Requests for Christmas music at the hospital where I work have been mounting. I am based on an oncology unit at a local hospital as a music therapist, and there are few times in the year where the emotional impact of music on patients is better understood than during the Christmas season.

The other day I was playing Silent Night, by request in the room of a patient who was awaiting transfer to hospice. It’s a tender song that for many connects them to the deepest sense of beauty, closeness and safety. I was aware that it was a comforting, intimate musical offering for this patient.

I was also aware of who else this melody might be reaching on the hospital unit. As the strains of Silent Night trickled down the hallway, I worried about other patients and families struggling with painful procedures, difficult prognoses, and the anxiety of uncertainty. I wondered where this song might be reaching them, and how.

This is one of the most challenging parts of my job.

Christmas music can pull on our heartstrings in a flash of a moment. It’s powerful and memory-rich for most people, even if they didn’t grow up celebrating Christmas. Most of us are also no strangers to the familiar melodies that, if we grew up in North America, we’ve been exposed to since birth. With every tune can come decades of associations, some reaching back to early childhood. This is nothing to take lightly.

Christmas music can convey all the complexities of a festive season. It can bring people back instantly to a time of joy and peace that may feel painfully long-gone. It can wrap a person in warm fuzzy feelings and be of profound spiritual comfort. It can reinforce someone’s feelings of isolation, loneliness, anger or depression. It can bring a person to tears. It’s also no secret that, with all the joy and cheer associated with this time of year, it’s also when suicide rates, domestic strife, and mental health crises are at their highest. The music of the season carries that legacy too.

This knowledge makes me nervous about playing Christmas music in my hospital, where everyone can hear it. I take comfort in the fact that, realistically, Christmas music is already everywhere. The same family I might trigger by playing Silent Night in a neighbour’s room would probably have heard that song from some TV commercial when they wandered into the family lounge for a coffee break. I take comfort in the strong team I work with of nurses, social workers, chaplains, physicians and other allied health, who will be able to provide support if someone suddenly finds themselves emotionally jarred. And I trust my own training and supervision that I am making clinically responsible musical decisions, and that I have the chops to support those who might be negatively impacted.

Having said all this, I still play tons of Christmas music at the hospital this time of year. For all my caution, the feedback from patients, families and staff is almost always overwhelmingly positive.

Perhaps it’s so effective because Christmas music is so complex. It’s not just connecting people with happy feelings. It’s connecting them with the broad spectrum of emotions that makes them who they are.

This, ultimately, is why I think music is such a powerful agent of care. Not because it can “cheer people up” – often it doesn’t. Rather, music can connect us to ourselves. And when we’re committed to delivering person-centered care, this is about as valuable an outcome as any.

A few words of caution when sharing Christmas music in your care space:
- Do it gently. Don’t saturate the space with it. Find music that is mellow enough in mood and tempo, at a volume that won’t dominate the space.
- Know your supports. Be aware that sentimental music of any kind may be the tipping point for a person under extreme emotional stress to finally let it out and cry. Be aware of this, and plan in advance. Do you have the capacity to support people through a cathartic cry? Are there people nearby who can?
- Keep it consensual. Whenever possible, let people “opt in” to attending a carol-singalong, Christmas concert, or music-listening time. If you’re playing music somewhere like a hospital, hospice, waiting room, or over a sound system, be aware of people’s ability to tune in or tune out. Keeping it at 20 minutes is a nice protocol when playing for a “captive audience” (roving carolers in a hospital, for example).
- Ask for requests. Engage with people and their relationships to Christmas music! Ask for their favourite carol, and ask what that carol means to them. Let the music be a point of connection. Make it safe to talk about not just happy associations with Christmas music, but challenging ones.
- Celebrate this music together. You don’t have to celebrate Christmas to find it significant, poignant and beautiful. It is a shared cultural language in North America and something that most people can connect over. Celebrate that wonderful opportunity for relationship! That’s what care through music is all about!

Sarah Pearson is a music therapist working in oncology and palliative care in Kitchener, ON . She is the Program Development Coordinator for the Room 217 Foundation and Lead Facilitator of the Music Care Certificate Program.