof.

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Chapter 2: Literature Review
Music therapy is often languaged as a profession which draws strengths from many
related fields. Figure 2 (adapted from Bruscia [1998]) shows disciplines which contribute to
current conceptions of music therapy. Emphasis has been added in Figure 2 to those related
disciplines which might identify spirituality as an important consideration of applied practice.

Figure 2: Disciplines related to music and therapy

Some sources which relate music therapy to the fields emphasized in Figure 2 are as follows. For
psychomusicology and psychiatry: Jones (2005); Juslin and Sloboda (2010); and Wigram,
Nygaard Pedersen, and Ole Bond (2002). For ethnomusicology and healing traditions: Horden
(2000) and Chiang (2008). For music ministry (spiritual musicology) and spiritual care (pastoral
care): Atkins (2012), and Lipe (2002).

8
Atkins' (2012) doctoral thesis regarding spiritual experiences in music and Lipe's (2002)
literature review of health, music and spirituality began to draw connections from music therapy
to spiritual musicology and pastoral care. Atkins (2012) interviewed 172 subjects and discovered
that their spiritual experiences while listening to specific music occurred independent of culture
or musical training and that spiritual and emotional experiences were mentioned with similar
frequency challenging the dominant emotion-based constructs of musical significance.
Consequently, he placed a strong call on the research community to engage with this
phenomenon of spirituality (p. ii). Lipe (2002) found fifty-two studies which mentioned music,
spirituality and health, ten of which related to end of life care. GIM was mentioned in twenty of
the studies, whereas other music therapy techniques were mentioned only twice. Of surprise to
Lipe was that nowhere did the literature mention collaboration with a spiritual director on the
part of clients or providers even when spiritual issues were paramount (p. 215).
Since Lipe's (2002) review of the literature, a number of MTs have expressed their
opinions about spirituality. For example, Amir (2002) said that in music therapy, the mysteries
of humans, arts and music are sometimes touched. She called for music therapy to draw more
from spirituality, stating her belief that "introducing spiritual elements, principles and
terminology in our work will ... allow us to build theories that will resonate more fully with what
we do." Aldridge (2003) proposed a theory of the relationship between music therapy and
spirituality. He suggested that spirituality is about the individual, the ineffable and the implicit,
and that music therapy allows spiritual transcendence above suffering by transforming
experiences of suffering into experiences of meaning. From a non-sectarian and non-religious
perspective, Arnason (2005) reflected on spiritual dimensions of improvisational music therapy.
She defined spiritual dimensions as wordless and deeply felt phenomena which reveal and

9
transcend the human condition (p. 4), and said that all three of silence, music improvising and
music listening could connect clients with transformative experiences, facilitate access to inner
resources, create experiences which reflect the spiritual, and inspire different levels of being and
consciousness, and spiritual growth.
Marom (2004) phenomenologically studied sessions which MTs understood as spiritual
and identified the role of the therapists as facilitating, nurturing, supporting, reconnecting clients
to reality, and being deeply emotionally present. Marom also described musics significant role
in bringing about the spiritual experiences, and in enhancing and sustaining them. Lastly,
Marom identified that the therapists had each been prepared to address spiritual issues by
conceptualizing music as spiritual, acquiring general knowledge about world religions, exploring
their own spiritual path, and being constantly open to the spiritual dimension and its
manifestations in music.
In 2002, the 10th World Congress of Music Therapy in Oxford, England included
spirituality as one of three main themes (Fachner and Aldridge, 2002). The conference spurred
many authors to write with reference to spirituality. O'Kelly (2002) investigated how African
culture and spirituality could inform western palliative music therapy by overviewing some ways
music and spirituality co-operate in traditional South African healing ceremonies and other
community events. Pavlicevic (2002) explored similarities and differences between the views of
Traditional Southern African societies and those of modern Western music therapy with regard to
self, health, and spirituality. Reher (2002) explored issues of early childhood trauma, loss, grief
and identity and native spirituality as integral parts of an Anishanabe (aboriginal) adoptee's
healing journey in GIM.

10
Many other articles proceeding from the 10th World Congress in 2002 mention
spirituality briefly, such as Beggs (2002) who described moments of spirituality (p.140) while
reflecting on integrating music therapy and narrative therapy for life review.. Forrest (2002a)
discussed cultural considerations in music therapy including that in some cultures, spirituality
may be an internal process regarded as unacceptable for discussion. In another article, Forrest
(2002c) mentioned spiritual and existential needs (pp. 586-587) as one potential need which
could be addressed using music therapy for those with motor neurone disease. Cadesky (2002)
wrote of vocal music therapy for clients with dementia in a Jewish facility. Spiritual needs were
mentioned as important, and Jewish melodies were sometimes characterized as spiritual
outpouring to G-d (p. 270). Forrest (2002b) examined three case studies using music therapy in
bereavement care. Spiritual and religious songs were mentioned as having potential to offer
supportive messages and a sense of continuity amidst disorder in the context of memorial
services.
Dileo and Loewy (2005) edited Music Therapy at the End of Life, which relates many
insights regarding palliative care music therapy. In the introduction to the book, Dileo and
Dneaster (2005) defined a three-level model of music therapy in palliative care. They suggested
that the first level, supportive care, attends to palliation of symptoms. The second
communicative and expressive level, attends to feelings. The third level is transformative, and
facilitates insight and growth on many levels including those that are spiritual and existential.
Magill (2002) reflected on four themes which, according to her experience, connect spirituality
and music therapy. These were building relationship, enhancing remembrance, being a voice to
prayer and instilling peace. Magill (2005) added to this list hope, faith, meaning and purpose.
She recommended that MTs address spiritual needs by focusing outcomes on self-worth, self-

11
identity, self-affirmation, and life review. Magill (2005) suggested practicing empathy,
acceptance and presence which dispels fears of abandonment is important for achieving
spiritual outcomes, and that music and lyrics can invite associations with spirituality, infinity and
universality to facilitate transformation of clients' thoughts and emotions.
Salmon (2001) used principles from Jungian depth psychology and spirituality to
construct a framework for understanding how music therapy operated in palliative care. She
suggested that music therapy creates a containing sacred space for psychospiritual ventures,
which facilitate transformation of suffering through meaningful spiritual connections. In another
article, Salmon (2002) reported that many MTs in palliative care found spiritual and religious
practises important for coping. Furthermore, MTs commonly indicated that spiritual awareness
and commitment to inner growth were necessary for competence in palliative care.
Other studies bear mentioning including that of Rio (2002), who described qualitative
research with a group of adults in recovery from substance abuse, who also struggled with
homelessness. Beauty / spirituality was an emergent theme in his research which included
aesthetically pleasing music and togetherness, personal character, faith beyond circumstances,
and an altered state which was connected with music. O'Callaghan, Hudson, McDermott and
Zalcberg (2011) found that music helped some people to connect with their spirituality while
coping with the stress of having a family member battling life-threatening cancer. Wlodarczyk
(2007) investigated the effects of music therapy on spiritual wellbeing using data from 10
hospice patients following music and non-music sessions with a MT. Using an adapted version
of the Spiritual Wellbeing Scale (Ellison & Paloutzian, 1982), subjects reported a significantly
higher level of spiritual wellbeing following music-visits by the MT than following non-music
visits. From specific religious perspectives, Hess (2002) explicated how music therapy for

12
wellness could employ Ayurvedic and Chinese healing practices in part by using instruments and
musical techniques to represent the fundamental Five Elements. Nakkach (2005) described the
potential role of yoga philosophy and practice for music therapy at the end of life. Ryan (1996)
summarized significant points regarding belief systems, use of music, and familiar songs for
those of Baha'i, Jehovah's Witness and Christian Science religions. Ryan (1996) also suggested
more training regarding religion for MTs, and interdisciplinary research between music therapy
and religious studies.
In summary, much of the music therapy literature which mentions spirituality has not
been articulate, or when it has been, has tended to fixate on GIM methods, on the use of religious
music, or on the opinions of a limited number of MTs who have written about the spiritual
aspects of their work. In resonance with Amir (2002) and Atkins (2012), I noted a need for
more research which could describe the spiritual aspects of music and music therapy. In
particular, I noted with Lipe (2002) that few research efforts had been made to specifically
engage SCPs in the discussion of music therapy in palliative care.

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Chapter 3: Methodology
3.1 Purpose of the Study
The present study sought to contribute to the body of research on music therapy in
palliative care by seeking to know what new understandings may come to the field of music
therapy from an interdisciplinary investigation into the field of spiritual care. To accomplish
this, the study sought to re-construct how spirituality and palliative care are understood by music
therapists (MTs) and spiritual care practitioners (SCPs). The purpose of this study was to
provide new insights for MTs regarding spiritual aspects of providing palliative care, and
regarding the spiritual processes therein.
3.2 Research Design
In line with Bruscias (2005b) definitions, this study would be classified as foundational
professional research because it begins investigation of a topic related to clinical practise,
seeking the perspectives of practitioners within and beyond the field of music therapy. The study
sought to lay some groundwork for responding to the spiritual needs of clients receiving
palliative care. The post-pilot goals of this research are also in line with those of foundational
professional research in that research in this area can identify and strengthen resources for
training practitioners about the potential role(s) of spirituality in their work. To these ends,
participants were interviewed and their interviews were analysed by phenomenological (Forinash
& Grocke, 2005) and Ricoeurian hermeneutic methods (Tan, Wilson & Olver, 2009). With Ole
Bond's (2005) ideas of a constructivist methodology, the study was designed to re-construct the
internal phenomena of how participants understood spirituality and palliative care.
This study design was based on Paul Ricoeur's hermeneutic phenomenology (1978, 1981)
which has been extrapolated to a qualitative research paradigm by Tan et al. (2009). Tan et al.

