Entrevista a Blanca Guillén Moreno

Conoce la musicoterapia en contexto hospitalario.

Entrevistamos a una de las veteranas de la musicoterapia hospitalaria en nuestro país. Blanca Guillén Moreno nos lleva de la mano por el día a día de la música entre una de las emociones más intensas que vive el ser humano el dolor y el suero. Con rigor y unos objetivos bien marcados, la musicoterapia trae luz y cambio para los pacientes hospitalizados, permitiéndoles modos de expresar lo inexpresable.

¿Cómo surge el proyecto de llevar musicoterapia al hospital La Paz en 2003?

Esta actividad surge cuando se hace un convenio entre el master de Musicoterapia de la Universidad Autónoma de Madrid (UAM) que se imparte en la facultad de Medicina y el hospital universitario de La Paz (Madrid). Los alumnos empezaron a hacer sus prácticas en algunas unidades y a raíz de eso comenzó la investigación y se publicaron varias tesis doctorales. En la actualidad, prestamos atención a las plantas de Oncología Pediátrica, Trasplantes Pediátricos, Pediatría, Cirugía, UCI Pediátrica, UCIN, Unidad del dolor de adultos y la unidad de Cuidados Paliativos. Casi todos los que estamos haciendo la atención directa o hemos tutorizado a los estudiantes tenemos que ver con el Máster de la UAM. Además formamos, junto con otras personas, una fundación llamada Musicoterapia y Salud, que tiene distintos proyectos aparte del de La Paz, donde pueden participar personas externas que tengan interés en este campo.

¿Cuál es el perfil de los profesionales en el programa de musicoterapia del Hospital La Paz?

El perfil de los musicoterapeutas es muy variado: músicos, psicólogos, médicos…pero todos con conocimientos musicales previos, aunque no tengan un título oficial. Pero sobre todo, el conocimiento de cómo acompañar, observar y deducir información de lo que vemos en sesión ¿Qué instrumento ha cogido espontáneamente el niño y qué instrumentos le han seguido? ¿Tocaba ritmo o no? Sabiendo cómo se toca un determinado instrumento ¿Lo toca de manera convencional? Ante todo el musicoterapeuta debe ser flexible y capaz de incluir todos los aspectos que encuentre en el camino, tanto internos como externos. Debe ser flexible a la interrupción: al trabajo que depende del constante cambio de la enfermedad, a la respuesta variable de los pacientes, y a las necesidades que van surgiendo.

¿Cómo es una mañana cualquiera de musicoterapia en La Paz?

Es muy variado. Nosotros acudimos una vez a la semana por la mañana: Las mañanas son mucho más movidas que las tardes, eso sin duda. Depende mucho de la planta: Yo me he centrado en el hospital materno infantil, he estado en la UCI infantil, pediatría 1 y 2, hemodiálisis infantil, neonatología… de manera continuada. Cada planta y cada unidad sigue unas dinámicas, normas y una manera de trabajar en equipo diferentes, así como una actitud o modo de entender la Musicoterapia. De una semana a otra pueden haberse dado muchísimos cambios, por lo que cuando llegamos, es el equipo de Enfermería el que nos informa y nos guía por dónde somos más o menos necesarios: trabajar con un niño determinado o con una familia… en función de los resultados de las pruebas, del efecto de la medicación, de los nervios. Nos acercamos a las habitaciones, preguntamos si les apetece que entremos y si no nos conocen, les explicamos quiénes somos y en qué trabajamos.

Tenemos que tener en cuenta también a los pacientes de las habitaciones contiguas, por lo que les preguntamos antes de cada sesión. Unas mañanas damos muchas sesiones seguidas y otras nos centramos en pocos niños, pero la intervención es más larga: no existe un tiempo fijado para las sesiones. Trabajamos de dos en dos, y es fundamental que haya muy buena conexión en el equipo: Uno se encarga de la terapia y la interacción con el paciente, y el otro se encarga de la parte musical (el co-terapeuta). Cada uno ve cosas diferentes en una misma sesión, que luego ponemos en común al rellenar la ficha de cada intervención. Se puede decir que somos seres simbióticos durante la sesión.

¿Cuál es el planteamiento musical?

