Music-centred music therapy

1. Introduction

Version followed: Kenneth Aigen, Music-Centered Music Therapy (Barcelona Publishers, 2005; ISBN 9781891278259), read through the publisher's description and full table of contents, plus Aigen's The Study of Music Therapy: Current Issues and Concepts (Routledge, 2014) as summarised in Colin Lee's full review (Approaches 10(2), 2018, pp. 212–214). Clinical procedures are taken from the Nordoff-Robbins-derived practice Aigen analyses (Being in Music, 1996; Paths of Development, 1998; Playin' in the Band, 2002; Aigen 2014, Music Therapy Perspectives 32(1):18–29). The Brazilian "musicoterapia musicocentrada" paradigm (Brandalise, 2001; presented in English in Brandalise 2009, Voices 9(1)) is a separate, related tradition and is not followed here. [source: Barcelona Publishers book pages; Lee 2018; Aigen 2014 abstract; Brandalise 2009 abstract; Sales & Freire 2024]

Sources: the content and chapter structure of Aigen 2005 (publisher page); the six-part content of Aigen 2014 (Lee's review); the abstract of the 2014 article; the Playin' in the Band description; and the UK and US credential routes (UK Regulated Professions Register; CBMT). The full text of either Aigen book and of the 2014 article (subscribers only) is not publicly available [uncertain]. The principles below are therefore named from Aigen's own headings and abstracts, but every step-by-step procedure in section 4 remains [synthesis], and Aigen's definitions of quickening and flow are [uncertain]. The publisher page gives no publication year; the 2005 date follows library catalogues and thesis bibliographies.

What it is. Music-centred music therapy is a theoretical orientation and set of rationales, not a manualised treatment. In Aigen's own phrase, being music-centred means "placing ideas about music at the core of music therapy theory" [source: Aigen 2005, p. 31, as quoted in Brandalise 2009]. Aigen built it to explain and justify practice in which music and musical experience are the centre of the work, and he traces it in Nordoff-Robbins, Guided Imagery and Music, Analytical Music Therapy, Aesthetic Music Therapy, Community and Culture-Centered Music Therapy. The procedures below are those of improvisational, mainly Nordoff-Robbins-derived practice, as Aigen describes them. [source: Barcelona TOC ch. 6–7; Christian & Putri 2025, p. 10]

Core idea of change. The therapy works through the way music itself works. Aigen calls this music acting as an "autonomous clinical force" [source: Aigen 2014 abstract], and the publisher's summary of the 2005 book adds that interventions are guided by musical properties and that musical analysis can show clinical processes [source: Barcelona book page]. Personal growth and musical development converge, so a client who becomes able to take part in more organised, expressive, mutual music-making is also changing as a person. Musical experience counts as a legitimate clinical goal in its own right. It does not have to be turned into verbal insight or a non-musical skill to count. [source: Barcelona book description and ch. 5 headings; Christian & Putri 2025, pp. 9–10] Aigen grounds this in theories of music: Elliott's "musicing", Dewey's aesthetics and its distinction between means and media, image-schema theory (musical time-as-space, force and motion), and Zuckerkandl's dynamic theory of tone. [source: Aigen 2014 abstract; Barcelona TOC ch. 8–10] In The Study of Music Therapy he uses musicing to give a socially based account of how therapy works. He argues that music's intrinsic value and integrity must be protected, and that the profession must state clearly what music's role and properties are. [source: Lee 2018]

Professional frame. This is a music-therapy orientation. Use it as music therapy only if you hold music-therapy training and registration. UK: "music therapist" is a protected title, regulated by the HCPC under the Health Professions Order 2001. New professionals qualify through an approved MA Music Therapy, and those trained abroad apply through the HCPC international route. [source: UK Regulated Professions Register, "Arts therapist"] The UK professional body is BAMT [uncertain]. US: the MT-BC credential is awarded by the Certification Board for Music Therapists (CBMT). It requires an AMTA-approved academic and clinical training programme and a pass in CBMT's written exam, and it is renewed every five years with 100 recertification credits. Certification is voluntary, but some states require it for licensure, state certification or registries. [source: CBMT, "What is the MT-BC credential?"] For the Nordoff-Robbins form, Nordoff-Robbins postgraduate training is usual [uncertain]. Elsewhere, use your national music-therapy association's equivalent. Aigen himself is listed with the Nordoff-Robbins credential "ACMT". [source: musiciselementary.com listing] The work also needs advanced clinical musicianship: improvising on piano or guitar across styles, and playing groove-based popular idioms. A psychotherapist without that training should not present this work as music therapy. Instead, refer to or co-work with a credentialled music therapist, and use music in talking therapy only in non-specialist ways. [synthesis]

2. Framework

Aigen gives no fixed phase model, session count or manual, and the sources stress that music-centred practice is applied "in varying degrees and ways" across models. [source: Christian & Putri 2025, p. 10] What follows is a working arc built from the processes Aigen documents in long-term case work: forms and structures, the will, creating a self, and mutuality. Stage names and transition criteria are [synthesis]. [source: Paths of Development contents; Playin' in the Band description]

Format. Usually individual sessions, sometimes groups, typically weekly and often long-term. The Playin' in the Band case ran seven years [source: Barcelona page]. Sessions are mainly live improvisation, with improvised and pre-composed songs [source: Being in Music contents]. Sessions are recorded for later musical analysis [source: Christian & Putri 2025, p. 10]. Nordoff-Robbins work traditionally uses a lead therapist at the piano plus a co-therapist; this is [uncertain] for music-centred work generally.

