How Can Music Therapy Improvisation Maintain or Improve Health?

Have you ever thought about the fact that you are constantly improvising? Language is perhaps the most obvious example of this. Unless you are giving a speech, you usually do not prepare what you’re going to say. You improvise it along the way! Yet, perhaps many of us would hesitate if we were asked to improvise musically. Hopefully this blog post will change your thoughts on musical improvisation. You will particularly learn about how music therapy improvisation can be so wonderful and helpful for patients.


Music Therapy Improvisation 

As a music therapy process, clinical improvisation is the free or guided extemporaneous use of music, undertaken by the therapist and/or client, using a range of tuned and untuned instruments and voice, to maintain or improve health (Bruscia, 1987). 

The goals of musical improvisation in this context can be to:

  • help a client be more aware of himself or herself and others,
  • help them gain personal insight,
  • hold the client’s attention,
  • help manage pain, 
  • promote well-being, 
  • enhance self-expression and creativity, 
  • and improve interpersonal relationships. 


The ways in which music therapy improvisation can promote health are many. And in fact, the act of improvising is more simple than most people think. We all improvise in our day-to-day lives. We encounter unexpected circumstances every day and as we adjust to them, we improvise. 

Music therapy improvisation is about letting patients explore this simplicity of their inner state through music. 

Yet, beyond what is evident, music therapy improvisation can also be a complex process between the therapist, the patient, and the music. Improvisation helps bring the inner state to the forefront of the therapy as the therapist helps the patient through their journey.


Who can benefit from music therapy improvisation?

Clinical improvisation can be used in a wide variety of settings and populations. Improvisation in music therapy may look different in relation to the population and setting. Therefore, a music therapist needs to be an expert in creating a space for improvisation to help the patient reach a certain therapeutic goal. The therapist needs to approach the patient with empathy, always attentive to their needs. 

Through this communication, patients can reach into a part of themselves that is inaccessible through words. This is particularly true when verbal communication is not possible.


Different approaches to music therapy improvisation

Improvisation plays a central role in many approaches to music therapy (Kim, 2008; Aigen, 2012; Keith, 2005). In the act of improvising, therapist and participant engage in a process that can be transformative and powerful. The interchange of ideas and energy create an environment in which communication beyond words is possible. 

There are differences of opinion in regards to how improvisation in music therapy should be approached. According to Kenneth Aigen (2013), the use of improvisation tends to fall into two categories: “based on particular musical styles and those based upon non-stylistic considerations” (p. 182). The Nordoff-Robbins approach, falls within the former category, while others like Juliette Alvin and Mary Priestly reject stylistic considerations. 

In the Nordoff-Robbins approach, the participant performs a role as part of a whole. In that opportunity, he or she can “have experiences that transcend their musical, cognitive, and motoric skills” (Aigen, 2013, p. 187). This music also tends to be highly structured and has all the elements that are found in nonclinical music. 

Mary Priestley, on the other hand, would generally reject any stylistic considerations because of her belief that musical styles would distract the client from their feelings and expression of their unconscious.

Bruscia has argued that “to teach therapists to improvise, then, is to teach them how to find alternative ways of being in the world: and to teach therapists how to improvise with others is to teach them how to explore and live in the alternatives of others” (as cited in Bunt, 2014, p. 20). By living in these alternatives, therapy can reach new levels of depth. Learning to improvise means learning to acknowledge external and internal stimuli and letting them influence musical decisions.


The Mirror Neuron System

Recent research also backs up the importance of the use of improvisation in music therapy. The discovery of the Mirror Neuron System (MNS) is key in understanding this. The MNS “allows us to understand and predict the behavior of others, by engaging the neural regions required to produce such behavior ourselves” (Molnar-Szakacs et al., 2011). 

When we see and recognize the emotional states of others, we can feel those same emotions. This is what many of us know as empathy. 

Molnar-Szakacs and Overy (2011) developed a model called the ‘Shared Affective Motion Experience’ which defends the idea that there is a “sense of a shared communicative and emotional link created between and among individuals, and to signify that, in fact, the same neural networks can be activated in agent and observer during a musical interaction.” Thus, in improvisation, a music therapist can evoke certain responses in the patient/participant through a positive musical experience.


So, Why Improvisation?

The therapist uses techniques to engage, evoke responses, and support the client. Music becomes a co-created space where the known and unknown can happen. The client/patient and the therapist are then engaged in meaning-making through the music. These meanings can give rise to hidden or unconscious concerns in the client/patient’s world. The client/patient can express their everyday struggles through improvisation.

In music therapy, the therapist attempts to enter the world of the client/patient through improvisation. And in this process, the music emerges. Just as there is the potential for change in the music, there is potential for change in the client. The everyday struggles of a client can be expressed in the music and as the music has the potential for change, the client may find the agency for change as well.

Here is an example of a therapist improvising the feeling of “anger” with a client:



And in another example, Turry (2011) describes a significant moment in his work with Gloria, a woman diagnosed with non-Hodgkin’s lymphoma. Take a look at this musical exchange, which represents a key moment in their therapeutic work:


Client sings: You listen to me deeply

Therapist plays: Single tones from the piano gently, slowly, sounds sustained to create harmony which contextualizes the client’s melody, creating momentum and leaving space for the voice to continue

And that makes me cry

A new minor harmony from the piano supports the sentiment of the words

Just when I got used to not ever being heard

The tender accompaniment pauses, then comes to a temporary resting place

I stopped talking

A countermelody from the piano gently echoes the melody

Oh I seem to talk

A pulse generated from the melody is now present in the harmony

People thought I talked

There is a rhythmic quality that now creates a gentle swing

But I didn’t speak from my heart

A song form with pulse and phrase structure emerges

Music goes to places that words can never go

The intensity builds

Music goes to places that words can never go

The lyric repetition solidifies the song form

Finding my true voice

The music begins to cadence, slowing down and clearly heading for the tonic

Not being afraid

The music and words slow down

You listen to me deeply

A final harmonic cadence

And that makes me whole

The music and words come to a place of completion (Turry, 2011, pp. 116–17)



We hope that you have learned about music therapy improvisation. Perhaps you can recognize how improvisation can be quite beneficial, both for patients and perhaps even for you. Thanks for reading!



Aigen, K. Social interaction in jazz: Implications for music therapy. Nordic Journal of Music Therapy, 22(3), 180-209.

Bunt, L. (2014). Music therapy: An art beyond words – second edition. Routledge. 

Bruscia, K. E. (1987). Improvisational models of music therapy. Thomas. 

Meadows, A., & Wimpenny, K. (2017). Core Themes in Music Therapy Clinical Improvisation: An Arts-Informed Qualitative Research Synthesis. Journal of Music Therapy,54(2), 161-195.

Molnar-Szakacs, I., Assuied, V. G., & Overy, K. (2011). Shared affective motion experience (same) and creative, interactive music therapy. Musical Imaginations Multidisciplinary Perspectives on Creativity, Performance and Perception, 313–331. 

Turry, A. (2011). Between music and psychology: A music therapist’s method for improvising songs. LAP LAMBERT Academic Publishing. 

L. Samuel Gracida

L. Samuel Gracida

Samuel is Sam's Fans Operating Director and our primary blogger!

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