SINGAPORE — As a harpist and during her music studies, Ms Karen Koh has performed with the Singapore Symphony Orchestra, at five-star hotels here and with the Kingdom Hearts Orchestra World Tour, which is the official full-orchestra concert of the Kingdom Hearts video game's soundtrack.

These days, however, the 31-year-old professional musician plays for a very different group of audience.

Now training to become an accredited music therapist, Ms Koh works with patients at St Luke’s Hospital, a community hospital in Bukit Batok. She is doing her internship there.

Some patients whom Ms Koh sees have suffered a stroke and are trying to get back on their feet. Others struggle with the debilitating effects of Parkinson’s disease or dementia. Another group she works with are on palliative care and living their last days.

At the hospital, she typically sings, plays the guitar, piano and other small percussion instruments during therapy. Sometimes, she may use a lever harp, which is a smaller version of the regular harp.

There is no enthusiastic applause or standing ovations at the hospital. Yet, the fulfilment that Ms Koh gets from supporting these patients keeps her going, even though there are uncertainties over a career switch during the Covid-19 pandemic.

“In a classical music performance, the audience pays to listen to you, they want to be there.

“With music therapy, some patients may respond in their own ways to say, ‘Leave me alone’ or ‘I don’t want to do anything’.

“This is especially at the start of the treatment since they may not be in a good emotional state,” Ms Koh said.

“Many of the patients whom we work with have conditions like stroke and dementia, and there is a loss of bodily functions. When one loses his or her independence, it’s normal to grieve, be in a low mood.”

WHY MUSIC THERAPY AND HOW DOES IT WORK

Music therapy is the clinical use of music to accomplish individualised goals. In the healthcare setting here, it is offered as an “allied health service”.

Music therapy is thus a relatively niche career option in Singapore.  

Mr Calvin Eng, president of the Association for Music Therapy Singapore (AMTS), said that there are just 36 accredited music therapists in Singapore.

AMTS is the professional association for music therapists here.

To practise in Singapore, music therapists must be accredited from an approved music therapy programme in their country of training, Mr Eng said.

They go through a comprehensive bachelor’s or master’s degree programme, which typically covers music foundations, music therapy foundations and clinical foundations such as psychology, anatomy and counselling.

At St Luke’s Hospital, music therapy is offered as part of its suite of rehabilitative services.

Dr Tan Xueli, the principal music therapist there, said that the hospital now has one of the largest teams of music therapists in Singapore.

Besides Ms Koh, there are three accredited music therapists who plan and use musical interventions and activities to support patients’ individual rehabilitative needs and goals. The team also does music therapy research, education and training.

​Dr Tan said: “The patients' doctors, nurses, physiotherapists, occupational therapists, speech therapists or any medical team member can refer the patients to music therapy if they see the potential for music therapy to affect a positive therapeutic change.” 

Patients who are referred to receive music therapy intervention do not incur extra costs, she added.  

Ms Koh said: “For each patient the music therapists see, we will have a plan based on their current progress, and what the patient or family hopes to achieve at the end of their time (at St Luke’s).

“Sometimes, we work with other therapists, especially the physiotherapists, in joint sessions to achieve a more optimal rehabilitation outcome.”

For instance, for a patient undergoing stroke rehabilitation, Ms Koh may work — under the guidance of her supervisor — with a physiotherapist to use musical activities to encourage physical movements in areas affected by stroke.

One of the “secret magic” of using music as a form of therapy, Ms Koh said, is its ability to excite and motivate patients.

Anyone can benefit from music therapy because musical training or background is not needed for one to enjoy music. For some patients who may not be as responsive to music or dislike music, Dr Tan said that the therapist may refer them to other rehabilitative services.

Ms Koh noted: “When we first tell the patients we are doing music therapy, many of them think that they are just going to sit back and listen to music. But they often end up doing plenty of things during their therapy session.

“For example, we had a patient who had undergone a knee replacement surgery. She complained of being very tired after 30 seconds of standing, but had no problems doing so when we played a three- to four-minute song.”

Ms Koh explained that other than distracting patients from pain and discomfort, for instance, music is also emotionally uplifting and provides a source of motivation.

“This is especially so when you play something that the person really enjoys listening to and loves. For example, for older folk, it could be a Teresa Teng song,” she said, referring to the Taiwanese singer who was a household name in the 1960s and 1970s with her hit ballads and folk songs.

Ms Koh joked that thanks to her internship at St Luke’s, she has built up an even wider repertoire of retro songs in various languages, including Malay, as well as songs in Chinese dialects such as Cantonese, Hokkien and Teochew.

