What is improvisation?

Don’t we all know how to improvise? Yes

What IS clinical improvisation?

  • Crafting musical ideas in session that are individualized for the client or group
  • Creating music that is immediately responsive to the client
  • Creating and developing musical forms based on the ongoing process in sessions

What clinical improvisation is NOT:

  • Free-wheeling, self-gratifying music making
  • Music making that lacks any structure or organization
  • Music making that lacks a clinical focus


In the section entitled Preparation of a Session", Bruscia writes:

By their very nature, improvisational therapy sessions need to be spontaneous yet planned, and open-ended yet structured…

In some models, the therapist formulates a long-range goal plan or overall therapeutic approach at the beginning of therapy and modifies it at periodic intervals thereafter. In other models, the therapist maps out the direction of therapy in shorter time frames. In some models, the therapist makes detailed plans for each session, whereas in others, the therapist allows each session to emerge according to some natural or organic structure.

Whether the model employs highly structured, planned sessions, or very spontaneous and open-ended ones, all therapists make certain basic preparations.
— Kenneth Bruscia, Models of Music Therapy, p. 15.


My many years of clinical experience has demonstrated to me the direct communicative power of spontaneous music and musical changes. 

  1. Step 1: Be present, listen, observe, and be in touch with your clinical intuition & experience
  2. Step 2: Play, form, develop
  3. Step 3: Incorporate, listen, change, develop, end



The music we create in sessions is based upon many variables:

  • the client's musical and clinical goals
  • his present state of receptivity, energy, affect
  • the music therapist's available musical craft, repertoire and style

When we make an opening musical initiative, we are creating a basis or structure from which we can then elaborate, develop and change.

This structure may stem from any, or a combination of, the following elements:

  • rhythmic feel or groove
  • tonality (major, minor, modes, idioms)
  • melodic phrase
  • harmonic progression
  • style

This initial choice sets the stage for a musical path that follows predictably or with creative contrasts and surprise.

Know your musical craft


Working with Pre-Composed Music Improvisationally

The development of musical mobility will then depend on your deliberate use of what are here termed Expressive Components:

Changes in tempo: Accelerando, Ritardando, Tempo Contrast, Fermata, Rubato

Changes in dynamics: Forte, Piano, Crescendo, Diminuendo, Dynamic Contrast, Accentuation
— Nordoff & Robbins, Creative Music Therapy, p. 321




An ongoing examination of music and of the experiences individualized musical activity can bring to children shows what an enormous, unlimited range of active, self-integrative experience improvisation makes available for therapeutic realization. There is the open palette of emotional awareness on which to draw: in addition to the more commonly shared range of emotions, all kinds of individualized moods and nuances of feeling can be generated, all subtleties and progressions of change, all degrees of intensity, all qualities of intimacy and mutuality. Improvisation can readily convey experiences of form and order, from the minute to the extensive, the simplest to the highly complex. These include the predetermined forms that induce stability into activity, and the forms that are spontaneously, expressively realized.
— Nordoff & Robbins, Creative Music Therapy. p. 4.
Permeating everything musical are the basic elements of tempo and rhythm, fundamental to music and fundamental to our extramusical organization and life. The uniquely significant melodic element contains all the above, as well as the possibilities for expressive nonverbal communication. Moreover, the melodic element offers the evocative concurrences between speech and music—
which also make directly possible in song, the setting and expression of statements and concepts that have especial meaning for a child. All this is inherent in the relationship between the human being and music; all this is available for creative therapy with the music child.
— Nordoff & Robbins, Creative Music Therapy, p.4.