Overture For Closure: Hospice Music Therapy

7 min readJul 18, 2020


MFA graduate Xiaotian Liu uses music therapy interventions to help patients and their families come to terms with their fatal diagnosis.

Xiaotian Liu

In 2017 Xiaotian Liu graduated from California Institute of Integral Studies with a Master of Fine Arts. In her practice, she employs music therapy interventions to treat both hospice patients and their families. Outside of hospice therapy, Xiaotian writes collaborative songs to help others who live with unresolved feelings. With her collaborators’ consent, Xiaotian performs concerts both in the United States and China, where she shares some of their songs and stories. We caught up with her this summer in an interview to learn more about her practice.

When did your passion for music first emerge?

I started learning piano when I was four. And I first realized that I had a more intimate relationship with it in junior high school. When I started to play pop songs, not just classical pieces, then I started to feel like, OK, this is the tool I can use to connect with myself.

What inspired you to create this hybrid process of songwriting and therapy?

I wanted to do something to help people live better so they could die better. I’ve heard enough stories about people regretting things they wanted to do and having all this baggage. So, I thought, OK, I want to do something to help.

I have read about the free word association technique you developed to assist in your patient’s songwriting process. In a way, you’re exploring the subconscious like the psychotherapist Carl Young.

Yes, in a way! I did this with songwriting collaborators (not patients). In addition to word association, I’ve also been trying free drawing and sense-bound writing. It’s amazing to watch how things outside of consciousness begin to show up in these games!

How closely associated do you feel the fields of medicine and art really are?

They are one thing, I think, art and medicine. In my experience, my start of having even a vague idea of music therapy as music-being-therapy came when I started writing songs by myself. And then, after writing those songs, I realized that how I process my emotions during the writing itself took me to a place of peace. The music and the lyrics, they contained the emotions that I would otherwise feel burdened by. So that was the beginning; when I truly realized that the writing of music could be therapeutic. But that idea was not aligned with how I was trained as a music therapist. So, I struggled there for a long time and eventually landed in an MFA program, hoping to find my answers. And they (California Institute of Integral Studies) showed me how it could work. I think because of how free I felt in the program — I got to decide what I wanted to do, how I wanted to do it — it pushed me to think about my position as an artist. And with that kind of freedom, I think it really helped me to be firm at what I believe on how music can influence people’s psyche. And it seems very effective.

What advantages do you see in songwriting therapy as opposed to traditional methods?

I find that when I focus on the songwriting perspective, patients are less defensive versus if I am a therapist. I feel like, just by having a frame of, OK, we’re making art here, not really talking about problems or emotions, it naturally gives some permission, and it helps people take their guard down a little more. That’s probably why I can work more or deeply on the emotional stuff.

I understand that, for a time, you exclusively worked with individuals undergoing hospice care. How does your work help your patients process their circumstances?

I think it’s usually the family members who have more to process than the dying one because more than often, the dying one is pretty much out of this world already or only semi-conscious.

Without breaching your patients’ confidentiality, are you able to share such an example?

I had my first collaborative songwriting experience with a family member of a patient.

That’s when I just started my internship in music therapy and hospice. It was a mother; her adopted son was dying. So, she had a really hard time watching her son die or even accepting the fact. And I saw how that emotional burden was bringing her down. So, I asked her, do you write journals? Do you write at all? And she said she does. So, I asked her, why don’t you write down some words about your feelings on your son and everything that’s on your mind, and let’s see if we can make that into a song. Her son loved music. Her son, even though physically constrained, always wanted to play guitar, and he had really good music taste.

So, I think it was just a week or two after when I visited her son again. She was not there, but she’d put the prose she wrote into an envelope and written my name on it. So, I opened it, and it was really lyric-ready. I guess it was because of how authentic and true and touching the emotion was that I had no problem writing the music. It just flew out so easily. Once I’d made the song, I recorded it and played it for her. She cried.

And then, later, I programmed the chorus of that song on my iPad, and together we rerecorded it using the garage band app. She held her son’s hands like this (she demonstrated) and moved it to strum the guitar. So he was accompanying me as I was singing the song about him and her. It was a private session, just us three. But it was really precious. You can’t even imagine the power of being in that moment. Yeah, I guess that was the very moment that made me believe that there is power in co-writing.

Are there any other examples of cowriting that you’d care to share?

The one that’s fresh in my mind is the song I just finished writing. It’s on the collaboration album on my website — the top one. It’s sung in Mandarin. So that song I wrote with a friend who was exploring her relationship with her mom. But initially, she thought it was about her grandma. So, we talked a lot about her and her grandma and grief and the emotions about that topic. But the image of her mom kept popping up. So, that part was therapy, just watching her having this urge from her subconscious keep trying to raise a hand, calling for attention.

Eventually, I asked her: ‘I think this is a song about your mom,’ and she thought about it for a couple of days and agreed. So, then she started writing letters to her mom, and she was really brave. I think it was her motivation to sort out her feelings and see how well she could improve her relationship with her mom, which made her write those letters. We had a good several crying sessions. And then, from the last letter, we got the raw material for lyrics.

With it, I started writing the music, the melody for the song. I sent her a draft, and we edited it. When we had the final version, she asked me, ‘can I sing a part of the song and record it?’ because she wanted to give that version to her mother. And I see that as a very brave action because the lyrics are pretty direct. There is frustration; there’s sadness; there’s anger. So, for someone who wanted to just give up on the person that the song is addressing, I thought that was amazing.

But she’s still trying to decide when to give the recording to her mom. She has already shown the song to her father and her friends. And I find it so beautiful because it’s such a nice, neat container for her emotions that she can share with her friends and her family without feeling vulnerable, without feeling shame.

Especially for an Asian, I think we are too shy to say or to even express anything close to our real emotions. So, I was really glad to see that she was able to use that song that way. Her friends and family commented on the lyrics saying how true it was, how beautiful it was. But the beautiful thing, I think, is that it was her words. I was just editing them.

Xiaotian Liu is an alum of the MFA Program at California Institute of Integral Studies in San Francisco. For more of Xiao’s work, follow her on Instagram @lxt3331 or visit her website: https://www.xiaotianliu.com/

Interview/Edited: @dean_talamantez




Blog of the MFA in Interdisciplinary Arts and Writing program at California Institute of Integral Studies in San Francisco, CA, U.S.A.