Nordoff-Robbins creative music therapy

1. Introduction

Version followed: Nordoff & Robbins, Creative Music Therapy: A Guide to Fostering Clinical Musicianship, 2nd ed. (2007, revised by Clive Robbins with colleagues at the New York, London and Australian centres; first ed. 1977), supplemented by later Nordoff-Robbins (NR) literature on adult work (Turry 2009) and team practice (Cooper 2010). [source: Barcelona Publishers book page] No legitimate preview of the 2007 or 1977 book text exists, so their step-level content is [uncertain]. Verified: the full table of contents of the 1977 first edition, whose Part Three lists the same clinical procedures as the 2007 Part Three (library catalogue record); the four stages by which a child's crying is led into singing, as quoted from the 2007 book by NR therapists (Freire et al. 2023); the levels and three response modes of Scale II, Musical Communicativeness, as used in a published reliability study (André et al. 2020); the chapter on categories of response in the 1971 book (publisher's contents); the bibliographic details and contents of the group book Here We Are in Music (Aigen 1997); and the authors of the hello-song article (Kantor & Kružíková 2016). Still not verified: the names and descriptions of the Thirteen Categories of Response, and the step-by-step content of the book chapters on free singing, leading into instruments, the basic beat, the tempo-dynamics schema and rhythm. Steps in 4.23–4.28 therefore remain largely [synthesis].

Professional frame first. This is not a technique a psychotherapist can pick up and use. NR is an improvisational music therapy approach practised by qualified music therapists with postgraduate NR training. Its central tool is the therapist's live, clinically directed improvisation, usually at the piano, which takes years of musical and clinical training. In the UK the Nordoff and Robbins charity runs a two-year Master of Music Therapy (MMT), validated by Goldsmiths, University of London. It is one of a handful of HCPC-approved qualifications, and HCPC registration is legally required to practise as a music therapist. [source: Nordoff and Robbins UK, Education and Training] In the US the Nordoff-Robbins Center for Music Therapy at NYU offers postgraduate certification for professional music therapists. Level I covers supervised individual and group clinical work plus weekly seminars in clinical musicianship, NR theory and group music therapy; Levels II and III cover advanced practice, supervision and training others. The Center is a CBMT Approved Provider. [source: NYU Nordoff-Robbins Center, Training Programs] US music therapists are usually board-certified (MT-BC via CBMT), and AMTA is the professional association [uncertain]. A psychotherapist without music therapy registration should not deliver NR. Refer, co-work, or take an introductory short course to understand the approach (the UK charity offers short courses, including for carers). [source: Nordoff and Robbins UK; synthesis]

What it is. Paul Nordoff (an American composer and pianist) and Clive Robbins (a British special educator) developed the approach over about 17 years of teamwork, from 1959 into the mid-1970s. They started with children who had varied disabilities, many of whom today would be described as developmentally delayed or autistic. After Nordoff's death, Clive and Carol Robbins extended it to hearing-impaired people. The London centre later took it into geriatric and palliative care and into work with adolescents and self-referred adults. [source: NYU Nordoff-Robbins Center, The Practice; Developments; Turry 2009]

How change happens (core idea). Every person has an inborn responsiveness to music. Nordoff and Robbins called this the Music Child, described as a universal sensitivity to music and its elements (Robbins & Robbins 1991, as cited in Sales & Freire 2024). Its counterpart, the Condition Child, is the person as currently shaped and limited by their condition. Live, aesthetically crafted music made together with the therapist engages the Music Child. As the client takes part more actively, expressively and communicatively, the person grows beyond the limits of the condition. [source: Sales & Freire 2024] The approach is music-centred. Interventions happen in the music, development is assessed through the client's musical responses, and musical forces (melody, harmony, rhythm, tempo, dynamics) are the main agents of change. [source: NYU Developments; Turry 2009] Clients make music with the therapist, not for an audience, and need no musical skill. [source: NYU, The Practice]

2. Framework

The available sources describe no formal fixed phase model with session counts. NR is open-ended and individualised. The stages below put together what the sources describe, and the transition criteria are partly synthesis.

Typical format. In the classic child model, sessions run about 30 minutes and are individual, with two therapists. The primary therapist improvises at the piano and leads the clinical-musical direction. The co-therapist works directly with the client, supporting participation and helping them respond to the music. Music-making is almost continuous. Every session is video- or audio-recorded. [source: Cooper 2010; Mahoney 2010; NYU, The Practice] A Greek NR therapist describes hospital sessions as individual or group, once weekly, 30–50 minutes, in a room with piano, guitar and percussion, recorded for the therapist's evaluation and kept confidential. [source: Froudaki, c. 2003] Adult work can be one therapist and one client, weekly. Courses can be long: Turry's (2009) case ran about 8 years and about 385 sessions. [source: Turry 2009] Groups are also run. The New York Center's group work is described in Kenneth Aigen's Here We Are in Music: One Year with an Adolescent Creative Music Therapy Group (1997, NR monograph series vol. 2), which follows four clients and two therapists, Alan Turry and Laura Beer, through a year of group sessions at the NYU Center (see 4.33). Its text is used here only through its catalogue record and contents list [uncertain]. [source: ECU Libraries catalogue record for Aigen 1997; NYU Developments] The UK charity also runs group and partner-organisation work, for example with Headway brain-injury services. [source: Nordoff and Robbins UK]

Stage A: Referral, intake and first sessions.

Goals: meet the client musically, find out how they respond to music, and begin a relationship.
How: instruments are set out around the room and the client is invited to explore them [source: Turry 2009]. A hello song gives structure and procedure [source: Kantor & Kružíková, citing Robbins 1993]. The therapists observe how the child responds, personally and musically, while drumming with the therapist at the piano, and how the child reacts to different idioms, elements and moods. This is what the Thirteen Categories of Response describe. [source: Mahoney 2010] Intake sessions are recorded and can be rated. [source: Mahoney 2010]
Move on when: there is a working hypothesis about the client's musical responses, their resistive patterns and the musical worlds that reach them [synthesis].

Stage B: Building musical communication and relationship.