Goals. Write musical goals as clinical goals, e.g. "sustains a shared groove for a whole improvisation" or "initiates changes the therapist follows". Aigen's chapter headings make this the defining move [source: Barcelona TOC ch. 5], and The Study of Music Therapy has a chapter on how therapists set musical and clinical goals [source: Lee 2018]. Where a team or funder needs non-musical outcomes, use Aigen's "alternative view of generalization". As the publisher's summary presents it, transfer to non-musical life is not a required test of whether the therapy worked [source: Barcelona book page]; the detailed argument is [uncertain]. The reporting wording that follows is [synthesis]: report what the client can now do in music as a capacity in itself, and describe any carry-over you actually observe, without promising it.

3. Guiding principles

Sources: principles are named from Aigen 2005 (description and chapter 4–5 headings, Barcelona page), the Aigen 2014 article (abstract; Annesley's citations), The Study of Music Therapy (2014) as summarised in Lee's 2018 review, and Christian & Putri 2025. The one-line practical meanings are [synthesis].

• Primacy of the client's experience. Judge a session by what the music was like for the client, not by whether a target behaviour occurred.
• Musical goals are clinical goals. Write goals and progress notes in musical terms first.
• Enhancing client involvement. Your first job is to make the music something the client wants to be part of.
• Convergence of personal and musical process. Read musical changes (initiative, flexibility, endurance, expressivity) as personal changes.
• Intrinsic rewards. Do not use music as a reward for doing something else; the music-making is the point.
• Interventions guided by musical properties. Choose what to play by its musical force, motion, tension, release and form, not by a non-musical protocol.
• Music as an "autonomous clinical force" [Aigen 2014]. Trust the music to do work without always explaining it.
• Musical analysis is clinical process. Listen back to and analyse your recordings; the clinical thinking happens there.
• Performance and products can be legitimate. Recording or performing can be part of therapy when it serves the client.
• Verbal processing is optional. Words are "not avoided" but are not required for change [Christian & Putri 2025, p. 12]. In The Study of Music Therapy Aigen argues that translating musical experience into words matters less for music-centred therapists [Lee 2018]. His position on interpretation became stricter between 1999 and 2013 [Christian & Putri 2025, pp. 11–12].
• The therapeutic relationship is a musical relationship. Attune, lead, follow and meet the client mainly in the music. On theory, Aigen argues that no single view of the therapy relationship should set the rules for legitimate practice; his stance "accepts all views of the therapy relationship" [Aigen 2014, p. 118, via Lee 2018].
• Holism and an alternative view of generalisation. Address the whole person through the whole musical experience, not isolated sub-skills. Do not make carry-over to non-musical life the test of whether therapy worked. [source: Barcelona book page, which names both themes]
• Continuity with non-clinical music. Draw on music as people live it in their culture and genres. The Study of Music Therapy treats music as culture and identity, and has a chapter on the relationship between clinical and non-clinical music (pp. 75–87) [Lee 2018]. Aigen frames a relationship to music as "an essential human need" [Aigen 2014, p. 39, via Annesley].
• The therapist is a musician working therapeutically. Keep your own musicianship alive; the quality of your music matters clinically [Christian & Putri 2025, p. 10].
• Psychotherapeutically informed. You can "operate from a music-centred position that is itself psychotherapeutically informed" [Aigen 1999, p. 79, via Annesley]. Keep history, transference and relationship dynamics in mind [Christian & Putri 2025, p. 11].
• Integrity of stance. Aigen says the right stance at any moment is one that "can be implemented with integrity" [Aigen 2005, p. 20, via Christian & Putri 2025]. Do not adopt techniques you do not believe in.
• Values central to musicing (Aigen 2005, ch. 4 headings): musical values, silence, listening, the individual within the community, surrender, respect for craft, and connection. In practice: leave silence; listen before playing; give each group member a voice; allow yourself to be carried by the music; take musical skill seriously; aim for felt connection.
• Theory widens what you can see. Aigen argues theory "can expand awareness" in clinical observation [Christian & Putri 2025, p. 3]. Use the concepts in this guide as lenses, not rules.
• Examine your own allegiance. Aigen warns that a theoretical stance can sometimes reflect a therapist avoiding the music or avoiding their own unconscious fears [Aigen 2014, p. 117, via Annesley]. Bring this to supervision.