14
(2009) described Ricoeur's methodology as both a theoretical perspective and a methodology, a
strategy or plan that lies behind the methods employed in a particular study (p. 2). The roots of
hermeneutic phenomenology are in Ricoeur's (1981) developments of Heideggers (1967) work.
The reason that Ricoeur's philosophies were chosen as a basis for this study was that his thought
had specific interest in the interpretation of language (Ricoeur, 1981; Porter & Robinson, 2011)
as well as in religion (Ricoeur 1966/1950, 2007/2004; Porter & Robinson, 2011). This was an
appropriate choice given this studys interest in investigating practitioners language regarding
spirituality.
Working definitions of hermeneutics and phenomenology for this study were,
respectively, the art and science of interpretation especially as applied to text, and the study of
the essence of a phenomenon as it presents itself in lived experience (Tan et al., 2009, p. 2).
With Ricoeur (1978), the present study welcomed the tension between listening to a source in
order to achieve some understanding, and analysing the source to achieve some explanation.
Ricoeur (1978) spoke of both distance and inextricable connection between the knower and the
known, encouraging a cycle of story-telling, dialectics, reflection, and guess-response
epistemology (Tan et al., 2009). The interviewing processes employed each of these methods by
requesting stories and perceptions of the participants and engaging with them in dialogue to
clarify what they were communicating. Ricoeur (1977) noted that these stories from participants
begin the hermeneutic process, because the events a participant chooses to re-present and how
they do so depends on her or his initial interpretation of the phenomena. Each participant's
stories were re-presented first by himself or herself, then by myself into the present paper.
Ricoeur (1981) held that distanciation should be in a constructive balance with
appropriation such that communication through distance is balanced by the interpretation of

15
self through interpretation of discourse. Distanciation and appropriation take into consideration
that participants' experiences are interpreted through both their sociocultural lenses, and those of
myself. Since these sociocultural lenses are unavoidable, the Ricoeurian hermeneutic
phenomenologic process encourages the reader to bring her or his own understandings to
interpret the present paper, and to simultaneously suspend them in the interest of seeing what
new insight might come from the presented material (Ricoeur, 1981).
3.3 Research Process
3.3.1 Research participants.
The music therapy community and spiritual care community are similar in that each is
small, each is close-knit (i.e. self-familiar, intraconnected and interdependent) and individuals
within each community tend to be dependent on one another for both formal and informal
support. As such, I conducted purposive sampling based on knowledge of who had professional
experience in palliative care as either a MT or SCP. This knowledge came through my own
contacts at the university and area hospitals, and from the suggestions of colleagues. Potential
participants were contacted separately by e-mail (see recruitment letter in Appendix A). E-mail
addresses were obtained from my existing contacts and from 2011 and 2012 membership
directories published by the Canadian Association for Music Therapy (CAMT). Each participant
signed an informed consent statement (see Appendix B).
The seven interviewed participants were three MTs, three SCPs, and myself (classified as
a MT for the purpose of this study). Those MTs who were most familiar to me were removed in
the selection process thus reducing the potential for bias due to pre-existing relationships. I was
minimally familiar with the scope of the professional work and the academic interests of those
MTs who accepted the invitation to participate. Likewise, I was only minimally familiar with the

16
SCP participants on professional and academic levels. I had had some interactions with the SCP
subjects prior to the study, occasionally about the potential for overlap between music therapy
and spiritual care.
All participants were practicing in clinical settings in Ontario, half were female and half
were male, and all were between 29 and 70 years of age. The sociocultural demographics of
participants were varied: most had completed graduate school or were in their final stages
thereof; the ratio of Canadian-born to those born outside Canada was 5 to 2, the ratio of
Caucasian participants to participants of visible minorities was 6 to 1. Participants were not
categorized with regard to religious and spiritual beliefs in order to give full value to their own
descriptions during the interview and hermeneutic processes.
3.3.2 Interviews.
Interviews were conducted face-to-face in a space familiar to the participant. Some
interviews were conducted using Voice Over Internet Protocol software. In both cases, spaces
were chosen in which the interview could be conducted privately, without intrusion, and with
minimal auditory and visual interruption. I entered each interview with a writing pad and list of
potential questions. An audio recorder was situated to optimize recording of both our voices.
Each participant was interviewed for a total of 55-75 minutes. The interviews were followed-up
with each participant to verify the emerging data. This was most often completed by e-mail as
dictated by each participant's preference.
3.3.3 Data collection.
Data came from interviewing study participants with focus on their stories of their
experiences of spirituality including the language they used to tell these stories. Open ended
questions were used as foundation for dialogue with participants. I transcribed participants'

17
interviews and verified inaudible data by recontacting the participants. Although sixteen
interview questions were asked, only the first three were coded, in the interest of time. This
paper represents thorough analysis of the following questions:
1

What is your understanding of spirituality?

1. Where does this understanding come from?

2. How is spirituality related to health, wellness, and illness?
These three questions were specifically chosen in the interest of focusing the research towards
understanding participants' fundamental views of the role of spirituality in their work. These
questions were coded extensively using NVivo qualitative data analysis software. NVivo
was also used for collecting data in the form of journals, memos, and annotations generated by
my reflections on the data.
3.3.4 Data interpretation.
Transcribed interviews were analyzed in two ways: using NVivo data analysis software,
and using hermeneutic phenomenological analysis based on the philosophy of Ricoeur (1978,
1981). As suggested by Tan et al. (2009), I practiced distanciation (a.k.a. bracketing my own
notions) as the researcher until all the interviews were completed. I submitted myself to answer
the interview questions as a study participant only after having completed transcription of the
other six interviews. During the transcription process, I journalled about my reactions to the
data. This was done with awareness that my person and experience would play a significant role
in selecting and filtering data, and in interpreting it as poignant (resonant) with my personal
desires, both conscious and unconscious. Thus journalling contributed to forming an audit trail
to facilitate transparency and thus establish trustworthiness. My own submission to the interview

18
questions and hermeneutic phenomenological analysis of my own data further strengthened the
audit trail.
Hermeneutic and phenomenological analysis was performed in line with Tan et al. (2009,
pp. 6-9) who suggested the following method:
1

Discourse (interview) recorded while speaker and hearer are present together with their
psychosocial circumstances

1. Text (discourse fixed in writing), transcribed while the writer practices distanciation
2. Examination and explanation of the internal world of the text
3. Combination of text with the world of the interpreter
4. Interpretation of meaning and consideration of external factors, leading to a new
understanding of the discourse
5. Appropriation of discourse into the interpreter leading to a new world of the interpreter
which will affect future discourses
As the researcher, I took on many roles: hearer, writer, examiner, interpreter,
understander, and re-presenter of the original discourse. The participants also played a major
role by presenting their own interpretations of discourse in the original interviews, and by
examining the emergent data with me (i.e. participant checking).
3.3.5 NVivo data analysis.
NVivo assisted throughout data analysis by facilitating distanciation and tracking of the
various layers of interpretive understanding and analysis. NVivo also assisted with distilling,
linking, and suggesting shape for emerging themes in raw transcripts. NVivo tracked lists of
all emergent codes, as well as my reflections on them. I constantly questioned the validity of
emergent themes in line with Ricoeur's distanciation (1981) and Husserl's attitude of bracketing

19
working convictions and assumptions (Beyer, 2013, para. 2). I often re-labeled and reconceptualized codes and the layers of context in which each was embedded, as I looked for
boundaries and connections within and between them. NVivo assisted with coding the
interviews to saturation through performing keyword text queries which included synonyms and
word forms from NVivo's internal dictionary and thesaurus, and gave rise to additional code
references
As the coding progressed, categories of related codes where formed when participants
wove codes together, either intentionally or otherwise. Codes were also sometimes placed into
categories when they were related by shared synonyms to facilitate more thorough text queries.
In general, categories are collections of codes which on a linguistic or temporal continuum.
Following coding and categorization, NVivo facilitated a cluster analysis based on
word similarity. The most strongly correlated codes and categories were grouped into themes
and then were re-investigated to inform a group identity based on the pattern of interconnected
codes. Emergent themes were checked with participants, and cohesion between all the layers of
analysis was sought.
3.4 Ethical Issues
It was considered in the process of ethical review that there may be some social,
emotional and psychological risks associated with participation in the study. Participants signed
the consent form shown in Appendix B which alerted them of these potential risks. These risks
were mediated and moderated by myself, and by empowering participants to reduce risk to
themselves as described in the consent form (Appendix B).
Other ethical issues which were addressed included: (1) not inviting participation from
MTs who would be evaluating the final study report for academic credit (2) using anti-oppressive

20
language throughout the paper where possible (3) contextualizing statements as my personal
beliefs where appropriate (4) bearing always in mind that despite my personal commitment to
certain beliefs, others are not committed to the same beliefs and thus I have no role in judging
their behaviours or opinions according to my beliefs. I also made a personal moral commitment
to carry out and present the research in a manner which could communicate love, honour and
respect for each participant. This commitment strengthened and surpassed my adherence to the
required ethical commitments of academic research.
3.5 Trustworthiness
Qualitative research understands bias from a non-positivist philosophy, and thus
considers validity and reliability differently than does quantitative research. In line with Lincoln
and Guba (1985), the design and execution of the present study focused on four aspects of
trustworthiness. These four aspects are credibility, transferability, dependability, and
confirmability (Lincoln & Guba, 1985). Each of these is addressed below.
According to Polit & Beck (2008) credibility refers to the confidence in the truth of the
data and interpretation of them. Purposive sampling (Patton, 1999) was used instead of random
sampling in order to gather data from professionals who had rich experiences regarding the
topics of interest. As such, both myself and the participants had familiarity with and training in
academic research, music therapy, spirituality, and palliative care (to varying degrees), all of
which enhanced confidence in the truth of the data (Patton, 1999). Similarly, the professional
accreditation and qualifications of the participants gave credibility to the content and context of
the stories they relayed. The study used data triangulation (Guba, 1981) by collecting data from
participants from two distinct fields. Within each field, multiple professionals from different
sites were interviewed. To help ensure participants were honest in answering questions, they