Goals: build a positive relationship through a sequence of developing musical communication patterns [source: Kantor & Kružíková, citing Robbins 1993].
How: clinical improvisation, improvised and composed songs, instrumental work, and beat, tempo and rhythm work (2007 Part Three topics) [source: Barcelona TOC].
Progress is tracked with Scale I (the child-therapist relationship in coactive musical experience). Its levels of participation each have a resistive counterpart. [source: Mahoney 2010]
Move on when: indexing and ratings show the client reliably taking part at higher Scale I levels, and resistiveness is less fixed [synthesis based on scale design].

Stage C: Developing musical communicativeness, expression and independence.

Goals: increase the client's ability to use music to communicate (Scale II) and the complexity and quality of their musical activity, i.e. rhythmic and melodic forms (Scale III, "musicing"). Also increase expressive mobility, meaning less fixed tempo and dynamics (Tempo-Dynamic Schema). [source: Mahoney 2010; Barcelona TOC]
With verbal adults: clinically improvised songs whose words and music carry emotional themes. The therapist also attends to the psychological process, including countertransference. [source: Turry 2009]
Move on when: the client's gains in music (initiative, flexibility, communicative intent) are stable across sessions, and you can see them, or others report them, outside the session [synthesis].

Stage D: Ending [synthesis; the available sources describe no ending procedure].

Plan the ending with the client and carers. Signal it in the music: return to the client's significant songs, and use a goodbye song or ritual. Use recordings to review the journey where that is appropriate.

Ongoing across stages: indexing of each session, ratings on Scales I–III, team discussion, and supervision [source: Turry 2009; Mahoney 2010; Cooper 2010].

3. Guiding principles

[source: as tagged per item]

Everyone is musical (the Music Child). In practice: never require musical skill. Assume there is a responsive musical self, even in clients with no speech or severe disability. [Sales & Freire 2024; NYU, The Practice]
Look past the Condition Child. In practice: listen for what the person can do in music, not just for deficit. Growth is the person expanding beyond the condition. [Sales & Freire 2024]
Music is the primary agent of change. In practice: intervene through musical choices (tempo, harmony, dynamics, texture, silence) before words. [NYU Developments; Turry 2009]
Make music with people, not for them. In practice: the client is a co-creator, and the therapist's music exists to meet and extend theirs. [NYU, The Practice]
The therapist's music expresses the client, not the therapist. In practice: shape your improvisation to what you hear in the client's music and presence, not to your own taste. NR training teaches students to set aside their musical biases. [Sales & Freire 2024; Nordoff and Robbins UK]
Aesthetic quality matters clinically. In practice: the music you play must be well crafted and alive. Clumsy or stock playing will not engage the Music Child. [Turry 2009; Kantor & Kružíková, citing Nordoff & Robbins]
Clinical musicianship. Turry names six components: creative freedom, expressive spontaneity, controlled intention, clinical responsibility, methodical musical construction and intuition. In practice: every improvised choice should be both spontaneous and clinically intended. [Cooper 2010, citing Turry]
Work in the here and now and time interventions well. In practice: respond to the "psychological moment", Aigen's term for the empathically timed point at which to act [Cooper 2010; Sales & Freire 2024].
Resistance is relational. In practice: refusal, avoidance or disruption is a form of relating to be met musically, not a failure. Scale I pairs each participation level with a resistive counterpart. [Mahoney 2010]
Rigorous listening and documentation. In practice: record every session and index it afterwards. This is the scientific half of an approach NR describes as both artistic and scientific. [NYU, The Practice; Turry 2009]
Teamwork. In practice: the piano therapist and co-therapist both contribute. Their alignment, suggestions and occasional disagreements shape the music. [Cooper 2010]
Meet the client as an equal and think about power. In practice: the aim is to make a space where people thrive, not to "normalise" them. [Nordoff and Robbins UK]
Verbal processing is a matter of school position. In practice: NR practitioners range from full integration of verbal psychotherapy to treating the music as sufficient. Decide and document your position for each client. Turry (2009) integrates psychological thinking with music. [NYU Developments; Turry 2009]
Anthroposophical roots are a tradition's theory. Nordoff and Robbins were influenced by Rudolf Steiner's anthroposophy, including ideas about the "life of intervals", and by Zuckerkandl's philosophy of music. These are historical and theoretical influences, not established facts about how music acts on the body or mind. Do not present them to clients as such. [Turry 2009; Sales & Freire 2024; synthesis]

4. Intervention inventory

How to read this section: NR has no fixed list of scripted techniques. Its "interventions" are clinical-musical responses improvised in the moment. The entries below are the procedures and responses named in the sources. Where the 2007 book has a chapter on a technique but its content is not drawn on, the entry says so; its steps are marked [synthesis], and nothing in them is attributed to Nordoff or Robbins. All example language is illustrative. Most of the "language" in NR is musical, so the examples are mainly co-therapist prompts or words sung by the therapist.

4.0 Practice frame and safety (applies to every intervention)

Who may deliver: registered and NR-trained music therapists only (HCPC in the UK; NR certification in the US). Psychotherapists refer in or co-work. [source: Nordoff and Robbins UK; NYU Training Programs]
Hearing safety: drums, cymbals and amplified or loud piano can push therapists over workplace noise action levels. A monitored music therapist's exposure over 10 days reached the lower action values of the UK Control of Noise at Work Regulations 2005. The authors recommend a noise risk assessment, control of exposure, hearing protection, and health surveillance where indicated. [source: MacMahon & Page 2015] Practical steps [synthesis]:
- Choose cymbal and drum sizes and beaters to suit the room.
- Use soft mallets with noise-sensitive clients.
- Provide ear defenders for clients with hyperacusis or sensory sensitivity, and check how they hear their own playing.
- Use musician's earplugs for therapists running many loud sessions.
- Keep peak sounds off the client's ear: no cymbal crashes at head height near a client.
Musical trauma triggers [synthesis; not addressed in the available sources]. Some sounds, songs, idioms or styles may be linked to trauma, for example music played during abuse, war or a funeral, a loud sudden crash or startle, or religious or national music. Ask the client and carers about music to avoid at intake. Watch for sudden freezing, startle, covering ears or dissociation, and drop to soft, predictable, steady music if they appear. Never use a known trigger deliberately as "exposure".
Physical safety [synthesis]:
- Check instruments for sharp edges, loose parts and small parts that a child could swallow.
- Secure cymbal and drum stands against tipping.
- Keep clear space around a client who moves or throws, and set drumsticks aside if they are being used to hit people.
- Clean wind instruments between users.
Children: follow local safeguarding and mandatory-reporting procedures. Get consent from parents or carers and age-appropriate assent from the child, and respect non-verbal dissent (turning away, distress). Agree with carers how session recordings will be stored and used, since every session is recorded. [synthesis; recording practice from NYU, The Practice]
Touch. The co-therapist works directly with the client to support participation [source: Cooper 2010]. Any physical guidance, such as hand-over-hand help with a beater, needs explicit prior agreement with carers and the client's assent. Use it only when needed, stop on any sign of refusal, keep it to hands and arms, and never make sexual or intimate contact. Take account of cultural and trauma history. [synthesis]
Not diagnostic: NR scales and Thirteen Categories describe musical response and relationship. They are not evidence of abuse, trauma or diagnosis. [synthesis; reliability limits under 4.29–4.32]