On some weekends, she still performs part-time at hotels and events.

WHAT RESEARCH SAYS

Studies here and abroad have shown that music therapy can improve well-being as well as reduce symptoms of pain, mood and depression.

Mr Eng from AMTS pointed out, for instance, that music therapy has been shown to be effective in managing behavioural and neuropsychiatric symptoms of dementia such as agitation, aggressive behaviour and anxiety.

At St Luke’s Hospital, research studies are underway to look into the benefits of music therapy for pain management, psychosocial support, palliative care and rehabilitation, Dr Tan said. 

Music therapy is listed as one of the recommendations in the Ministry of Health’s clinical practice guidelines for dementia.

“The guidelines mention the effect of music on agitated behaviours, and how music can be used to induce therapeutic effect, reduce caregiver distress, increase meaningful interactions, and improve mood and socialisation,” Mr Eng said.

Research by Alexandra Hospital in 2010 concluded that a weekly music and activity programme could reduce behavioural and depressive symptoms in dementia.

Another Singapore study, published in the international and peer-reviewed journal Healthcare in December last year, suggested that music therapy could support children undergoing cancer treatment.

The study’s authors wrote that music therapy “should be considered as an integral part of holistic paediatric cancer care”.

HOW SHE WAS CONVERTED

For Ms Koh, who also sings and plays the piano and guitar, a career in music therapy is a natural extension of her love for music and science. She also has a master’s degree in applied neuroscience.

“As a professional musician, it was not too difficult to switch to music therapy.

“The process has allowed me to take my existing skills in performance and combine it with new skills in music therapy, and apply them in a different way,” she said.

She started learning to play the piano when she was three years old and picked up a harp at 14 after seeing a classified advertisement on learning to play the musical instrument.

She was 26 by the time she completed her studies: A bachelor’s degree in harp performance from the Yong Siew Toh Conservatory of Music at the National University of Singapore (NUS) and a master’s degree in harp performance at the University of Toronto in Canada. 

Ms Koh’s first brush with music therapy was in Canada where she was doing her master’s.

She attended a lecture by a music researcher who talked about the benefits of music therapy on people with dementia.

Later, she and her course mates visited a hospice, performing live for residents at their bedside and witnessing the effect that music had on them.

“I wasn’t training to become a music therapist at the time. But knowing that my performance could be the last time (the hospice residents) would ever hear live music left a deep impression on me,” Ms Koh recalled.

“I remember performing a song request of When Irish Eyes Are Smiling, and when we were done, one woman cried so much. She thanked us and told us the performance brought her so much joy.

“The experienced showed me that music has the power to bring us to a place where we can’t usually go in ordinary life.”

It was not until the Covid-19 pandemic hit that Ms Koh decided to venture into the field of music therapy.

“I wanted to do more with my music, rather than just perform. I didn’t want to sit around.”

The opportunity to complete an overseas degree programme in music therapy came up due to the widespread use of remote learning during the pandemic, and Ms Koh jumped at the chance.

She is now pursuing a bachelor’s music therapy degree programme from Pennsylvania’s Slippery Rock University in the United States.

She chose to do her internship at St Luke’s Hospital in part to gain exposure to different segments of the population and to get a more holistic education in music therapy.

THE HEALING POWER OF MUSIC

Since starting work at St Luke’s Hospital in February, Ms Koh has not had a dull day.

Seeing first-hand how music therapy has helped patients walk again, heal emotional wounds and bring back lost memories, it has reaffirmed her choice of a new career.

“Every day, I am challenged to come up with strategies to help patients in my care achieve their goals. But when breakthroughs happen, the joy of feeling that you’ve helped enable the breakthrough is truly boundless.

“To help someone speak normally again, to spend meaningful time with someone in their last days of life or help them learn to do something new, the feeling is indescribable.”

For patients on palliative care, music therapists may sometimes work with them to create a musical souvenir or gift for their loved ones. An example would be a recording of a song the patient sang on his or her wedding day, Ms Koh said.

“There was someone I met in the palliative ward who made a recording for the family as a memento. When the family eventually received the recording, their gratitude was immeasurable — they did not even know that the patient could sing.”

Ms Koh feels that her training in the hospital has also changed her as a person.

She finds that she is becoming more resilient, patient and comfortable in expressing herself. Through her interactions with patients and their loved ones, she has gleaned important life lessons.

“With each person I meet, I learn a little more about what it means to be human, whether it is communicating difficult but important messages to loved ones or coming to terms with the end of life.”

She hopes that more people will consider music therapy as their choice of career.

“To me, work is not just about earning money, but it should also be meaningful.”