21
were repeatedly assured of the confidentiality of their responses, and were specifically asked to
reflect on their personal experiences, opinions, perceptions in replying to interview questions. I
kept a journal throughout the research process which allowed monitoring of my developing
subjectivities regarding emergent codes, categories and themes. As one of the study participants,
my perspectives were considered with those of other participants, and were subjected to the
balancing effect of critique from other participants' contributions to the whole study. Lastly, the
emergent codes, categories and themes were taken to both the existing literature and the study
participants for member checking to give each an opportunity to confirm, deny, or comment on
preliminary findings.
With regard to the transferability, the findings are not transferable beyond the context of
the interviewees' experiences. The interviewees described the majority of their experiences as
being within clinical (hospital and hospice) in Southwestern Ontario. Thus, the study
participants represented a small portion of the music therapy and spiritual care fields, and a small
portion of the Canadian and international caregivers involved with end-of-life populations.
However, many participants also mentioned significant amounts of life experiences in other
contexts and cultures as having shaped their responses to questions. Some of the other contexts
mentioned were mental health care, British Columbia, Japan, and the United States. The data
also showed that participants reflected a variety of personal spiritual and religious positions,
some, for example, considered themselves religious whereas others considered themselves
not spiritually-seeking or generally interested in the topic of spirituality. Participants
reported the following histories and cultures as having informed their present perspectives:
Aboriginal, Arabic, Buddhist, Christian, evangelical, Jewish, Indian, inclusive, intercultural
dialogue, intertwined sacred and secular, Mennonite, Muslim, non-judgmental, pagan, trinitarian,

22
United As mentioned with regard to ethics (Section 3.4), the findings of the study may not be
transferable to those who prefer to not consider the spirituality of others or spirituality in general.
Dependability was confirmed in part by credibility (discussed above) since as Lincoln
and Guba (1985) imply, there can be no credibility without dependability. Furthermore,
consistency of the method was illustrated in the detailed methodology above (Section 3.1
through Section 3.3.5). The methodology also illustrated constant and appropriate application of
distanciation (Tan et al., 2009) and reflexivity throughout data collection and analysis processes
which are the key areas of concern with regard to dependability (Collier-Reed, Ingerman, &
Berglund, 2009). It is the nature of phenomenological enquiry that ever-shifting social contexts
will give rise to new perspectives if the study is repeated. That is, even if the identities of the
study participants were revealed and they were re-interviewed, their responses to the same
questions may vary. Another way to comment on dependability of the results is to reflect on the
execution of the study (Lincoln and Guba, 1985). In doing so, I found that my interviewing
skills increased throughout the study. All interviews were performed in the same semi-structured
manner, but the last interviews probed participants' responses more often than did the first
interviews. This finding was corroborated by the fact that NVivo showed coding to be less
dense in the earlier interviews.
Confirmability of the study results is most strongly corroborated by triangulation
(discussed above with regard to credibility), literature review and member checks (discussed
above with regard to credibility), and by coding the interviews to saturation (discussed above in
Section 3.3.5). No formal evaluation was sought from a third-party to confirm the study
findings. However, my engagement in the process of distanciation added perspective to the
results (discussed in Section 3.3.4 and Section 3.3.5 ).

23
Chapter 4: Results
4.1 Introduction
This section presents the combined results of all the levels of analysis phenomenological, hermeneutic, and NVivo qualitative data analysis. All levels of analysis
were interlinked in the sense that NVivo both facilitated the hermeneutic phenomenological
analysis, and all NVivo outputs were verified through submission to the hermeneutic analytic
circle.
The first type of phenomenologic results that emerged were called codes. The density of
coding varied; often five to ten codes were present in any given portion of text. Most often
coding regions spanned one or two sentences, but occasionally varied from half a sentence to a
whole paragraph or story. Sixty-four codes (e.g. connection, embodiment, humanity) were
applied nine-hundred times to phrases, sentences and paragraphs of participants' interviews.
As the coding progressed, some of the codes grew into categories of related codes (this process
was discussed in Section 3.3.5 above). Categories (e.g. Connection Sharing; Journey Story;
Religion Tradition Ritual) represented larger processes, or codes which nested within one
another. Some categories may be envisioned as conglomerates of related codes.
The main results which emerged from the data analysis are presented as groups of codes
and categories in Figure 3. Each area has been labeled: Self with other, Life-journeying and
Life-storying, and Witnessed spiritual needs. These will hereafter be referred to as the themes
or theme areas. This section of the paper will overview each theme, and summarize what
participants said in corroboration of the theme. The themes discussed in this section arose from
NVivo cluster analysis. Specifically, the top 20 correlations confirmed by two methods of

24
word similarity analysis were mapped and are presented here. Each theme is presented below,
3

beginning with Self with other, Life-journeying and Life-storying, then Witnessed spiritual
needs. Each theme area shares some codes and categories with the other themes and these
thematic intersections will be addressed in greater detail in chapter five. Along with the
presentation of theme and category material, a model will be proposed for each theme suggesting
how its constituent codes might relate to one another.

Figure 3: Venn diagram of main results

NVivo assigned the following ranges of statistical support as evidence to support these correlations: 0.40
Jaccard coefficient 0.55; 0.94 Pearson product moment 0.96

25
4.2 Theme 1: Self With Other
This theme represents participants' descriptions of relational interaction (i.e. self with "other") as
contributing to their experiences and understandings of the spiritual nature of humanity, and the
spiritual nature of their work (whether in music therapy or spiritual care). It is important to note
that Emmanuel Lvinas (1961/1991) formalized a variety of arguments regarding the other in
his philosophy of ethics and religion. Quotation marks around other are in homage to Lvinas
as his work has influenced my construction of this theme. As shown in Figure 4, the following
codes were included in this theme: Humanity, Connection Sharing, Embodiment, Culture,
Religion Tradition Ritual, Relationship Community, Unique expression, and Music.

Figure 4: Self with other theme

26
Humanity and Connection Sharing were each coded more frequently than any other codes
or categories in this study. As such, they were strong definers of the Self with other theme.
They were also strongly associated with one another. Humanity was conceptualized as what
connects us; that is to say, humanity is the collection of characteristics, tendencies, abilities and
limitations we share as humans. In a reciprocal manner, participants described the relational acts
of connecting and sharing as uniquely and innately human. All participants spoke of spirituality
as something universal to humanity. Exactly how it was universal was variously described. For
example, one MT said of spirituality I don't see it as being separate. .. it's related to
everything ...it's just who they are. I think that our health care system may tend to segregate
them and see spiritual life as something that's taken care of by... religion. [But] I see people as
being highly integrated. This MT spoke of spirituality being integrated with people and as
something that requires taking care. Another MT said that (s)he found the practical realities of
daily life more engaging, or spiritually satisfying than things that are often identified as
spiritual. This MT indicated that spirituality is sometimes found unidentified or unlabeled.
Spirituality was said to facilitate the human processes of coming to understand what is
meaningful, believable, and valuable. One event which participants regularly said they believed
to be valuable and meaningful was when humans connected with each other, with the earth, with
G-d or with something bigger beyond themselves. For example, one SCP said spirituality is
understanding a person's core identity. Who they feel like they are. ... And that core identity they
associate with the family ... their social connection ... a connection to the divine, a sense of G-d
in their life. According to Poll and Smith (2003), identity is correlated with spirituality and
spiritual identity can be strengthened "by reflecting upon spiritual experiences from the past and
by projecting such experiences into the future through faith, individuals are able to feel

27
continuity and constancy of their spiritual selves as eternal beings" (p. 133). Another SCP said
of identity I think its incredibly important that you know what your own roots and beliefs are.
Not so much that you would over-identify with those you care for, but you know where you're
coming from and can join a conversation. This comment shows how ones own story and
relationships can be seen as part of a larger conversation about spirituality and origins. When
describing spiritual connections with others, families were frequently mentioned as were
communities and groups of musicians or spiritual leaders (these were coded within Relationship
Community). Connection was also mentioned regularly as a spiritually poignant facet or
outcome of human-human interactions (most often musicking, conversation, being present with).
This type of connection may be similar to what Richards and Bergin (1997) refer to as metaempathy, which they suggested as a way of meeting psychotherapy clients on a spiritual level.
Another MT suggested that spirituality includes a larger context for a finite humanity
who knows there is something beyond themselves... life is bigger than themselves and people
try to define that and find where they fit in that. Another MT spoke of the magnitude of the
spiritual context saying spirituality provides lenses of meaning for knowing those entities which
humans commonly consider to be polar extremes. Spirituality contains, supports and permeates
both the everyday and the unknown, the macro and the micro, the multi-dimensional quantum
universe and personal relationships. Within this broad spiritual context, humanity's suffering
and difficulty were also commonly mentioned. One SCP spoke of the disparate nature of human
faith and hope in times of crisis as prone to being overstretched bringing them closer to a
point of giving up. Related to this, humanity was portrayed by another SCP as surprisingly
resilient. One MT spoke of spiritual needs which sometimes need to be addressed including
anguish, guilt, sorrow, unhealthy relationships, and what's left when all the other things in life

28
get stripped away. In short, humanity was communicated as strong but finite, capable of, aware
of and able to be many things but not everything.
Culture4 was a prominent phenomenon witnessed in this study and fits well into the
theme of Self with other. For the purposes of this study, culture was considered to involve the
embodiment or reification of shared humanity and unique expressions thereof. Cultural variety
was perceived to reflect localized combinations of those which contribute to cultural formation
such as history, geography and spiritual beliefs (Encyclopaedia Britannica, 2013). In any given
place or time, culture can be thought of in layers of social organization, from individual to the
global level of social organization, and as not an entity but, instead, as continuously developing
ways of life (Stige, 2002, p. 1) . This layered nature of culture was alluded to by a SCP who
said I know that my Christianity has come from pagan rituals to begin with. So when we
celebrate Easter or Christmas or baptism, I mean these all have deep pagan roots that we have
forgotten about." Similarly, a MT pointed to Sylvan's (2002) ethnographic study of the religious
dimensions of popular musical subcultures which, Sylvan contended, have often been imprinted
or influenced by roots in West African music and spiritism. Pavlicevic (2002) and O'Kelly (2002)
spoke to this relationship between music and spirituality in other parts of Africa.
The way participants described culture went further than the topics of national,
geographic, and religious boundaries which I had expected to be included in the discussion of
culture. All three SCPs and one MT mentioned that hospitals can have their own cultural norms,
nurturance, and pressures with regard to spirituality. Such cultures were described as impacting
both care-receivers and care-givers. For example, one SCP said sometimes when the
spirituality is ideal, you pray to G-d and use the best of words and you put on your best self. But
4

Note that the scope of this paper and my expertise form two major limitations to a full discussion of cultural
influences on this study. For a fuller discussion of cultural considerations in music therapy, confer with Ruud (1998)
and Stige (2002).