4.1 Room set-up and first-session exploration

Purpose / when: first sessions and intakes. Lets the client find instruments and lets the therapists see spontaneous musical behaviour. [source: Turry 2009]
Steps:
1. Place a range of conventional and specialised instruments around the room [source: NYU, The Practice; Turry 2009].
2. In the classic child format, place a drum and cymbal where the client can play while the therapist plays piano [source: Mahoney 2010, on drumming with the therapist at the piano].
3. Start recording (video if consent allows) [source: NYU, The Practice].
4. Invite exploration, and support it from the piano with music that follows the client's activity [source: Turry 2009].
5. Afterwards, index the session and note responses (see 4.3, 4.29) [synthesis].
Example language (illustrative): Co-therapist: "Have a look — any of these you want to try." Therapist (sung over piano): "You found the drum, you found the drum."
Watch for: what the client avoids as much as what they pick up, and responses to particular idioms or moods. Working sign: the client starts to orient to the piano music.

4.2 Hello song and goodbye song

Purpose / when: greeting songs play a structural and procedural role in Creative Music Therapy. They should reflect the individual child and be of high aesthetic quality. [source: Kantor & Kružíková, citing Robbins 1993 and Nordoff & Robbins] The available sources do not describe goodbye songs; using one to close is [synthesis].
Steps:
1. Improvise or compose a greeting that uses the client's name and fits their tempo and energy on arrival.
2. Keep its core form stable from week to week so it becomes a recognisable frame, and vary details to match the client's state that day.
3. Leave places in the phrase for the client to contribute: a beat, a sound, their name.
4. Close with a matching goodbye song. [synthesis, built on the cited role]
Example language (illustrative, sung): "Hello Sam, hello Sam, it's good to see you here today."
Watch for: anticipation, such as the client filling a gap or beating at the expected moment. Avoid stale, formulaic songs; the sources stress aesthetic quality and individual reflection.

4.3 Thirteen Categories of Response (assessment)

Purpose / when: intake and early sessions with children. The Thirteen Categories of Response are a tool for describing how an individual child responds while beating a drum with the therapist at the piano, including reactions to different idioms, elements and moods. Mahoney cites them to Nordoff & Robbins (1965) and to Bruscia's 1987 summary. [source: Mahoney 2010] The founders' 1971 book has a chapter titled "Individual Music Therapy: Categories of Response". [source: Barcelona Publishers page for Therapy in Music for Handicapped Children] The 1977 and 2007 contents lists have no chapter with this title. [source: ECU Libraries catalogue record for Nordoff & Robbins 1977; Barcelona TOC] The names and definitions of the thirteen categories are not given in any publicly available source used here [uncertain]. Learn them from the 1971 book, Bruscia (1987) or NR training; do not improvise your own version and call it the NR categories.
Steps:
1. Give the child a drum (and cymbal) and improvise at the piano.
2. Vary idiom, tempo, dynamics and mood systematically while staying responsive.
3. Afterwards, from the recording, classify the child's beating and response using the published categories. [steps 1–2 synthesis from the published description]
Example language (illustrative): Co-therapist: "Let's play the drum with the piano."
Watch for: whether the child's beating is free or rigid and whether it relates to the piano music at all. Use the categories to plan, not to diagnose.

4.4 Teamwork: primary therapist and co-therapist

Purpose / when: classic individual child sessions. The primary therapist at the piano sets the clinical-musical focus and decides moment to moment what to play. The co-therapist works directly with the client to support participation and responses to the music and the primary therapist's intentions. [source: Cooper 2010] The 2007 book has a chapter on teamwork, whose content is [uncertain].
Steps:
1. Agree before the session on the focus and on each person's role.
2. In the session, the co-therapist positions themself near the client, models, prompts, and helps hold instruments or beaters (with consent; see 4.0). They do not take over the musical lead.
3. The primary therapist takes in the co-therapist's suggestions and adopts or declines them depending on whether they fit the musical direction.
4. Review the recording together. [source: Cooper 2010 for steps 2–3 in outline; details synthesis]
Example language (illustrative): Co-therapist to client: "Listen — the piano's waiting for you." Co-therapist to primary therapist (a look or nod, or a brief word): "slower?"
Watch for: the co-therapist over-prompting so the client's own initiative is lost, and the two therapists pulling in different directions. Cooper's therapists described balancing alignment against accommodation.

Entries 4.5–4.16 are clinical-musical responses named by five NR therapists in Cooper's (2010) interview study [source: Cooper 2010]. Step detail beyond the named response is [synthesis].

4.5 Framing

Purpose / when: present the client's musical offering back in a pleasing, coherent musical setting, so the client feels free to offer new ideas. Use it when the client produces tentative or fragmentary sounds.
Steps:
1. Catch the client's sound or pattern.
2. Place it inside a clear harmonic and rhythmic setting at the piano, for example by harmonising it, repeating it as a motif, or ending phrases on it.
3. Leave space for the next offering.
Example language (illustrative, sung): "That's your sound — bom, bom — and the piano sings it too."
Watch for: the client repeats or extends the offering, or offers something new. If they stop, your frame may be too loud or busy; thin it (4.14).

4.6 Matching and supporting intensity

Purpose / when: meet intense expression with music of matching drama, so emotional release can happen inside the music. Use it when the client plays or vocalises forcefully.
Steps:
1. Match the energy, density and register of the client's playing.
2. Give it musical shape (phrase, harmonic direction, climax).
3. Be ready to lead the shape down afterwards (4.7).
Example language (illustrative): Co-therapist: "Big drum! Keep going with the piano."
Watch for: the difference between expressive intensity, which is organised and connected to the music, and escalation into dysregulation, which is disconnected and unsafe. In the second case switch to containment. Hearing safety applies (4.0).

