in her own music therapy work. Prior to training as a music therapist, Powell studied piano and organ and worked in community theatre and music workshops, where she found the accordion a useful instrument with all ages. When she began training as a music therapist her supervisors did not discourage her use of the accordion, but there was never any time spent on how to use it effectively. Despite this, Powell has continued to play her accordion successfully for many years in her clinical work with older people with dementia. She also uses it in her Nordoff-Robbins work with children and adults with learning disabilities.
Powell (2004a, p.21) lists the accordion’s advantages, particularly: its portability; its ability to be played in close proximity to her clients; the way that she can provide a left-hand accompaniment whilst dancing and singing with a client; and the accordion’s ability to sustain and hold. She says the accordion is a versatile and useful instrument in music therapy and that she feels it becomes a part of her, allowing the freedom ‘to be with the person physically and musically’.
In one of her case studies, Powell describes the particular importance of the accordion for Peter, a 70-year-old man in the early stages of dementia, in a group session:
When I played the accordion he began to cry and said that his brother used to play. He proceeded to sing ‘Alexander’s Ragtime Band’ which he remembered his brother playing. Then I offered him the keyboard of the accordion to have a go. He played a few notes tentatively and as I provided the rhythmic and harmonic structure on the buttons with my left hand he became bolder. He played with vitality, melody and increasing virtuosity with glissandi up and down the keyboard to the cheers of encouragement and appreciation from the rest of the group. He still had tears in his eyes with a broad smile on his face. (Powell 2004a, pp.20–21)
With James, a frail and elderly ex-miner suffering from confusion, memory loss and depression, Powell (2004b) explained how their musical relationship became more interactive over time, with James playing harmonica and Powell playing her accordion. These sessions helped James to free himself from isolation, rediscover his musical skills and regain a sense of identity. Powell’s use of accordion seemed to have resonated with James, who had played accordion and harmonica in his youth; indeed she mentions that there were times when he corrected her accordion technique (2004b, p.174). It is also relevant that the accordion and harmonica are related free-reed instruments, which provided another link between the two players. Bright (2007) believes that it is essential for all music therapists to play a portable instrument. She specifically mentions the accordion as being ideal for work in dementia and writes:
I myself play a piano accordion, sitting at the same level as the individual, making direct eye contact and playing appropriate music for each in turn. (I got an accordion originally for work in a children’s ward of a big hospital and the two situations are not dissimilar – each child wanted different music, played to him or her personally). (Bright 2008, p.3)
Bright (1997) also describes a particular piece of work in hospital with a stroke patient, where she was working ‘to change the cycle of fear and pain’. A physiotherapist was working simultaneously with this particular patient, facilitating passive movements of the woman’s arm to prevent her shoulder from becoming frozen and painful. As the woman saw the physiotherapist lift the arm she screamed in pain, but when Bright played accordion music to her on the other side, ‘the arm could be lifted…without any awareness of pain’ (Bright 1997, p.142). It could be argued that the strength and self-contained harmonic completeness of the accordion were particularly effective here at engaging the attention of the patient and distracting her from the pain.
In another case, Bright (2006, p.4) describes a piece of group work involving an elderly man who had recently undergone an above-knee amputation. When group members were asked to choose favourite pieces of music, this man chose a romantic waltz, which was important to him from his courtship. As Bright played his music on her accordion the man wept, saying ‘I can’t dance any more!’ The music represented both movement and dance, areas of significant loss to this man who had recently lost a leg. Bright goes on to explain how the dance music then provided a focus for grief-work over the life changes endured by this man.
Bright considers how to choose the best instrument in palliative care (Bright 2002, p.73). She suggests that the therapist should choose an instrument on the basis of her own preference and skill but also crucially, taking into account the preference of the client and suitability of the instrument for the patient’s capabilities. Bright describes several specific instruments that she finds useful in this work, and again she values the accordion, explaining that it:
Is useful because it gives a clear melody that is easily heard even by those with partial deafness, who can touch the instrument, feeling vibrations to support what is heard; player and listener are in eye contact and in close proximity, and the instrument brings back varied memories. I have been told of church services and bush dances, the accordion being used for both. (Bright 2002, p.73)
Case vignette: The dancer
Dawn Loombe
In a case described by Harriet Powell (2009), she met an elderly lady with dementia sitting on a chair in the corridor of the care home. The lady soon became engaged with Powell’s accordion music and stood up to dance. Powell found that holding the lady’s left hand with her own right hand was not quite supportive enough, so she guided the lady’s right hand to hold on to the accordion bellows. Powell and the lady were dancing face-to-face in this way for several minutes, with the accordion between them. Importantly, the lady’s keyworker then arrived and took the lady’s hands to dance and sing with her, freeing Powell to play more in support of their dancing. The lady was very engaged with both the accordion music and her keyworker and they danced together for a while. Powell explained how significant this was, as the lady and her keyworker had needed to work on developing their relationship and this gave them an opportunity to connect. The accordion was a key feature in providing this breakthrough. Powell commented that in her opinion, no other instrument is as good as the accordion is, in dancing with older people.
Case vignette: Eva’s hymn
Dawn Loombe
In a long-standing piece of work in a residential home for people with dementia, I worked with a group of four elderly residents (all aged over 85 years) with severe dementia, in a small private room. All of the group members were in wheelchairs and were very frail. They had few remaining verbal skills and could often be very confused and agitated. Usually, at least one member of the group would be unable to come to music therapy because they were too unwell; and if they did come, they would often fall asleep in their wheelchairs and could remain asleep for the whole session. This group was no longer able to take part in the home’s organised activities, owing to the advancement of their dementia. The staff valued this music therapy group, as it provided important opportunities for these patients to interact, to engage in holding and playing instruments, and to sing or join in with musical activities.
The accordion was of great value in this setting; familiar tunes from the war era, or hymns and organ pieces often elicited responses and it was possible to get very close to individuals to capture the brief moments when they were able to participate. As well as sharing percussion instruments, the keyboard of the accordion could also be offered to an individual to play a solo; the piano keys being relatively easy to press down, offering less resistance than actual piano keys and the therapist remaining in control of the bellows and the left-hand accompaniment.
In one very memorable session with this group, 95-year-old Eva began to sing the hymn ‘Now the Day Is Over’. As she did this, she moved her fingers in the air in front of her, as if playing the piano. I quickly moved close to her, to allow her fingers to touch the accordion keys. Eva found the middle C on the accordion keyboard with her right thumb and her other fingers followed. I soon realised that she had learned this hymn on the piano, or perhaps the organ, as she suddenly became more animated and said ‘How does it go?’,