29
when it's in a health care setting, it's almost like you are you are in your worst self. Another
SCP suggested that part of the unique contribution of spiritual care to hospital culture was that
they can offer hospitality which other departments can rarely do. Two MTs and one SCP also
spoke of music therapy as having the ability to create and transcend cultural norms by its
associations with celebration, metaphor, poetry, story and various spiritual traditions. Reflecting
on participants comments regarding culture suggested that culture results from the summation of
past and present human expressions and connections. Furthermore, participants' responses
indicated that religion, tradition and ritual form a subset of unique expressions which can be
personal or cultural in nature, or both. This is shown best by one SCP who said There's a lot of
times I feel very earthy, simple and individual in my spirituality ... and then I ceremonialize it
and ritualize it and add some of my own culture to it ... and it grows from there.
Participants spoke of embodiment when referring to different dimensions and parts being
in cooperation with each other, equal, enmeshed or inseparable. For example, one SCP spoke of
a lifelong understanding that spirituality was so much intertwined with everything that happens
and later, that when people find themselves in a hospital they have not checked out their
spirituality at home before they come in. Another example of embodiment was when one MT
said G-d created humans as reflectors and carriers of a G-dly nature, and later we are able to
engage in relationship with G-d and each other using our whole self which includes the heart or
emotion; the mind or intellect; the strength or body; and the soul or the passionate willful spirit.
Another SCP talked about how a challenge to health causes suffering when part of one's identity
is embodied in the area being challenged. The SCP used the example of a professional pianist
whose identity and relationships were challenged by a severe hand injury. Embodiment was also
indicated when participants talked about sensing the immaterial or used metaphors which defined

30
spiritual and non-spiritual phenomena in terms of one another. For example, a SCP told a story
of a patient who said "I'm feeling very little faith, I don't see grace, and I'd like to have more
faith, but I don't." The SCP told me the Biblical story (s)he had portrayed to the patient in which
Moses received help to hold his weak and tired arms up so that they would not fall. The SCP said
to the patient "allow me at this time to hold faith for you. To be the one who comes to support
that little faith. To keep that little candle, to keep the wind from blowing it. In brief,
participants indicated that embodiment was important to spirituality because it allowed invisible
and internal realities to be externalized and made visible. Embodiment facilitated what Atkins
(2012) described as different planes of reality intersecting with the stream of human experience.
The placement of embodiment in the Self with other model (see Figure 4) was
informed by both participants' comments and by the literature. As shown in Figure 4,
embodiment sometimes occurred through seemingly disperse events, such as the evolution of
human connections and experiences into a shared culture. Other times, embodiment occurred by
intentional human design, as when human expression and cultural notions were translated into
ritual, tradition and religion. Atkins (2012) confirmed that such intentional embodying processes
can involve music as a medium or actuator of embodiment. Specifically, Atkins (2012) wrote
that musical and spiritual expression are capable of designating external meaning, that music can
embody meaning and that spirituality can be expressed through music. Embodied music was
referred to by one SCP who spoke of members of the German-Methodist tradition knowing in
their bones the hymnody of their lives. A MT may have denoted an embodied experience when
(s)he indicated a regular strong feeling that the music of the people who have died stays with
me".

31
Music was also mentioned in other ways throughout the interviews as an action, event or
object. Ethnomusicologist Small (1998) pointed to the fact that music always involves some
level of human participation and thus forms an event with potential for significance. Because of
this, Small (1998) made an argument for use of the verb to music in place of using music as
a noun denoting an object. Nevertheless, some participants objectified music as a cultural
product, as a bridge between individuals or cultures as a composition, as a hymn, a psalm, a
chant, a resource for inspiration, a spiritual tradition, or as a humanly perceivable intersection
between polar entities. It is interesting to note that in many of these instances, when study
participants spoke of music as an object, they strongly implicated the presence of a human and
often, the presence of some other entity. As an action, participants said music could involve
singing a space into life, playing an instrument, or creating a song. Music was also commonly
portrayed by participants as an event such as a ritual, a ceremony, or as a time of prayer. Each of
these was often also mentioned alongside close relationships or community. Regarding
relationality in music, Warren (2013) investigated the mysterious power of music arguing that
music can and should be better understood through the non-teleological openness to others as
embodied in the philosophy of Emmanuel Lvinas (p. 7). Much to the point of this study,
Warren (2013) even indicated that music therapy and improvisation embody this openness. But
Warren (2013) was not content with the merely functional understandings of music which some
might impose on music therapy or improvisation. Warren (2013) said [n]ot allowing music to
reside within the enclosed circle of musical understanding by applying it to ethical and social
usage, is exactly the type of critique that Lvinas is writing about. It is critique such as this that
allows music to be understood in relation the human subject, that unstable place between

32
metaphysical meaning and pure sounds (p. 10). In addition, many participants referred to music
in portions of the interviews which were not coded for the present study.
To summarize this Self with other theme, participants described humanity as
inescapably spiritual, and described that the self is able to connect with an other in a spiritual
way. These connections were both experienced and expressed uniquely in layered contexts of
relationship, community and culture. Spiritual connections between self and other were often
facilitated by processes of embodiment including ritual, tradition, religion and making music.
Spirituality facilitated embodiment of humanity and culture through activities including
connecting, awareness, seeking, finding, experiencing, questioning and learning,
4.3 Theme 2: Life-Journeying and Life-Storying
In the interview, participants were asked to reflect on their own experiences,
understandings, perceptions, and opinions as they responded to questions about spirituality and
palliative care. As a result, life stories of both the study participants and their clients are
prominent in this theme Life-journeying and Life-storying. Again, it becomes me to note that
this theme title resonates not only with the codes and categories put forth by the software, but
also with paradigms of Narrative Therapy (White and Epston, 1990; White, 2007). Narrative
therapy is rooted in the postmodern thought of Foucault (Madigan, 1992), and considers people
to be subjects within a field of dominant and non-dominant discourses. These social and
historical discourses construct a subject's self-understandings and world-views, in a manner
similar to how a narrator constructs a character in a story. The constructed narrative influences
the subject's feelings, thoughts and behaviour. Narrative Therapy seeks to help subjects
recognize and name their subjective position in the field of discourses, and then to
therapeutically narrate for themselves an alternative, empowered subjectivity (Trotter, 2011). In

33
line with idea of subjectivity and constructivism, the Life-journeying and Life-storying theme
collates what participants narrated having seen, experienced, discovered, and learned from their
personal and professional subjectivities, and how these narratives continued to bear significance
for them at the time of being interviewed. Participants' awareness of Narrative Therapy may
have strengthened this theme (participants often used terms related to the concept of narrative,
and one SCP specifically mentioned Narrative Therapy).
Unlike the complex flowchart of the Self with other theme, hermeneutic reflection on
the Life-Journeying and Life-Storying theme led to the more organic visual conception
illustrated in Figure 5.

Figure 5: Life-journeying and life-storying theme

34
Figure 5 has a few main components: the Journeying and Storying processes, a collection
of contributors to life and death, and a life story. The journeying and storying processes emerge
from the realities and ideas of life and death, and contribute to an existing life story.
Appendix C includes portions of each participant's transcript in which each described
how her or his understanding of spirituality arose from her or his life journey and story. These
personal stories illustrate how experiences interact with journey and story in the process of
living. Participants related that their professional work in palliative and spiritual care, their
personal history, their upbringing, intercultural transitions, asking questions, and education were
all important to developing a perspective about spirituality. In participants' stories, realities of
life and death became part of their life journey and life story when they discovered, learned
about, engaged and questioned these realities. Participants consulted their life stories to interpret
experiences and then modified their journeying and life story based on the outcome. Participants
often described that their identities and subjectivities often underwent transition, transformation,
change or solidification as a result of journeying and storying. In summary, a person's life story
is both of-the-past and of-the-present; memories, present awareness, understandings,
inspirations, decisions and the absence of each contribute to the formation of the life story,
which leads to a perspective on spirituality.
Religion Tradition Ritual as a category had a disperse placement within the theme Lifejourneying and Life-storying. As described by some of the participants (c.f. Stories C, D, E and
G, in Appendix C), ritual, tradition and religion were sometimes experienced as events carried
out by one's community or family. For others, tradition and religion were noted as things they
confronted or are still confronting (c.f. Stories B, C, D and G, in Appendix C). Some
participants noted religion as being a natural part of their upbringing not separate from other

35
areas of life. These participants suggested that spirituality is a connecting force between
sociocultural and personal aspects of life, supportive of both. Some participants noted the
function of religion as a way to live out one's spirituality, or simply as a necessary part of an
inclusive model of health care. Overall, a strong relationship was stated or implied between
religion and spirituality, and sometimes the concepts were used interchangeably.
As mentioned at the beginning of this section, the study participants also relayed stories
of their clients, patients and humanity in general. One common way client's stories were
developed in palliative care was through life review. A MT described life review using
songwriting to process and relay important aspects of one's life, similar to the legacy work
described by Cadrin (2006). One SCP described a spiritual focus of life review, a process in
which the SCP helps clients compare the alignment of their spiritual beliefs and their life stories.
This life review process may make explicit a process that is already occurring implicitly. For
example, participants agreed that people are often compelled to re-evaluate their purpose,
identity, and life priorities in response to realities which become part of their life story when they
enter the health care system. As one MT said:
When you're living through a crisis whatever form that crisis happens to be in ...
suddenly what the world has told us is important (where we live, what job we
have, what car we drive) we suddenly realize it's not important. What happens
then is if these other issues aren't so important anymore ...suddenly what I would
call the embellishments of life are not the priority. And that leads us into the
journey of seeking more of the spiritual aspect of life which is much broader and
deeper.