4.7 Calming and containment

Purpose / when: lower escalating energy, or keep the musical environment going when the client is fragile. Cooper's therapists used melodic, calming music, a quiet steady rhythm, and repetitive descending chords with a lullaby-like quality.
Steps:
1. Start from the client's current level so you do not abandon them.
2. Reduce tempo, dynamics and density gradually.
3. Settle into a predictable, steady pulse, or a repeated descending harmonic pattern.
Example language (illustrative, sung softly): "Slow now, slow now, we can rest here."
Watch for: slowing breath, softer playing, re-engagement. If the client escalates further, the change may have come too abruptly.

4.8 Musical dialogue (call and response)

Purpose / when: encourage the client to initiate communication. Leave intervals of space and engage in call and response.
Steps:
1. Play a short phrase.
2. Leave a clear gap, and hold the pulse silently or with a sustained chord.
3. Answer whatever the client puts in the gap.
4. Gradually lengthen or vary the phrases.
Example language (illustrative, sung): "I play … (pause) … now you."
Watch for: the client filling the gap at the right moment, and later starting exchanges themselves. That turn-taking is a key sign of communicativeness (see Scale II, 4.31).

4.9 Holding back (waiting)

Purpose / when: withhold an immediate response so the client can struggle and release energy, and signal that the therapist will wait.
Steps:
1. Sustain a quiet chord or pulse, or simply stay present without adding.
2. Keep your body orientation and readiness visible.
3. Re-enter when the client offers.
Example language (illustrative): usually none. A co-therapist may whisper "We'll wait for you."
Watch for: a client who needs more structure than waiting gives. A long wait can feel like abandonment; return to supportive playing.

4.10 Deliberate silence

Purpose / when: used when the client's responses move out of the musical realm, e.g. leaving the instruments for non-musical activity.
Steps:
1. Stop playing cleanly.
2. Let the silence register.
3. Re-enter with a clear musical invitation linked to the client's last musical moment.
Example language (illustrative): Co-therapist: "The music's stopped … it's waiting for the drum."
Watch for: the client noticing the silence and returning. If silence brings distress or a rise in self-injury, resume soft music.

4.11 Offering an alternative musical world

Purpose / when: decline to follow the client's playing, for example rigid drumming, and propose different music for them to join. Use it when following would reinforce a stuck, repetitive pattern.
Steps:
1. Briefly acknowledge the client's music.
2. Set up a contrasting tempo, idiom or mood, and sustain it long enough to be attractive.
3. Leave a door open for the client to step into it.
Example language (illustrative, sung): "Your drum goes boom-boom-boom — come and hear this song."
Watch for: the client adapting to the new music, which is a sign of flexibility. If they withdraw, return to meeting them first.

4.12 Unpredictability and musical teasing

Purpose / when: draw responses from a provocative or teasing client, and encourage two-way responsiveness through playful music.
Steps:
1. Set up an expectation, for example a repeated phrase.
2. Break it playfully with a surprising pause, an unexpected chord, or a sudden soft or loud moment.
3. Respond with delight to the client's reaction.
Example language (illustrative, sung): "I'm going to stop … just … NOW!"
Watch for: laughter, anticipation and eye contact. Avoid startling or loud surprises with clients who startle easily or have a trauma history (4.0).

4.13 Familiar song material

Purpose / when: play a song the client may know to invite a response. The 2007 book has a chapter on "Singing and Songs", whose content is [uncertain].
Steps:
1. Choose material from the client's culture, age and history, asking carers if you need to.
2. Play it in a responsive way, adapting tempo and key to the client and leaving gaps for them to fill.
Example language (illustrative): "Do you know this one? You sing the last word."
Watch for: recognition (orienting, smiling, joining in). Screen for songs with painful associations (4.0).

4.14 Texture reduction

Purpose / when: thin dense piano textures (Cooper's example is lifting the pedal) so that the client can hear themself and be heard.
Steps: drop the sustain pedal, reduce the voicing to two or three notes, move away from the client's register, and lower dynamics.
Example language (illustrative): none; this is a musical act.
Watch for: the client's sound becoming more audible and more deliberate.

4.15 Singing to console and empathise

Purpose / when: use the voice to console, to respond to a smile, or to convey empathy with sadness.
Steps:
1. Sing simply and close to the client's register.
2. Use words that name what you observe, or wordless vocal lines.
3. Support the voice with sparse harmony.
Example language (illustrative, sung): "You look sad today, and that's okay here."
Watch for: the client turning towards the voice or vocalising back.

4.16 Changing material: song form and free improvisation

Purpose / when: shift the music when clinical needs change, for example moving from song forms into free improvisation, or back into a song for structure.
Steps: move to songs when the client needs predictability, and move to free improvisation when the client can tolerate openness and you want more initiative. Make transitions musically, for example through a pivot chord, rather than with an abrupt stop.
Example language (illustrative): Co-therapist: "Let's make up our own music now."
Watch for: the client's capacity for structure versus freedom. Note which works on the recording.

Entries 4.17–4.22 are harmonic and vocal resources described in an adult case of clinically improvised songs (client with stage 4 non-Hodgkin's lymphoma) [source: Turry 2009]. Use them in the same way with any verbal client who sings. Step detail is [synthesis].

4.17 Supporting the voice through chord-tone placement

Purpose / when: support a client's singing from the first moment, and shape their confidence and emotional colour by which chord tone their melody sits on (root, third, fifth, sixth, seventh, ninth). Turry tabulates the effects he observed.
Steps:
1. Follow the client's sung line, and harmonise so that it lands on a stable tone (root, fifth) when they need confidence.
2. Re-harmonise so the same note becomes a sixth, seventh or ninth when you want more poignancy or openness.
Example language (illustrative): "Keep singing — I'll find you on the piano."
Watch for: changes in vocal volume, sustain and expressiveness as harmony changes.

4.18 Modal and harmonic colour

Purpose / when: give emotional states a musical home. Turry used Dorian mode and minor ninth chords to support sadness, Lydian mode for hope and imagery, and harmonic ambiguity to hold unresolved feelings.
Steps: choose a mode or chord type to fit the expressed feeling, hold it long enough for the client to inhabit it, and change it only as their expression changes.
Example language (illustrative): "What would the music sound like if it had hope in it?"
Watch for: the client's words or vocal quality shifting with the colour. These are associations observed in one case, not fixed rules [synthesis].