Pocas veces tocamos canciones conocidas o a petición del paciente; generalmente improvisamos, y es necesario tener un abanico de registros muy grande para poder generar efectos en distintos contextos y momentos. Normalmente la familia interviene y colabora en la producción con otros instrumentos y así se genera un poco más de dinamismo ¿Cómo te activas en una habitación pequeña de hospital después de varios días? Viendo la televisión, leyendo, pero poco más. La idea no es que dependan de que nosotros estemos, sino que les dure el resto de la semana, hasta la semana siguiente y que poco a poco vayan adquiriendo las herramientas suficientes para hacerlo solos. Todo depende de los objetivos que nos marcamos.

¿Qué objetivos os marcáis?

Nuestros objetivos son principalmente psicológicos y emocionales, que es la única parte que en el hospital no está siendo suficientemente atendida. Podría decirse que la improvisación es musical pero no se improvisan los objetivos: la pareja de musicoterapeutas establecen unos objetivos en función de lo que Enfermería nos cuente o de lo que percibamos en los primeros segundos de entrar en una nueva habitación: bien sea la decoración, las personas acompañantes o el cambio de sábanas. Estos objetivos después se van revisando al ver el resultado de las grabaciones de cada sesión. Trabajamos con lo que tenemos, porque la situación no nos permite establecer objetivos a largo plazo. Buscamos ser eficaces y útiles en el tiempo que nos es dado con cada paciente.

Si tuviéramos que hacer un resumen para que todo el mundo lo entendiera sería este: realizamos un trabajo psicológico cuya herramienta principal es la música.

¿Nos puedes decir algún ejemplo de intervención?

Lo que ocurre con la hospitalización es que a veces los roles en las familias se invierten, y vemos cómo los padres hacen de hijos y los hijos de padres, de modo que es necesario reestablecer esos vínculos. También los vínculos se modifican por la vivencia tan dura que acontece en sus vidas dentro del hospital, y a través de las sesiones contribuimos a la mejora de ese vínculo. Y por otro lado, como ocurre en los casos de adolescentes, donde el tratamiento de la enfermedad es muy invasivo, nosotros trabajamos su rabia, la injusticia que siente, la aceptación de la enfermedad, su adaptación a las consecuencias negativas de la quimioterapia, preparación para la salida del hospital y readaptación a su contexto anterior, etc. ¿Quién hace ese trabajo? ¿Ellos solos, que aún no tienen herramientas para ello? ¿Su familia, que está directamente involucrada? Con la música, todo ese trabajo previo a la racionalización de las emociones, es mucho más sencillo y ayuda a expresar la rabia y la tristeza. Solo cuando han podido manejarlo ellos internamente, pueden exteriorizarlo y trabajarlo fuera. A todo el mundo le gusta la música, por lo que con la vía ya tenemos ganado al paciente. Además, para el Ser Humano, la motivación es crucial, y la música ya tiene esta motivación implícita. Es una vía de trabajo exitosa y más rápida que otras, donde a pesar de lo que parezca por fuera, todo tiene una razón de ser y está muy dirigido: no se canta porque sí. Hay mucho trabajo previo y a posteriori de cada sesión.

¿Qué instrumentos utilizáis?

En el trabajo del musicoterapeuta, es adecuado que haya un instrumento armónico, que pueda construir los cimientos musicales de la sesión, cuanto más fácil de desplazar, mejor. Por ejemplo guitarras, arpas, teclados pequeños, flauta travesera…Después se pueden añadir otros elementos, como la voz (nuestra parte más personal, emocional y domesticada y en la que mejor pueden contribuir los pacientes) o la percusión (la parte más instintiva).

Cuando trabajamos con niños muy pequeños, que tienen la prensión adquirida, podemos trabajar con instrumentos de percusión pequeños. Con niños un poco mayores trabajamos con instrumentos que no requieran por su parte una técnica musical, que llevamos en una maleta grande: instrumentos de percusión, carillones, morteros de cocina para golpear y expresar la rabia, etc. Del tipo de instrumento que coja espontáneamente el niño ya sacamos mucha información: puede estar probando pero también nos puede informar sobre su estado emocional, de sus necesidades, el concepto que tiene de sí mismo. Y nosotros con nuestras herramientas debemos amplificar aquellos efectos que él busque y que con el instrumento o la voz no alcancen el nivel que esperan.