36
Other participants said similar things regarding crisis causing people to pursue spirituality. An
alternative point was also raised though, by another MT who said sometimes terminal illness
brings people much closer to their faith. But in other instances people are angry about their
faiths and it's alienating from their faith." The potential for such anger illustrates that events in
ones life and how they are storied can have a combined impact on spiritual perspective.
Clements-Cortes (2007) described a case study in palliative care in which Peter worked through
issues of anger with G-d. In contrast, a different MT shared the perspective that ones view of
spirituality can impact one's view of illness. Similarly, a SCP identified two opposite perspectives from which people understand crisis. (S)he said:
In the trying to make meaning do people understand that the higher power ... has only
given them as much as they can handle ... as if these things are done to us or
given to us, or conversely, do they get the strength they need to deal with the
situation? And I obviously come very much down on the other side of that
paradox, but I listen to people who locate themselves in one or the other ...
Sometimes I will offer the opposite view to the person who says well I guess I'm
only being given as much as I can handle ... I say well I hope you find the
strength you need to deal with what you're handling.
Regarding the paradoxes practitioners confront with palliative populations, one MT described a
unique perspective saying:
"The tremendous paradox that there is with someone when their life is ending, music is
able to hold all that. The light, the dark, the joy the sorrow, the holding-on the
letting-go can all be expressed and that's all part of the I guess you'd say the
spiritual journey and it's a struggle but it's rich. And I'm part of that."

37
In summary, MTs and SCPs often help their clients to story their lives, and sometimes to
story how they are located in the field of spirituality. The storying process was described as
spiritually important since people undergoing crisis often evaluate how and why they have been
journeying in life up to the point of crisis. In a sense, life review allows this internal processing
to become explicit. Life review also offers opportunities for one to evaluate one's held beliefs
which influence how one stories one's life and spirituality. An enlightening finding was that how
one narrates events in one's life can influence (even transform) how one narrates one's
spirituality, and vise versa.
Participants tended to refer to living and dying as temporal events or processes (e.g.
birthing, going through life), whereas they referred to life and death in many other ways. For
example, one MT indicated a perspective of life as a valuable possession and as something (s)he
could be thankful for. Possessing life seemed to bring some goodness to the MT which (s)he
wanted to be thankful for rather than taking for granted, and for this MT, thankfulness for life
was directly connected to the experience of providing palliative care. A SCP corroborated the
significance of providing care saying that expressing value for the life and death of other humans
is part of one's expression of value for oneself. Back to the MT's comment though, (s)he also
perceived the possessed life as fragile, particularly in the contexts of palliative care and
challenges to health. This fragility implies life is susceptible to forces which can negatively
impact it, perhaps even destroy it.
Another MT indicated a personal opinion that life included a spiritual dimension and that
(s)he understood people as interested in trying to define their place within this spiritual
dimension. This MT illustrated another common perception of life and death as an experience to
be had or a place to be inhabited. Another MT spoke of bringing beauty, peace and meaning into

38
the place where suffering and dying occurs. (S)he said these things are brought into this place
through moments of human connection in which something of the spirit is shared. Regarding
place, a SCP described caring for people affected by trauma as a process of re-orienting after
one's core identity was disrupted. This SCP indicated that identity is related to both where one
is placed and the story surrounding that placement. This assertion relates to Narrative Therapy's
concepts of subjectivity within a field of discourses (Trotter, 2011). In line with the SCPs
comment then, a spiritual process of re-orienting might be approached as a journey into this
disrupted field in order to re-locate one's identity and ways of relating through it.
What participants said about life and death had connections to categories not immediately
visible in the Life-journeying and Life-storying theme: namely Value Gratitude, Health Illness
Wellness, Crisis Challenge, Questions and answers, Connection Sharing, Place, and Identity
Identification. Some of these will be discussed in the following sections. For the moment, let us
close discussion of the Life-journeying and Life-storying theme with the awareness that
journeying implies an origin, a destination and an as-yet unfinished venture. Storying also
implies development, an unfinished process of building or construction.
4.4 Theme 3: Witnessed Spiritual Needs
Witnessed spiritual needs, as a theme, speaks to the times and spaces in which
participants encountered expressions of spiritual need. The needs participants described were
ones they had seen as common to many clients. Occasionally, participants described having
witnessed unique needs of a specific person or scenario. Figure 6 shows different areas where
spiritual needs were most often witnessed: in humanity, in times of crisis or challenge, in life and
death, and in brokenness.

39

Figure 6: Witnessed spiritual needs theme

As discussed in the previous section, many participants said that humans are spurred to
pursue spirituality in times of crisis and challenge. It was said that crisis sometimes leads to the
development of a new perspective of spirituality, and the converse as well, that spirituality can
lead one to develop a new perspective of crisis. Developing new perspectives of crisis and
spirituality can be part of a pursuit of wellness which surpasses mere treatment of illness (Ardell,
1986). Participants identified ways that spirituality could be a resource for wellness. One SCP
said (s)he has seen greater resilience and ability to cope with adverse events in those who know
from whence they come and to whom they belong. This SCP suggested that spiritual care seeks
beyond the present to origins or destinations, and beyond a challenging crisis to beliefs and
values. A MT also suggested spirituality was valuable for the support it lends to priorities which
are alternative to those of the material world, saying that when confronted with a health crisis,
priorities such as social status, material possessions, physical and cognitive function may be
subject to de-emphasis. Another MT said healing should help one to overcome crises which

40
separate one from a pursuit of, relationship with, or rest in G-d, implying prioritization of a
non-medical definition of health. A SCP also said maintaining spiritual strength is important in
crisis during which people sometimes come to the end of their hope, faith, and beliefs. In these
examples, spiritual care was described as an encouragement to continue valuing life, humanity
and divinity, even when these seemed distant from one's experience as a result of crisis.
The potential magnitude of spiritual needs must be made clear too. Spiritual needs were
often described as those which were most overwhelming. For example, one SCP said:
many times peoples spirituality is abstract and G-d is not tangible, and they will blame
G-d or be angry at G-d or feel depressed, ... at themselves or the circumstances or
the surroundings. There is the language of blame and regret ... wondering how
they got there, seeing that they are stuck, that there is no hope. The language that
comes out will sound something like: 'I hate - Im a very active person, I have my
schedule, Im in charge or in control, I have a family. And [now] look at me. I
dont know how long this will continue.'
Along with the anger, depression, hopelessness, hate and loss of control specifically described in
this story, the SCP's tone also conveyed that bitterness, cynicism, disgust and frustration can be
part of this place of deep spiritual need. It could be very difficult for a practitioner to find the
personal and professional resources to respond to a complex situation as given by this SCP,
especially with a client at the end of life. To build a relationship which could lead to healing in
such a situation, all of a practitioner's own spiritual strength and resources could be necessary
(Boston & Mount, 2006). In such a self-giving relationship, a practitioner could develop
spiritual needs as well, such as was alluded to by Salmon (2002). Examples of spiritual
challenges which may be unresolved at the end of life include those referred to by one MT:

41
anguish, guilt, sorrow, emotional wounding and being entrenched in unhealthy relationships. Let
us consider each of these spiritual challenges in order.
Resolution of anguish and guilt could involve the pursuit of spiritual concepts such as
peace and forgiveness. Whereas peace is often associated with music therapy (Fried, 1990;
Magill, 2002; Martin, 1991), forgiveness is mentioned less often. Aldridge (2003) quoted two
definitions of spirituality which included forgiveness as an expression of the human need for
transcendence. To move from anguish and guilt to peace and forgiveness, the therapeutic
response must consider the spirituality of both the practitioner and the client. This is necessary
with forgiveness because different beliefs exist regarding how one gives and receives
forgiveness. Similarly, there are at least two philosophical positions regarding unresolved grief one which seeks eventual closure of grief (Rando, 1984, 1993) and the other which understands
grieving as non-linear, a journey of existence with an ambiguous outcome (Boss, 1999).
Releasing grief, finding freedom within it, or normalizing extended grieving might be helpful for
a client with sorrow and palliative care needs.
Similar to forgiveness and grief, spiritual beliefs of the client and practitioner will be
major factors in how support is offered to a palliative client with emotional wounds. A SCP
described an understanding that trauma can disrupt one's core identity which links to
relationships, and that spiritual healing in such situations requires re-orientation. This concept of
orienteering might speak to a model of spiritual healing that involves seeking new ways: new
ways of identifying oneself, and new ways of relating to others. One's spiritual beliefs can
encourage the seeking process, present a stable foundation for rebuilding and exploration, or
hold a desired outcome of the process - such as forgiveness - until it can be attained. Participants
indicated that spirituality has a role in palliative care with regard to peace, forgiveness, grief,

42
emotional wounds and identity formation. Practitioners seeking to provide spiritual support as
part of palliative care would need to develop personal positions regarding these spiritual
concepts .
Participants also mentioned destruction, separation and other severe crises in interviews.
Such material formed the code Brokenness, and included: difficulty coping with serious or
terminal illness; suffering; lack of beauty, peace, or meaning; destructiveness; fear; rejection;
loneliness; coming to the end of one's hope, faith or beliefs; destruction of core identity and
subsequent challenges to one's roles and relationships. Participants said people who were
experiencing these kinds of brokenness could benefit from spiritual care. A number of potential
spiritual goals of care are suggested here as counterpoints to the brokenness. Some of these were
confirmed by the music therapy literature search: seeking new coping mechanisms; peace
(Magill, 2002); beauty (Lee, 2003); meaning (Lee, 2003; Magill, 2005); transcendence of
suffering (Aldridge, 2002); fostering creativity (Nordoff & Robbins, 1977); assurance of love
which is stronger than fear; acceptance; relationship (Magill, 2002, 2006); reconciling or
recovering hope, faith, identity, roles, relationship.
Another response to spiritual needs was described by participants as offering an
embrace, comfort or holding of the client. This was offered through music, or one's
complete presence, or both. For example, one MT said music can provide a kind of embrace
around the dying person when they are no longer able to respond. The music can be like a
bridge a way for the family to reach out and embrace them and each other. The same MT
talked about singing compassionate words about the presence of love and peace, and, without
words, humming with the intention of surrounding the person with love and peace. Other
participants talked about the comfort that people often experience from music associated with