4.19 Ostinato as a stable base

Purpose / when: a stable repeated figure gives safety, which allows freedom in dynamics, tempo and responsiveness.
Steps: set a simple left-hand ostinato, keep it steady, and improvise freely above it while the client sings or plays.
Example language (illustrative): "This pattern will keep going — you can go anywhere over it."
Watch for: greater client risk-taking while the ostinato holds.

4.20 Transitional harmony

Purpose / when: move the client gradually toward a new emotional state. Turry used two harmonically incompatible chords sharing a common tone to signal transformation, and repeated contrasting chords to lead gradually.
Steps: alternate the current chord with a new chord that shares one tone, let the client settle on the shared tone, then let the new chord predominate.
Example language (illustrative): none; this is a musical act.
Watch for: the client following the change or resisting it. If they resist, return to the original colour.

4.21 Figuration and imagery

Purpose / when: evoke imagery and relational qualities. In Turry's case, flowing arpeggios suggested motion or travel, parallel thirds suggested companionship, parallel dissonant intervals suggested tension, and open inverted chords left room for the client's melody and a sense of mutuality.
Steps: choose the figure to match the image or relationship the client is expressing, and keep it below the client's register.
Example language (illustrative): "It feels like we're travelling somewhere."
Watch for: imagery appearing in the client's improvised words.

4.22 Clinically improvised songs (verbal clients)

Purpose / when: with adults and verbal young people, the client improvises words and melody while the therapist improvises piano. The songs link feelings (e.g. about illness) to life-long themes. In Turry's case these included being "stifled". Words and music influence each other.
Steps:
1. Start with piano support and invite the client to sing whatever comes.
2. Follow their melodic direction, e.g. with an ascending line that does not resolve, creating suspense.
3. Use driving rhythm and dynamics when the client needs to sing more assertively.
4. Watch non-verbal cues (finger snapping, swaying, head movement) for the tempo and style they want.
5. After the session, review recordings and attend to the psychological meaning and your countertransference.
Example language (illustrative): "Sing about what's on your mind, even one word, and I'll play with you."
Watch for: growing confidence in shaping the music, and emotional material that may need verbal processing and integration with other psychological care. Coordinate with the client's other therapists.

Entries 4.23–4.28 are the clinical procedures set out in Part Three of the 2007 book, "The Practice of Clinical Musicianship" [source: Barcelona TOC]. The 1977 first edition already had them, in Part Three, "Clinical Techniques and Procedures": creating a musical-emotional environment; putting music to the movements of a musically inactive child; matching a child's outburst or crying; using physical forcefulness; leading into singing; leading into instrumental activity; working with the child's way of beating and leading into the basic beat; expressive musical mobility and communicative emotional experience in beating; and rhythmic structure (perception, control and forms of experience). Each is illustrated with short case stories. [source: ECU Libraries catalogue record for Nordoff & Robbins 1977] The chapter texts are not publicly available [uncertain]. One procedure, the four stages from crying into singing, was verified through a quotation by NR therapists (4.23). Otherwise each entry gives the topic as published, any detail verified from NR case reports, and cautious [synthesis] steps, with no claim about Nordoff and Robbins' exact method. Learn these through NR training and the book's audio examples. The 1977 headings "Creating a musical-emotional environment", "Putting music to the movements of a musically inactive child" and "On using physical forcefulness" have no separate entry here because their content is not publicly available [uncertain]; 4.1, 4.6 and 4.25 cover related ground in [synthesis] form.

4.23 Meeting a child's crying or outburst

Purpose / when: respond musically when a child cries or has an outburst in session. The 1977 book's section is titled "Matching a child's outburst or crying"; the 2007 Chapter 9 uses a child called Nunnu as its case. [source: ECU Libraries catalogue record for Nordoff & Robbins 1977; Barcelona TOC] NR therapists describe Nordoff and Robbins as hearing all a client's sounds and movements as possible musical expression, including those of children who arrived crying, and as helping the child go from crying into singing. [source: Freire, Sales, Rodrigues & Turry 2023]
The four stages (verified): the 2007 book (p. 216, as quoted by Freire, Sales, Rodrigues & Turry 2023) describes a progression:
1. vocalising that is influenced tonally, rhythmically or expressively by the music;
2. "crying-singing": the more or less continuous crying starts to be shaped by the improvisation;
3. "singing-crying": the child begins to sing on purpose with her crying voice;
4. "non-crying self-expressive singing": the start of a vocal musical partnership.
Steps [synthesis, organised around the four stages]:
1. Do not stop the session reflexively. First rule out pain, illness or sensory overload.
2. Take the pitch, rhythm and intensity of the crying as musical material, and meet it with supportive harmony (4.6), without mocking or caricaturing it. (In an NR case of laughter rather than crying, the therapist shaped their vocal improvisation to match the pitch and duration of the child's laughing. [source: Freire, Sales, Rodrigues & Turry 2023])
3. Listen for any moment when the crying follows the music (stage 1) or takes on its shape (stage 2), and make the music clearer and more predictable around it.
4. When the child seems to be singing through the crying (stage 3), leave spaces and answer the voice as a partner (4.8).
5. If distress is escalating or appears physical (pain, illness, sensory overload), stop the music and attend to care needs.
Example language (illustrative, sung): "You're crying, crying, I hear you crying."
Watch for: the crying taking on musical shape and moving through the stages above, versus escalation. Stop if there are signs of pain or panic.