¿Qué efectos produce la música?

A nivel fisiológico la música modifica el ritmo respiratorio, cardiaco, la presión arterial y la ondas cerebrales, provoca cambios en el tono muscular, la temperatura, el en nivel de glucosa, en la secreción hormonal y en el sistema límbico. Activa el hemisferio derecho del cerebro y estimula el trabajo conjunto de los dos hemisferios. Ayuda a la regeneración de los tejidos en pacientes con quemaduras, y aumenta la resistencia al dolor.

A nivel psicológico la música favorece los procesos de comunicación y la capacidad de expresión emocional, refuerza la autoestima y disminuye el sentimiento de soledad, así como facilita el contacto con ella. Altera la dimensión temporal y espacial, favorece la visualización, la atención, la memoria, el aprendizaje y la capacidad de observación. Ayuda a elaborar el duelo y aporta seguridad y contención.

¿Se ha realizado alguna investigación con la muestra hospitalaria del hospital La Paz?

Hasta la fecha se han publicado dos tesis doctorales sobre musicoterapia con bebés de 0 a 6 meses en Cuidados Intensivos Pediátricos y musicoterapia para Mujeres con Cáncer de Mama. Ahora mismo tenemos un trabajo de investigación en curso con población adulta de Hemodiálisis.

¿Cuál es la respuesta del paciente y la familia? ¿Y del personal sanitario?

La respuesta es muy positiva por parte de todos, por parte de los pacientes, de sus familias y del equipo hospitalario. Sin embargo, es muy importante la valoración del servicio por parte de dirigentes del hospital, y ellos no lo ven. De alguna manera existe un respaldo oficial de nuestro trabajo en el hospital, pero a la hora de la verdad y por falta de tiempo, nos falta apoyo real: los jefes de planta no tienen tiempo para poder conocer el trabajo en primera persona. Sabemos que la Sanidad pasa por unos momentos difíciles y el trabajo se multiplica en cada unidad del hospital. Sabemos que les gustaría poder asistir cada cierto tiempo a ver nuestro trabajo, pero no es posible por esta razón. Medios de comunicación e impulso de más investigación empírica ayudarían mucho a que esta actividad tuviera el reconocimiento que se merece.

¿Quién financia este proyecto? ¿Qué sostenibilidad tiene en la actualidad y en el futuro?

La sostenibilidad económica del proyecto es prácticamente nula, y el trabajo es absolutamente voluntario y vocacional. Recibimos apoyo de Hard Rock Café, que organiza un concierto benéfico al año para recaudar fondos para nuestra labor en el hospital Materno Infantil de La Paz. La Fundación Musicoterapia y Salud funciona a partir de donaciones voluntarias.

Así se trabaja en el Hospital de La Paz (Madrid):

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  2827. Wow that was strange. I just wrote an really long comment but after I clicked submit my comment didn’t appear. Grrrr… well I’m not writing all that over again. Regardless, just wanted to say fantastic blog!

  2828. Currently it seems like Movable Type is the best blogging platform out there right now. (from what I’ve read) Is that what you are using on your blog?

  2829. Aw, this was an exceptionally good post. Spending some time and actual effort to generate a really good article… but what can I say… I put things off a whole lot and don’t seem to get anything done.

  2830. Hey I know this is off topic but I was wondering if you knew of any widgets I could add to my blog that automatically tweet my newest twitter updates. I’ve been looking for a plug-in like this for quite some time and was hoping maybe you would have some experience with something like this. Please let me know if you run into anything. I truly enjoy reading your blog and I look forward to your new updates.

  2831. Aw, this was an exceptionally nice post. Taking the time and actual effort to make a very good article… but what can I say… I procrastinate a whole lot and never manage to get nearly anything done.

  2833. Hello there, You have performed a fantastic job. I’ll certainly digg it and individually recommend to my friends. I am confident they’ll be benefited from this website.

  2834. At this time it sounds like BlogEngine is the preferred blogging platform out there right now. (from what I’ve read) Is that what you’re using on your blog?

  2836. Hello there, You have done an incredible job. I’ll certainly digg it and for my part recommend to my friends. I’m confident they’ll be benefited from this site.

  2837. Right now it appears like Expression Engine is the best blogging platform available right now. (from what I’ve read) Is that what you’re using on your blog?

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