43
their faith traditions (Cadesky, 2002). A number of MTs have written about music therapy as a
holding experience (Ahonen-Eerikinen, 2007; Scheiby, 2001; Wigram, 2004) in which people
experience resonance and being understood. This may occur through the musics specific words,
rhythm, or emotional tone. Spirituality was also referred to by another MT as a nourishing
source which surrounded those in need. SCPs referred more often to bolstering otherwise
weakened faith, or to the social support of ones faith community or the hospital spiritual care
team. In a beautiful summary of all these ideas about responding to brokenness, Lochner and
Stevenson (1988) wrote about the use of music in therapy as a bridge to wholeness. They
described this wholeness as being locatable throughout life and death, by finding understanding
and experiencing connections, touch and belonging.
Some participants commented that responding to spiritual needs sometimes required
operating beyond the bounds of their abilities. In such situations, one SCP described that greater
resilience may be afforded to those who invest in a healthy relationship to the spiritual dimension
by reviewing one's autobiographical theology. Through life review which attends to the
client's times of spiritual need and experience, the client can explicate a set of spiritual beliefs,
origin and belonging which can add to the client's sense of resilience. In addition to resilience,
participants shared examples of how spirituality can give humans access to valuable things
which are near impossible for humans to obtain of their own accord, given the limits of human
life and abilities. For example, regarding the spiritual significance of music, one MT shared that
music can hold disparate things together, and that it can be both a call to life and life-giving.
Another MT shared similar opinions that spirituality can help one to relate to polar extremes
including an infinite G-d who is the source and creator of all that lives and all that sustains

44
life. These MTs describe a type of human interaction with spirituality which accesses divine
resources. These resources are then shared to those struggling with the finite nature of humanity.
Participants' different experiences regarding the theme of Witnessed spiritual needs have
been presented in this section. Specifically, a spiritual need for significance and value to be
revealed was witnessed in times of crisis and challenge. A spiritual need for resilience was
witnessed in both clients and practitioners coping with overwhelming situations. In situations of
brokenness and loss of wholeness, a spiritual need was witnessed for people to be able to orient
themselves in unfamiliar places and for their brokenness to be embraced with compassion. In
confronting the finite nature of humanity and life, spiritual needs were also witnessed for divine
realities of the spiritual dimension to be held within reach of humans, and for support to be
offered for humans to reach for these realities.

45
Chapter 5: Synthesis and Application
5.1 Introduction
As shown in Figure 3 (above), each theme overlaps with the others.5 This chapter seeks
to demonstrate how the emergent categories and themes interact to support an idea of palliative
care as a spiritual field of work. The nature of this chapter is philosophical and theoretical, but
also draws on the analyses of chapter four and seeks to name points for application of the theory
in addition to those already implied in chapter four. With regard to philosophy, recall that the
study methodology is based on Ricoeur's hermeneutic phenomenology, which involves the
combination of text with the world of the interpreter and culminates in appropriation of
discourse into the interpreter leading to a new world of the interpreter which will affect future
discourses (Tan et al. 2009, pp. 6-9). The synthesis thus relies heavily on my own worldview as
I appropriate the material into my world, but the re-presentation of study results is included so
as to balance appropriation with distanciation. (Please refer to Section 3.3.4 for further
discussion of the method of interpretation.)
The themes which formed the basis of the discussion in chapter four are presented in
pairs below, and the relationship between each pair is considered. Within each relationship, the
categories of Life Death, Humanity, and Religion Tradition Ritual (from Figure 3) are strongly
referenced as illustrative of thematic synthesis.
5.2 Journeying and Storying Life Together
I would posit that the life journey and life story of the self always includes an other.6
That is, even the most isolated people relate with the environment around them. Relating occurs
5

It will be helpful for the reader to refer to the themes summarized in Figure 3 (Section 4.1, p. 25).
There is an interesting relation to music here, in that the smallest piece of music necessarily includes an other. A
single, isolated, unfluctuating musical unit (e.g. tone, rhythmic unit, timbre, lyric) would rarely, if ever, be classified
as music if it were not followed or accompanied by another musical unit. Perhaps, given a relationship with some
(non-musical) referential other, the single, isolated unfluctuating musical unit could be classified as music.

46
7

through one's will, consciousness, identity and senses. One can use these four avenues of
relation, to reject, give to, block-out, or receive from the other. Regardless of the direction of
the relationship, a life journey and story of the self could not exist without some sort of relation
between the self and other. Furthermore, the stories shared by participants (described in
Section 4.3, and Appendix C) illustrated that the self always engages in some form of life
journey and life story. As one pursues, engages, discovers, learns and questions using one's
avenues of relation (will, consciousness, identity and senses), one's life story is consulted to
interpret experiences. Kierkegaard (1846/1992) describes this process as forming subjective
truths from objective truths. Then, the addition of new material to one's life story influences
what and how reality is pursued, engaged and questioned. This process is similar to Ricoeur's
(1981) description of appropriation in which the interpretation of discourse culminates in the
re-interpretation of self. The story of the self includes many other realities, including those
realities with a spiritual dimension. Experiences contribute to ones perspective on spirituality
which also becomes part of ones life story. Life stories which include spirituality help people to
remain oriented within the spiritual dimension and to evaluate their life journeys in times of
crisis. Since ones spirituality and life story can be so mutually connected, it is important that
MTs and SCPs who are leading their clients in a process of life review take the clients
spirituality into consideration. Making spirituality an explicit part of life review could help
clients to engage in spiritual processes such as locating their identity and new ways of relating to
others in the midst of crisis.

The term identity is used here in relation to what participants earlier referred to as soul, essence and core
identity - the inherent and inescapable spiritual nature of humanity. It is not separate from the body, but an
instinctual part of it; as one MT participant said, spiritual [is] just who we are. At the same time, there is an
aspect of spiritual identity formation which bears similarity to psychological identity formation. For an interesting
discussion of this topic, please refer to Poll & Smith (2003).

47
Regarding the application of assisting a client in palliative care with making spirituality
an explicit part of life review, there are many avenues which can be employed. Drawing on the
field of spiritual care, ritual, tradition and religion can be ways to reify, commemorate or recreate important experiences. Beyond being formalized habits, inner attitudes towards life and
the spiritual dimension can be externalized through embodiment in ritual, tradition and religion.
Ritual and tradition can also be created between the practitioner and client and then maintained
from one session to the next through the ritualistic use of elements which bear significance for
the client. Loewy, Altilio and Dietrich (2005) narrated a case of a woman who used various
creative rituals as a significant part of her transition from life to death. Religious elements which
bear significance to the client can also be included through the use of particular religious
language, prayers and music.
5.3 Relating with The Spiritual
I would posit that it is a spiritually healthy act to recognize one's own limitations and then
to willingly share these with an other. The coming together of human finitude, relation of the
self with other, and witnessing humanity's spiritual needs can lead to the development of
humility, compassion, and empathy. Of course, the human capacity to develop these spiritual
traits is also finite, and speaks to the fact that the human spiritual need can extend beyond a need
for mere human relation to a need for spiritual relation. Related to this is that many spiritual
needs involve pursuing healing in ones relationships with others.
To enter into a spiritual relationship in which a palliative practitioner attends to a client's
spiritual needs, the practitioner can begin by being present. The practitioner should seek to
exercise presence using deep listening (Wilberg, 1998) and by embodying open resonance
(Scheiby, 2001). The listening and resonance might be described as openness to all the ways the

48
client chooses to relate using any of the aforementioned avenues of relation (will, consciousness,
identity,8 and senses). In palliative care in particular, a practitioners' fully open presence is
necessary because many of a client's own avenues are in decline. Relating through embodied
spirituality in a way that allows spirituality to be sensed may be of particular importance in
hospital environments which are physically or materially centred. For example, the goal of open
listening could be to inform an embodied response which invites the client to experience being
embraced and held by the sense that she is deeply understood. This concept is borrowed from
Ornstein and Ornstein (1996) who said that being understood is the grownup equivalent of a
child being held by its parent. Yet, I would posit that despite all justifications we may apply to
it, no human can understand death. Thus, the palliative client's spiritual need to be understood
and held is incompletely satisfied as it meets the human limitations of understanding. Thus,
spiritual informed palliative care might be that which assists the client to engage the spiritual
dimension in a way that allows him or her to experience being held by some other that exists in
a context that is bigger than life and death. Such an entity would have a perspective which
understands both life and death and, by holding the client, could give him or her the experience
of being safe and at peace.
5.4 Spiritual Needs Within and Beyond Life
Spiritual care and music therapy are partially about finding resilience. However, the
resilience needed to contend with human mortality can exceed the human capacity for
understanding, compassion, empathy and ability to remain in control. As Magill (2005) said,
death is a common destiny on the universal journey of life (p. 3). I would invite you in

(c.f. Section 5.2, footnote 7)

49
considering the role of spirituality in palliative care, to pause and ponder the meaning of spiritual
care at the moment of death.9
The processes of journeying and storying are essential to spiritual life, evidenced in the
catastrophic impacts of having one's journey or story denied, silenced or destroyed.10 Spiritual
care obviously becomes important then when one feels one's life-journey and life-story being
overwhelmed, attacked or wrested from one's control. Yet, all of humanity approaches the
mysterious destination called death which lies in that dimension beyond life. And in that
dimension beyond life, journeys and stories may or may not begin anew. The process of life
review becomes spiritual in nature as it necessarily considers the value of human life and death.
At the moments leading up to death, other spiritual needs may arise related to the
possibility of the dimension beyond life. For example, if one finds oneself journeying and
storying their experiences beyond life (i.e. in spirit, in death or the after-life), questions of
infancy become relevant again. What can be trusted and how should one orient themselves
within the spiritual realities beyond the life one has known? What is the relevance beyond life of
the epistemology one has developed throughout one's life? Will this epistemology facilitate
discernment and safe journeying beyond life? Helping a person to elaborate or develop an
epistemology of spirituality as part of palliative care is a spiritual task of incalculable
significance.