4.24 Stimulating free singing (nonverbal or verbal)

Purpose / when: draw out spontaneous vocal expression in non-verbal and verbal clients. The 1977 book's section is "Leading into singing", with a case titled "Pernilla and the children's tune"; its Part Five adds material on speech and music, setting speech phrases and singing with improvisations. The 2007 Chapter 10 is "Stimulating Free Singing, Nonverbal or Verbal". [source: ECU Libraries catalogue record for Nordoff & Robbins 1977; Barcelona TOC] The chapter's procedure is not publicly available [uncertain].
Verified case detail: in a published NR case, the therapists led a girl's laughter into singing. They matched the pitch and duration of her sounds with their own voice, left deliberate spaces for her to answer ("laughing in the tempo"), used a recurring precomposed song with call-and-response gaps, and set a repeated minor chord cycle and waited for her vocal "call". Her singing later widened to new vowels, timbres and registers. [source: Freire, Sales, Rodrigues & Turry 2023]
Steps [synthesis, drawing on that case]:
1. Pick up any vocal sound the client makes, and sing it back inside a phrase (4.5), matching its pitch and length.
2. Leave gaps where their voice fits (4.8), and keep a steady harmonic cycle underneath so the gaps are predictable.
3. Use open vowels and a comfortable register.
4. With verbal clients, set their spoken phrases to melody and invite them to sing them back or change them (see 4.22).
Example language (illustrative, sung): "Aah … (gap) … aah."
Watch for: more frequent and more pitched vocalising, imitation of contour, and the client starting vocal exchanges.

4.25 Leading into instrumental activity

Purpose / when: move a client from passive listening or vocal activity into playing instruments. The 1977 section is "Leading into instrumental activity", with a case titled "Philip and a peekaboo-piano-playing game"; the 2007 Chapter 12 has the same title. [source: ECU Libraries catalogue record for Nordoff & Robbins 1977; Barcelona TOC] The chapter's procedure is not publicly available [uncertain]. In one NR case the child often threw instruments or held her hands behind her back; in a later session she played egg shakers together with the co-therapists while the therapist sang and played guitar. [source: Freire, Sales, Rodrigues & Turry 2023]
Steps [synthesis]:
1. The co-therapist offers an instrument at the right musical moment, for example at a phrase ending.
2. The piano creates an obvious place for a beat or stroke.
3. If the client refuses to hold an instrument, the co-therapist plays alongside them with a small, easy instrument rather than pressing.
4. Celebrate the first sound musically.
Example language (illustrative): Co-therapist: "Here's the drum — the piano's leaving a space for you."
Watch for: the client's own initiative versus compliance with prompting.

4.26 Working with the child's way of beating: leading into the basic beat

Purpose / when: start from however the child beats a drum, and help them find and share a steady basic beat with the music. The section has the same title in the 1977 book, with a case titled "Melvin, a hymnlike song and the tango", and in the 2007 Chapter 13; the 1977 Part Five also has an improvisation exercise on the basic beat for the therapist. [source: ECU Libraries catalogue record for Nordoff & Robbins 1977; Barcelona TOC] The Thirteen Categories of Response describe children's responses at the drum with the therapist at the piano. [source: Mahoney 2010] An analysis of recordings of Nordoff and Robbins' sessions with ten children (Hadar's time model) describes the therapist first setting up a temporal expectation through pauses, musical space and antiphonal playing, then drawing the child into synchronised playing: simultaneous singing or playing, a shared beat and longer stretches of play together. [source: Epp 2026, reviewing Hadar] The chapter's own procedure is not publicly available [uncertain].
Steps [synthesis]:
1. First match the child's own beating (fast, irregular or fixed) at the piano.
2. Within that match, introduce a clear, attractive pulse.
3. Leave space and phrase endings that make a steady beat rewarding.
4. Reinforce any moment of shared pulse with musical arrival.
Example language (illustrative, sung): "Beat, beat, beat with me."
Watch for: brief moments of synchrony, then longer stretches of it. Rigid, unvarying beating that does not respond to the music suggests a stuck pattern (see 4.11; 5).

4.27 Tempo-Dynamic Schema (expressive musical mobility)

Purpose / when: assess and widen a client's expressive range of tempo and dynamics. The 1977 section is "Expressive musical mobility and communicative emotional experience in beating"; the 2007 Chapter 14 is "Expressive Musical Mobility: The Tempo-Dynamics Schema". [source: ECU Libraries catalogue record for Nordoff & Robbins 1977; Barcelona TOC] The schema links emotional states to musical expressivity through tempo and dynamic range. A state is called "pathological" when it is inflexible and musically meaningless, and "normal" when it falls within common musical practice. [source: Mahoney 2010, citing Bruscia 1987] The schema itself is not publicly available [uncertain].
Steps:
1. From the recording, chart the tempo and dynamic range the client actually uses [synthesis].
2. In session, invite movement outside that range gradually: a little slower, a little softer [synthesis].
Example language (illustrative): Co-therapist: "Can the drum go very quiet … like a mouse?"
Watch for: increasing flexibility. The "pathological" label applies to musical states, not to the person, and is not a diagnosis.

4.28 Rhythm: forms, levels of experience and developing rhythmic skills

Purpose / when: structure rhythmic development. The 1977 section is "Rhythmic structure: perception, control, and forms of experience"; the 2007 Chapter 15 covers forms and levels of rhythmic experience and perception and developing rhythmic skills. [source: ECU Libraries catalogue record for Nordoff & Robbins 1977; Barcelona TOC] Scale III includes hierarchies of rhythmic forms, derived mainly from drum work, ordered by complexity. [source: Mahoney 2010] The chapter's procedure is not publicly available [uncertain]. In one NR case the therapist introduced a compound metre (12/8) to fit the rhythm of the child's laughs, and later used a more flexible tempo and looser phrase structure. [source: Freire, Sales, Rodrigues & Turry 2023]
Steps [synthesis]: once a basic beat is established, introduce accents, rhythmic patterns and changes of metre and tempo, at the client's pace. Choose a metre that fits the rhythm the client already produces before asking them to fit yours.
Example language (illustrative, sung): "Boom-boom-TAP, boom-boom-TAP."
Watch for: the client imitating and then initiating rhythmic patterns.

4.29 Indexing (session documentation)

Purpose / when: after every session. Record the session and analyse it closely, noting client and therapist musical events and tying them to numbered time points on the recording. [source: Mahoney 2010; Turry 2009] Indexing is said to build the rigorous, precise listening the approach needs (R. Verney, cited in Turry 2009).
Steps:
1. Play back the whole session.
2. Log each significant musical event (client initiative, a change in your playing, response or non-response) against the time code.
3. Mark key excerpts.
4. Note your own responses and their effect, and how your music and the client's music interacted.
5. Plan the next session from the index. [steps 1–3 synthesis; step 4 from Turry 2009]
Example language (illustrative, an index entry): "12:40 C. pauses, looks at piano; T. holds dominant; C. strikes drum on resolution."
Watch for: time cost. Indexing is labour-intensive, but it is central to the approach and to supervision.

