What Happens in a Hospice Music Therapy Session

By Sarah McInnis, Music Therapist at Valley Hospice

People often imagine music therapy in hospice as someone coming in to play a few songs. While music can certainly be part of it, a hospice music therapy session is less about performance and more about presence, listening, and responding to what matters most in that moment.

Each session looks different because each person is different.

It always starts with listening

Before any music is offered, I spend time noticing and listening. This might include how someone is breathing, whether they are alert or fatigued, who is in the room, and what the emotional tone feels like. Sometimes a session begins with conversation. Other times, words are already too heavy, or simply unnecessary.

Music therapy in hospice follows the pace and preferences of the patient. Nothing is rushed. Nothing is forced.

Bedside singing and live music

One of the most common approaches is bedside singing with live accompaniment, often guitar or voice alone. Songs are chosen carefully, sometimes requested by the patient or family, sometimes suggested based on what I am observing.

Live music allows for flexibility. I can slow the tempo to match breathing, soften dynamics to reduce stimulation, or repeat a familiar chorus if it brings comfort. If someone becomes restless or overwhelmed, the music can change or stop entirely. Silence is always an option, and often an important one.

This is not about filling the room. It is about supporting comfort, grounding, and connection.

Music for life review and storytelling

Music can open doors to memory in a way few other things can. Many sessions involve music for life review, where songs become a bridge to stories, relationships, and identity.

A song from childhood might spark memories of growing up on a farm. A wedding song may lead to laughter, tears, or a shared story between partners. Sometimes patients speak. Sometimes families do. Sometimes the music holds the story when words feel too fragile.

Life review through music is not about summarizing a life neatly. It is about honouring moments that still feel alive.

Songwriting together

Some sessions involve songwriting, which can be a powerful and surprisingly gentle process at the end of life. This does not require musical training or poetic skill. Songwriting in hospice is collaborative, flexible, and entirely guided by the patient.

A song might be created as a message to loved ones, a reflection on a life lived, or a way to express feelings that are hard to say directly. Sometimes patients offer a few words or phrases and I shape them into lyrics. Other times families contribute lines together, creating something shared.

The music itself is often simple. What matters most is that the song feels true to the person. For many, songwriting offers a sense of agency, creativity, and legacy at a time when so much feels out of their control.

The finished song may be sung once at the bedside, recorded as a keepsake, or simply held as a meaningful moment. There is no pressure for a final product. The process itself is the therapy.

Lyric analysis and meaning making

For some patients, lyrics matter deeply. A session may involve reading or listening to song lyrics together and talking about what stands out. Certain lines can reflect themes of love, regret, faith, resilience, or letting go.

Lyric analysis in hospice is gentle and patient led. There is no right interpretation. The goal is not insight for its own sake but rather meaning. Even a brief conversation about a single line can help someone feel seen or understood at a profound level.

Creating audio recordings and keepsakes

When appropriate and desired, music therapy can also involve audio voice recording to create keepsakes for loved ones. This might include a patient speaking a message, reading a poem, singing along to a song, or sharing part of a collaboratively written piece.

These recordings are always done with informed consent and great care. The focus is on capturing something authentic, not polished. A wavering voice, a laugh, a pause, these are often what families cherish most.

For some patients, creating a recording offers a sense of legacy. For families, it can become a lasting connection that carries the sound of their loved one forward.

Supporting families, not just patients

Hospice music therapy sessions often include family members, whether they are sitting quietly, singing along, or simply listening. Music can make it easier for families to be present without needing to say the perfect thing.

For loved ones, these moments can ease anxiety, reduce the fear of silence, and create shared experiences that remain meaningful long after the session ends.

Sometimes the music is as much for the family as it is for the patient, and that is entirely appropriate.

Ending the session

Sessions end based on cues, not clocks. I may gently close with a familiar song, a few soft chords, or quiet reflection. If someone falls asleep, the music follows them there. If emotions surface, the ending is paced with care.

There is no expectation that a session must feel uplifting. Comfort, connection, and authenticity are the markers of success.

A final note

Hospice music therapy is grounded in professional training, ethical standards, and a deep respect for the complexity of end of life care. In Canada, music therapists work as part of an interdisciplinary team and tailor each session to the physical, emotional, cultural, and spiritual needs of the person and their family.

At its core, a hospice music therapy session is about meeting someone exactly where they are and offering music only if and how it serves them in that moment.