A full discussion of thanatology, grief literature and their association with religious studies, is beyond the scope of
this paper. The interested reader is referred to Bardis (1981), Kubler-Ross (1991) and Oliviere, Monroe, and Payne
(2011).
10
To be clear, I am thinking here of situations in which a person's spiritual freedom is trampled upon, in disregard of
identity and relationship. Examples might include human traumas like intentional child neglect or any rape, and
social atrocities like torture, terrorism and genocide.

50
5.5 Summary of Synthesis
This synthesis chapter provided insights regarding the spiritual nature and processes of palliative
care music therapy. With regard to journeying and storying together, there is a mutual connection
between how one narrates events in one's life and how one narrates one's spirituality. A life story
which includes spirituality can help one to remain oriented within the spiritual dimension and
evaluate their life in times of crisis. This bears relevance to the process of life-review which is
common in palliative care music therapy. Furthermore, sharing one's life story and continuing to
engage with others in creating one's life story can also be spiritual processes, thus making
spirituality relevant to music therapy. Second, practitioners and clients can learn to relate with
the spiritual. This involves communicating and listen more fully, sharing through the will,
consciousness, identity11 and senses, and being open to what others express through these same
avenues. Relating in this full way can help both parties develop spiritual traits like resilience,
humility, compassion, and empathy in the midst of crisis. One particularly full way of relating
can be through embodying spirituality in music, ritual, tradition, or religion. Third, when
confronted with crises, one can feel that one's journey and story are being denied, silenced or
destroyed. Third, spiritual needs can exist both within and beyond life. When confronted with
crisis and death, one can feel that one's life-journey and story are being denied, silenced or
destroyed. This creates a spiritual need for resilience which can be found within oneself, within
human relationships and in relationship with the divine. Development of such resilience can
support one spiritually both within and beyond life.

11

(c.f. Section 5.2, footnote 7)

51
Chapter 6: Conclusion
6.1 Summary
MTs and SCPs were interviewed about the spiritual nature of providing palliative care.
Hermeneutic phenomenological analysis was performed on the interview transcripts. The first
finding that emerged was the theme of Self with other. Spirituality was referred to by
participants as relational, as engaging with someone or some thing beyond the self. Beyond the
self, spiritual connections were described as those made with one's physical and spiritual
environments with community, family, a therapist, a musical moment, a deity, a memory, a
cultural heritage. Connections and relationships with spiritual significance most often occurred
intentionally. Spiritually significant connections were described as occurring through intentional
relationships and intentional embodiment of internal and invisible realities. Things like: religion,
tradition and ritual were described as common ways that spiritual connections were embodied.
Conversation, musical interaction, and being fully present with an other were also described as
processes which could embody spiritual connections. Participants mentioned that the other
that people connect with in the spiritual dimension can include God, one's identity, humanity or
other humans' spirits, culture, meaning, love, and peace.
The second theme that emerged was that of Life-journeying and Life storying. The
idea of Life-Journeying emerged from participants descriptions of engaging life spiritually as part
of larger processes. Participants said that one's experiences, and one's interpretations thereof,
influence one's spiritual realities like values, beliefs, and priorities. Other participants described
a complementary process; that some faith perspectives can re-orient people in times of crisis, can
give them resilience, strength, coping abilities, reason and purpose which both include, and
transcend, their present life and their imminent death. The idea of Life-storying also related to

52
viewing one's life in a larger context, as part of a story that includes others. Life storying also
related to the potential spiritual significance of a client sharing his or her life story with others.
Parts of a life story which often held the most spiritual significance for people, are those parts of
the story that relate to identity, to one's personal sense of orig, belonging and destination. A
person's sense of origin, which can stretch beyond the present life, and a person's sense of
belonging, which can stretch beyond the self, often enmesh one's sense of origin and belonging
with one's spiritual values and beliefs.
The third theme of Witnessed spiritual needs offered expanded understanding to music
therapists. Spiritual needs were generically described as the ability to cope in crisis, and to
continue to value life, humanity and divinity in the face of difficulty and death. Other needs
which might be described as specifically spiritual included: overwhelming anger, hopelessness,
hate, bitterness, guilt, sorrow, and many other severely destructive realities. Constructive
counterparts to these were theorized, and should be considered as an important part of spiritually
informed music therapy. In responding to spiritual needs, the intentional consideration of
spirituality in a therapist's approach would be helpful in palliative care, and perhaps even
necessary.
This synthesis chapter provided insights regarding the spiritual nature and processes of
palliative care music therapy. These insights pertained to the value of journeying and storying
life together, relating with the spiritual, and considering spiritual needs both within and beyond
life.

53
6.2 Opening the Way for Future Research
A number of research questions would be interesting for future study in this field. (Some
of these were asked in the original interview, but were not analyzed due to limitations of the
present study.)
What specific resources from the field of spiritual care are available to and used by music
therapy students, educators and professionals to understand and address clients' spiritual
wellness? What resources are suited to work with clients who have different spiritual beliefs?
What are some common spiritual needs encountered by MTs? How can a MT train oneself to
become aware of a clients state of spiritual wellness or need? How can MTs specifically address
implicit and explicit spiritual needs of clients?
6.3 Closing Remarks
It would be naive for any MT to assume that music will address spiritual and existential
needs of people in palliative care just because music therapy can address these needs. Pursuing
training regarding what these needs are, and how to open ones being to recognize them and
respond appropriately, is becoming of any competent therapist in palliative care.
The therapeutic relationship can hold spiritual significance for either or both client and
therapist. But spiritual significance can remain internal and invisible, in part due to Western
cultural norms which designate spirituality as being non-medical, and which designate other
people's spirituality as not my responsibility, or some other department's responsibility. At
best, these kinds of phrases gloss over the spiritual dimension of providing humanitarian
services. At worst, these phrases represent attitudes which negate the value of the human spirit.
It is not helpful to talk about spirituality as not being this person's responsibility or not that

54
department's responsibility. It can be more helpful to talk about spirituality as being every
person's responsibility.
Points from this research which I believe are most important, are as follows:
1. Spirituality is a real area of need, especially for palliative clients
2. Practitioners should be as intentional about caring for a client's spirit as they are about
caring for the client's emotions, body, psyche, etcetera.
3. Practitioners of music therapy, especially those who claim to work with clients' spiritual
and existential needs, should be competent in, and attentive to, the provision of spiritually
significant care.
4. It is incumbent upon music therapy researchers to further investigate the intersections of
music therapy and spiritual care.
5. Some resources which are currently available to help music therapists develop generic
abilities in spiritual care include:

professional willingness to learn about and discuss spirituality

the body of spiritual care literature

the spiritual care department of one's workplace

a personal commitment to develop an understanding of spiritual health

a personal investigation or understanding of the role of spirituality in one's life

and a personal commitment to develop one's own spirituality

55
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Appendices

62
Appendix A: Letter of Recruitment
Dear Colleague,
My name is Nathan Thorpe. I am a student in my last year of the Master of Music Therapy
program at Wilfrid Laurier University. As part of the program, I am embarking on a major
research project. My project is seeking new knowledge about the meaning of spirituality for
those who have practised in palliative care. The study is seeking to gain insight into the spiritual
nature and significance of providing palliative care in hope that the conversations will deepen
and vocabulary will expand pertaining to spirituality in the context of music therapy and
palliative care.
This study is inviting each participant to participate in a personal interview. It is anticipated that
the interview will take 50-60 minutes. The interview will be scheduled for a time and location
agreeable to you. It will ask for you to consider your experiences in providing palliative care.
Based on this experience, the interview will invite you to outline your perspectives on spirituality
as it pertains to your work, your clients, and their wellness.
A consent form is attached and it gives more information about the study. If you are interested in
participating in this research project please reply to this email address. I will choose the
participants from the people who have responded to this email.
Thank you,

Nathan Thorpe, BSc

thor1140@mylaurier.ca
Cell (226)xxx-xxx6
REB Tracking Number: 3447

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Appendix B: Informed Consent Statement
WILFRID LAURIER UNIVERSITY
INFORMED CONSENT STATEMENT
What does spiritual mean? Articulating language for addressing spirituality in the
context of palliative care
Principle investigator: Nathan Thorpe, BSc
Advisor: Dr. Heidi Ahonen, MTA, MA, PhD
You are invited to participate in a research study. The principle investigator is a student in the
Master of Music Therapy program at Wilfrid Laurier University (WLU). The purposes of this
study are to gain insight into the spiritual nature and significance of providing palliative care.
The study will be based on the experiences of music therapists and spiritual care providers in
palliative care. It is hoped that the results of the study will deepen conversations and expand
vocabulary pertaining to spirituality in the context of music therapy and palliative care.
INFORMATION
Your participation in the study would involve
- Your participation in an interview. The interview will be scheduled for a time and
location agreeable to you. It will ask for you to consider your experiences in providing
palliative care. Based on this experience, the interview will invite you to outline your
perspectives on spirituality as it pertains to your work, your clients, and their wellness.
Specifically, the interview might ask you to describe
- resources you find helpful for addressing client spirituality
- your awareness of spirituality while working with clients or patients
- your perceptions of how your practice affects your clients' or patients' processes
- Your contact again in the early stages of data analysis. This is for three reasons:
- to clarify any inaudible data
- to comment on categories and themes
- to confirm or deny the acceptability of quotations for (anonymous) inclusion in
the study
Time required:
- The interview will require approximately 50-60 minutes and will be scheduled for a
time and location agreeable to you.
A total of 6 participants (3 music therapists and 3 spiritual care providers) are being sought for
this study.
Interviews will be recorded using a digital audio recorder.
RISKS
There may be some social, emotional and psychological risks associated with participation in the
study.
- An increased discussion of spiritual beliefs may follow the publication of the study, and / or
a participant's self-disclosure of her or his involvement in the study. It is possible that this