4.30 Evaluation Scale I: client-therapist relationship in musical activity

Purpose / when: rate the developmental level of the musical relationship over a session or course of therapy. Originally 10 participation levels, each with a resistive counterpart (20 behaviours). Level 10 was later dropped as more group-related, and the first three levels were collapsed, leaving 7 levels and 14 items. In the 2007 edition the scale is titled "The Child-Therapist Relationship in Coactive Musical Experience". It is the most used NR scale and the one most taught. [source: Mahoney 2010; Barcelona TOC]
Steps: rate from the recording over the whole session. Robbins suggested rating several segments or equal divisions of one session. [source: Mahoney 2010]
Reliability: in one study, 34 certified therapists rated 2–4-minute excerpts. 78% of ratings fell within one point of the mean (82% for NR-trained raters, 74% for others), and agreement was lowest (49%) for a strongly resistive excerpt. The study reported no validity data and said there were no earlier published reliability studies. [source: Mahoney 2010] NR scales were described in 2010 as "under evaluation". [source: von Moreau et al. 2010]
Watch for: low agreement on resistive behaviour. Do not use the scales as standardised outcome measures without further validation [synthesis].

4.31 Evaluation Scale II: musical communicativeness

Purpose / when: chart the client's ability to use music as communication. [source: Mahoney 2010] Versions differ: Mahoney (2010) describes the scale as having 10 levels; the version used in a 2020 Brazilian reliability study, based on Nordoff & Robbins (2007), has 7 levels. [source: Mahoney 2010; André, Gomes & Loureiro 2020] [uncertain: which edition each describes]
Structure (2007-based version, paraphrased): responses are rated separately in three modes, instrumental, vocal and body movement, with a fourth column for the overall score. The seven levels rise from no communicative musical response; through evoked responses that are first fleeting and fragmented, then more sustained and musically related; to awakening musical awareness, shown intermittently and with intent; then sustained, directed responses with growing motivation; then firmly established communicative participation with growing musical self-confidence and independent use of rhythm, melody and expression; and finally musical intelligence and skills working freely and competently, with enthusiasm for musical creativity. [source: André, Gomes & Loureiro 2020, Table 1] Use the published scale and its manual for ratings, not this summary.
Steps: rate from video. In the reliability study, trained raters with a manual scored 30-second excerpts as a form of microanalysis; in clinical use the published form and NR training set the unit of rating. [source: André, Gomes & Loureiro 2020; synthesis for clinical use]
Reliability: five music therapists rated 24 excerpts from two children (one in music-centred music therapy, one in neurologic music therapy). Mean Spearman correlations between raters were about 0.79 (instrumental), 0.87 (vocal), 0.68 (body movement) and 0.73 (total); agreement was weakest for body movement. The paper's tables and text are not fully consistent. The scale has been translated into Brazilian Portuguese, and Scales I and III have Portuguese versions too. [source: André, Gomes & Loureiro 2020]
Watch for: any rise from responding to initiating. Treat body-movement ratings with most caution.

4.32 Evaluation Scale III: musicing (forms of activity, stages and qualities of engagement)

Purpose / when: separate hierarchies of rhythmic forms (from drum work) and melodic forms (from vocalising or singing), ordered by complexity. In 2007 it was retitled to cover forms of activity, stages and qualities of engagement. [source: Mahoney 2010; Barcelona TOC]
Steps: rate from recordings, and plan rhythmic and melodic next steps from them (4.26–4.28) [synthesis].
Watch for: do not confuse musical skill learning with therapeutic progress. The scales concern engagement and communication [synthesis].

4.33 Group work

Purpose / when: NR has used groups from the start. The 1971 book covers composed songs, instrumental activities and music theatre for groups, alongside individual improvisation, with chapters on experimental group activity, "Pif-Paf-Poltrie: The Working Game as Therapy", group activities with "trainable" children and a rationale for group music therapy. [source: Barcelona Publishers page for Therapy in Music for Handicapped Children] The New York Center's improvisational group work is described in Aigen's Here We Are in Music (1997), a year with an adolescent group led by Alan Turry and Laura Beer. Its contents cover body communication and physical contact, group process (challenging the leaders, making room for feelings), the aftermath of conflict, group cohesion, termination, and the role of music in facilitating transitions, meeting individual and group needs, working with physical expressions, increasing emotional self-awareness and enhancing interpersonal relating. [source: ECU Libraries catalogue record for Aigen 1997] NYU Level I training includes group music therapy seminars, and the UK charity works with groups in partner organisations. [source: NYU Developments; NYU Training Programs; Nordoff and Robbins UK]
Steps [synthesis]: use songs and instruments with defined roles (e.g. a part each in a composed or improvised piece), and keep the piano as the organising centre. Give each member moments of individual musical attention inside the group form. Expect challenges to the leaders and conflict as part of group process, and use the music to carry the group through transitions and endings.
Example language (illustrative): "Everyone plays on the big chord — then just the drums."
Watch for: members who disappear in the group sound; use solos and dialogue. Agree rules on physical contact in adolescent groups in advance (see 4.0).

4.34 Developing musical resources (therapist practice)

Purpose / when: ongoing therapist training. The 2007 Part Five offers improvisation exercises, techniques and idiomatic styles, and the book covers piano and vocal technique and the use of varied musical resources. [source: Barcelona book page] Nordoff also composed therapeutic material, e.g. Music for Eleven Eurhythmy Exercises [source: Foster 2021 review].
Steps [synthesis]: practise improvising in a wide range of idioms, modes and styles, including the client's own cultural music. Review your recordings for musical habits that limit your responsiveness, and take NR supervision.
Watch for: relying on a narrow personal style. NR UK training explicitly works on setting aside one's own musical biases [source: Nordoff and Robbins UK].

5. Handling problems

Source-based guidance is tagged with its source. Everything tagged [synthesis] is this guide's own practical advice and is not from NR sources.

Resistive behaviour (refusal, avoidance, disruption). NR treats resistance as relational; each Scale I level has a resistive counterpart [source: Mahoney 2010]. Responses:
- hold back and wait (4.9);
- use playful unpredictability or teasing with provocative clients (4.12);
- offer an alternative musical world instead of fighting (4.11) [source: Cooper 2010].
- Rate the resistive level separately so you can see change in resistance itself [synthesis].
Stuck, repetitive or perseverative playing (e.g. fixed, unvarying beating at one tempo and loudness). The Tempo-Dynamic Schema frames inflexible, musically meaningless states as the target [source: Mahoney 2010]. Responses [synthesis]:
- match the pattern first;
- then add small variations around it: an accent, a change of harmony, a pause;
- or offer contrasting music (4.11).
- Check the index for which change has ever produced a shift.
Client leaves the musical frame (wandering, non-musical activity). Use deliberate silence, then a clear musical re-invitation (4.10) [source: Cooper 2010]. The co-therapist can re-orient gently [synthesis].
Escalating intensity or overwhelm. Meet the intensity, then shape it down: calming music, a steady quiet rhythm, repeated descending harmonies, thinner texture (4.6, 4.7, 4.14) [source: Cooper 2010]. If the client is dysregulated or at risk of injury, stop. Prioritise safety by moving instruments and beaters, and lower volume and light. Use carers' known regulation strategies [synthesis].
Crying or outbursts. Both editions have a dedicated section, whose text is not publicly available [uncertain]; the four stages from crying into singing were verified through a quotation (see 4.23) [source: Freire, Sales, Rodrigues & Turry 2023]. Rule out pain, illness or sensory overload first [synthesis].
Sensory overload and hearing. Some autistic clients, and clients with hyperacusis, find loud piano, cymbals or drums aversive. Responses [synthesis]:
- start soft;
- offer ear defenders;
- let the client control their own volume;
- move loud instruments away from them.
- Protect therapists' hearing too: do a noise risk assessment and use hearing protection [source: MacMahon & Page 2015].
Musical trauma triggers [synthesis]:
- Signs: sudden freezing, startle, ear-covering, dissociation, or distress at a song, idiom, instrument or loud crash.
- In the moment: stop or soften to predictable, steady, quiet music. Name safety simply ("The music's quiet now"). Do not continue the triggering material.
- After the session: record the trigger and add it to an "avoid" list agreed with the client and carers. Liaise with the client's psychotherapist if the trigger relates to trauma.
Emotional material emerging in adult work. Turry's case shows improvised songs bringing out denial, repression and life themes, and the therapist working with countertransference [source: Turry 2009]. NR practitioners differ on how much verbal processing to add [source: NYU Developments]. Agree the position with the client [synthesis]. If you are the client's psychotherapist and someone else is the music therapist, agree a plan with the client's consent for sharing material across the two therapies [synthesis].
Co-therapist disagreement or misalignment. Cooper's therapists described balancing alignment against accommodation, and sometimes declining a co-therapist's suggestion [source: Cooper 2010]. Agree roles beforehand, use agreed non-verbal signals, and debrief from the recording [synthesis].
Ruptures (client angry at the therapist, or refuses to enter the room) [synthesis]:
- acknowledge the rupture musically or verbally, and don't press for participation;
- offer a minimal, low-demand musical presence (e.g. play softly near the doorway if that is safe and the setting allows);
- review on the recording what preceded it.
Non-attendance or irregular attendance [synthesis]: NR work relies on continuity and recorded progression. Agree attendance expectations with carers or partner organisations, and use the hello song and familiar material to re-establish the frame after gaps.
Pressure to "perform" or to produce visible skill. NR is not music lessons. Explain to carers that the goals are engagement, communication and relationship (Scales I–III), not musical skill as such [synthesis; source: Mahoney 2010 for scale content].
Over-reading the scales or using them as diagnosis. Reliability data are limited, and agreement drops on resistive behaviour [source: Mahoney 2010]. Never use NR ratings, drum beating patterns or song content as evidence of abuse, trauma or a diagnosis [synthesis].
Safeguarding disclosures in songs. A child or adult may sing about harm. Treat it as a possible disclosure and follow local safeguarding and mandatory-reporting procedures. Do not probe with leading questions, and record words verbatim from the recording [synthesis].
Suicidal or self-harm content in improvised songs [synthesis]: respond as a clinician, not only musically. Pause the music, and complete a standard risk assessment per local policy (current thoughts, plans, intent, protective factors). Involve the client's care team and agree a safety plan, including lethal-means counselling (safe storage or removal) where relevant.
Cultural mismatch of musical idioms. Western tonal piano idioms may not reach every client. Ask about musical background and widen your idiomatic range (4.34) [synthesis; source: Nordoff and Robbins UK on setting aside musical biases].
Anthroposophical claims. If clients or carers come across anthroposophical ideas (e.g. that intervals act on the soul), explain them as historical influences on the founders, not as proven mechanisms or medical treatment [synthesis].
Therapist lacks the musicianship (e.g. a psychotherapist wishing to "try NR"). This is a contraindication to delivery. Refer to an HCPC-registered or NR-certified music therapist, or train through the NR MMT or NYU certification routes [source: Nordoff and Robbins UK; NYU Training Programs].

Sources

Pages consulted:

Books cited:

Nordoff, P., & Robbins, C. (1971). Therapy in Music for Handicapped Children. Title, authors and contents verified on the Barcelona Publishers page (current reprint); the 1971 date is not shown there [uncertain: date].
Nordoff, P., & Robbins, C. (1977). Creative Music Therapy: Individualized Treatment for the Handicapped Child. New York: John Day (with audiocassette). [verified: ECU catalogue record]
Nordoff, P., & Robbins, C. (2007). Creative Music Therapy: A Guide to Fostering Clinical Musicianship (2nd ed.). Barcelona Publishers. [verified: publisher page]
Aigen, K. (1997). Here We Are in Music: One Year with an Adolescent Creative Music Therapy Group. Nordoff-Robbins Music Therapy Monograph Series, vol. 2. St. Louis, MO: MMB Music. [verified: ECU catalogue record]
Bruscia, K. E. (1987). Improvisational Models of Music Therapy. [cited via Mahoney 2010 and the MARA table]
Robbins, C., & Robbins, C. (1991/1980). Music for the Hearing Impaired and Other Special Groups. [uncertain: details not verified]
Lee, C. (1996). Music at the Edge: The Music Therapy Experiences of a Musician with AIDS. [uncertain: details not verified]
Wigram, T., Pedersen, I. N., & Bonde, L. O. (2002). A Comprehensive Guide to Music Therapy. Jessica Kingsley. [uncertain: details not verified]

← Previous · VIII-043Free-improvisation music therapy Next · VIII-045 →Music-centred music therapy