64
increased discussion could result in tension or conflict with those who prefer to not
consider the spirituality of others or spirituality in general.
- It is also possible that a participant's increased reflection on her or his personal beliefs may
lead to emotionally or psychologically difficult confrontation with existential questions.
- It is possible that a participant's reflection on her or his spiritual beliefs could have negative
social ramifications. This might occur if participation in the study causes a participant to
become more deeply committed to act upon beliefs which are socially disparaged.
The investigators will mediate and moderate these risks as follows:
- Data which may identify participants will be removed from the presentation of the data
(names, places of work)
Participant Initials __________
- The results of the study will be presented and discussed from a perspective which seeks to
love, honour and respect each person and her or his beliefs.
- The final report will include statements in support of anti-oppressive worldviews.
The following recommendations might also reduce risks to yourself:
- It is NOT recommended that participants disclose their personal involvement in the study.
- It is recommended that you consider the supportive resources available to you before
engaging in conversations relating to spirituality.
- It is recommended that you have a plan for engaging a support system in the event that you
encounter an existential crisis.
BENEFITS
The intended application of the study results would facilitate more culturally competent practice
in the fields of music therapy, spiritual care and palliative care. This will benefit practitioners,
those they work with and society as a whole. It is the hypothesis of the researcher that including
awareness of spirituality in the discussion of competencies could foster greater sensitivity
towards existing spirituality of individuals in society, and bolster the spiritual health of society.
The research community will also benefit from the interdisciplinary topic which will expand
boundaries for future research within and between the helping professions.
CONFIDENTIALITY
While the study is in progress, each participant and all of her or his data will be assigned alphanumeric codes which will prevent identification of the participants by anyone other than the
researcher. Confidentiality of this data may be compromised only in the event of a court
subpoena.
The coded data will be available to nobody except the researcher and his supervisor. Electronic
files will be stored on the researcher's personal hard drive. File backups will be stored on a
dedicated USB stick which will not be taken out of the principle investigator's residence. All
files will be protected with an individual password and stored in a password-protected folder.
Following the completion of the study, or graduation/termination from the principle investigator's
school program, all records and evidence of participants' names and contact information will be
destroyed. From this point on, all data will be confidential and anonymity will not be broken.

65
The anonymous data will be kept indefinitely by the researcher and will only be utilized for
research purposes.
QUOTATIONS
Selected quotations may be included in the published study. These quotations will be ascribed to
a generic individual, i.e. participants will not be identifiable in these quotations. The study will
not link individual participants or individual opinions with any particular institutions at which he
or she may work. Participants can participate and study and choose to withhold quotations.
Participants will be contacted prior to finalization of the study and be given the opportunity to
withhold her or his quotation from (anonymous) inclusion of her or his quotations.
CONTACT
If you have questions at any time about the study or the procedures, (or you experience adverse
effects as a result of participating in this study) you may contact the researcher, Nathan Thorpe,
at 75 University Avenue West, Waterloo, ON, and thor1140@mylaurier.ca. This project has been
reviewed and approved by the University Research Ethics Board (Tracking # 3447) If you feel
you have not been treated according to the descriptions in this form, or your rights as a
participant in research have been violated during the course of this project, you may contact Dr.
Robert Basso, Chair, University Research Ethics Board, Wilfrid Laurier University, (519) 8841970, extension 4994 or rbasso@wlu.ca. Please refer to the study tracking number 3447 when
contacting the Ethics Board.
Participant Initials __________
PARTICIPATION
Your participation in this study is voluntary; you may decline to participate without penalty. If
you decide to participate, you may withdraw from the study at any time without penalty and
without loss of benefits to which you are otherwise entitled. If you withdraw from the study,
every attempt will be made to remove your data from the study, and have it destroyed. You have
the right to omit any question(s)/procedure(s) you choose.
FEEDBACK AND PUBLICATION
Participants will be asked to provide their preferred method of contact at the end of the interview,
and will be contacted by this method to comment on the study findings. Furthermore, the
principle investigator will submit the results to Wilfrid Laurier University as part of a major
research paper to fulfill requirements of his degree. If the study is made available to the public:
- The entire academic report is likely to be published online at http://soundeffects.wlu.ca
before 2014. This report may mention the institutions from which participants are
recruited, but anonymity will be maintained by not linking individual participants or their
opinions with any particular institution.
An abbreviated version of the study may be submitted to academic journals (for example
those of the Canadian and American music therapy associations), and / or presented at
one or more conferences.
CONSENT

66
I have read and understand the above information. I have received a copy of this form. I agree
to participate in this study.
Participant's signature______________________
Investigator's signature_____________________

Date _________________
Date _________________

67
Appendix C: Participant's Personal Spiritual Positions
Portions of each participant's transcript in which each participant described how her or his
understanding of spirituality arose from her or his life journey and story. Stories are in random
order with identifying details removed.
Story A. My understanding of spirituality is informed by both my upbringing and training ...
My upbringing was in a context where sacred and secular were so intertwined that you
don't step out of the door and live your secular life and go back to a private place to live
your sacred life. So spirituality was so much intertwined with everything that happens
whether its the profession, whether its the schooling, whether its the work or
occupation ... To work in a public context then the training part of it is important [to
learn] what other beliefs are there. And [to see] the connecting threads almost, to be able
to address diverse perspectives
Story B. I went for a couple years just pretending that there was nothing besides just my
existence on earth 'when I die I go to the grave, too bad so sad.' But my deep conviction
was there was a whole spiritual aspect to life and I had to return to my studies to seek
that out. In my early mid 20s I really had to search through my questions. Is there a
god? ... And are there many gods, or do all roads lead to Rome? ... So I did a lot of
studying of different faiths and basically it narrowed down to Christianity or 'other'
which is a huge umbrella. ... I wanted to know is there a higher being, and if there was
was he truly interested in human kind, and how am I going to respond to that. I did years
of reading and questions and flipping back and forth ... it finally came down to Jesus and
is he who he said he was? Was he just a clever teacher ... giving values and guidelines
and so on, or was he who he said he was: the son of G-d, a god who was actually
interested in us and wanted to have a relationship with us? And so I spent quite a bit
more time and sorted through all that. So I don't mean to impose on anyone, but my
personal conclusion was that he was in fact who he said he was. And so I then base my
personal spiritual beliefs on that. So I would identify myself as a Christian.
Story C. I'm a child of the church. I grew up in a traditional protestant background ... Had
some lost years in my 20s like many in my peer group, but found my way back when I
was [older], initially to seminary out of a curiosity around theology, which led me to
clinical studies at the [hospital] working the palliative unit ... I went from that clinical
training interestingly back into a congregation doing worship leadership ... and one of
the first things that happened was our director of music found out she had cancer and
was dying ... so being involved in the funeral service about 9 months after I got there. So
that was the next step for me. And then moving to this community [many] years ago ... in
a new tradition [denomination] for me ... and then [many] years ago I came here ... I
work in a pluralistic inclusive model. I used to be called a chaplain in pastoral care, now
I'm distinctly spiritual care because I understand that it's my privilege with patients
family and staff, volunteers to help them get in touch with that spirit, to reach out to the
resources that they may already have or be seeking.
Story D. I don't consider myself a very deeply spiritual person in the conventional sense ... I
don't consider myself to be a like with quotes a "spiritual seeker" the way some other
people who were in my life would consider themselves to be. But at the same time, I am

68
interested in these things. I get something out of participating in things that people often
identify as "spiritual" in quotes. But at the same time I find just the practical realities of
daily life more engaging, or spiritually satisfying ... playing music as part of a music
ensemble in a worship service is much more spiritually fulfilling or satisfying than any
kind of conventional participation in the prayer service which just doesn't particularly
resonate with me ... So it's complicated. I've explored temples in Buddhist temples in
Thailand, I've read quite a lot about the history of Christianity ... I find that kind of
interesting ... In my clinical work, I've worked with practitioners of Native Canadian
spirituality ... I've got an interest in some of the forgotten music and spiritual parallels
between Jews and Arab, Muslim, Christians and I've been a little bit ... involved in some
intercultural dialogue groups.
Story E. I was raised in a very religious home, so that's sort of my antenna towards faith, but
it's definitely been shaped by [many] years of ... experience including palliative care, ...
acute care ... work with bereaved people through a hospice, and work with elderly people
with dementia. So it's been influenced by my work with people who are suffering ... The
basis from which I come is a Christian-based faith, but I've learned that suffering unites
all of us. When I work with people , I do so from a place of compassion which is not
related to spiritual beliefs - mine or theirs, but I do rely on my spirituality to support me
in the work.
Story F. As a child, I had experiences with G-d as a source of infectious joy, and peace which
overcame fears ... when my parents would pray with me ... when I felt hurt by others. I
gradually came to understand creating art as another source of joy, and peace and truth,
however, my human creativity was not perfect, and sometimes I created things that
caused destruction. For a number of years I made a lot of destructive choices and had a
really hard time experiencing G-d ... those were simultaneous. Then in the midst of the
darkness, G-d's spirit reconnected with me. And joy and peace and love (for myself and
others and G-d) flooded in to a level I had never experienced before. Now I know that Gd's spirit has made a home inside me, and that will never leave. So those have been my
experiences in chapters ... In the chapter being written right now, there are way more
experiences than I can recount which show me how real G-d is and the whole spiritual
dimension.
Story G. "I was pretty well, cocooned up to my high school years ... I lived in a small
community ... very Anglo-Saxon, protestant ... Everything was well defined and explained
as to how we were supposed to act and live up to that time ... University sort of opened
up my eyes to experiencing different lifestyles, different ways of thinking. The biggest
transition was after I graduated. [While teaching internationally I was disturbed that] I
had brought in a lot of my prejudice into this and how my own religion was very
prejudiced ... My faith journey has taken steps, and I've come to accept it as very
important steps in my life ... I want to honour them for what they were and how they
shaped me, but I know that my spirituality is more than or bigger than that viewpoint I
used to have. So it's holding it in perspective knowing that I moved on to [something]
more universalistic, very liberal, open ... global.