4. Intervention inventory

Scope note: Aigen describes rationales and clinical processes and no numbered technique list. The procedures named below come from his books' chapter topics and case descriptions. No published step-by-step protocol for music-centred practice was found, so every step sequence is the writer's synthesis [synthesis], written so a trained music therapist can follow it; it is not Aigen's wording. All example language is (illustrative). Most music-centred interventions are musical acts, not spoken ones, so the "language" is often a musical description. [source: Barcelona TOCs for Aigen 1996, 1998, 2002, 2005]

Safety for all interventions [synthesis]. Hearing: drum kits, amplified guitar and cymbals in small rooms can reach harmful levels. Keep amps low, use rods, brushes or practice pads, and offer musician's earplugs, including for you over a long caseload. Watch for clients who cover their ears or show sensory distress, and ask about tinnitus or hyperacusis at intake. Musical trauma triggers: specific songs, genres, hymns, anthems, loud percussion or sudden crashes can be tied to abuse, war, torture, coercive religious settings or bereavement. Ask about music to avoid at intake, warn before sudden dynamic changes, and stop or change the music at any sign of a trauma response. Physical: secure heavy instruments and cables, keep sharing of wind instruments and mouthpieces hygienic, and check for latex or nickel sensitivity. Touch: hand-over-hand help on an instrument needs explicit consent (assent for children, carer agreement where relevant), a clear opt-out, and must never be sexual. Prefer modelling or adapted instruments.

4.1 Meeting the client in music (musical assessment)

• Purpose / when: First sessions and any new phase. Find out how the client already lives in music: pulse, tempo, preferred register, timbres, styles and the range of their responses. Being in Music covers "therapist preparation" and a "personalized source of music" under this heading. [source: Being in Music contents; Christian & Putri 2025, p. 10] Music-centred therapists interviewed in Brazil describe the core skill as listening to the client's own musicality and needs, and playing to serve that musicality rather than the therapist's own taste, even with less comfortable musical resources. [source: Sales & Freire 2024, pp. 8–9]
• Steps: (1) Ask about musical history, preferences, music to avoid, and hearing or sensory issues; with children, ask carers too. (2) Offer a few instruments that are easy to sound. (3) Start by matching whatever the client produces in pulse and dynamic, without leading. (4) Try small variations, such as tempo, mode, style or a sung phrase, and note which ones draw a response. (5) Record the session. (6) Afterwards, listen back and write a musical profile: points of contact, what the client avoids, how long they stay engaged, and whether they initiate.
• Example language: "You don't need to know how to play. Anything you do on this drum, I'll make music with it." (illustrative)
• Watch for: Over-reading the music as diagnosis. Musical behaviour is not evidence of abuse or disorder, and no validated music-centred diagnostic manual exists in the literature used here. It is working: you have two or three dependable musical points of contact.

4.2 Establishing a musical world (frame or container)

• Purpose / when: Early and ongoing. Give the client a stable musical space they can recognise and enter. This is a Nordoff-Robbins concept Aigen reviews as music-centred. [source: Aigen 2014 abstract; Barcelona TOC ch. 14, "expanding containers"]
• Steps: (1) Choose a clear, consistent musical frame: a key, a style, a tempo near the client's natural pulse, and a recognisable chord loop or song. (2) Use the same opening and closing music each session. (3) Leave regular, predictable spaces in the frame for the client's sounds. (4) Keep the frame steady while the client tests it; do not drop it when they stop. (5) Once they are secure, mark the frame's sections clearly (verse, chorus, break) so the client can find their place.
• Example language: Musical: a sung greeting with the client's name over the same two-chord vamp each week. Spoken: "Here's our music again. Come in whenever you're ready." (illustrative)
• Watch for: A frame so rigid it becomes background, or so loose the client gets lost. It is working when the client shows anticipation: they reach for the instrument at the opening song or play the expected next beat.

4.3 Clinical improvisation shaped by musical force, motion and space

• Purpose / when: The core of sessions. Aigen's theory (image schemata of force, motion and time-as-space; Zuckerkandl's dynamic tones) explains why tension, pull and release in music can mobilise a client. His chapter 11 applies this to "quickening and the creation of a self". [source: Barcelona TOC ch. 8–11; Aigen 2014 abstract] Aigen's own definition of quickening is not publicly available; take it as a named Nordoff-Robbins concept for a client's musical awakening into active participation. [uncertain]
• Steps: (1) Hold a steady pulse that gives the client's playing forward motion. (2) Build harmonic or melodic tension, such as a dominant chord, a rising line or a held suspension, and wait for the client before resolving. (3) Use the resolution to confirm what the client did. (4) Use crescendo, accelerando or rhythmic drive to invite more energy, and pull back to invite settling. (5) Follow the client's initiatives at once so their sound visibly changes the music. (6) Note which musical forces drew the client in.
• Example language: Mostly musical. Spoken, if needed: "Listen, the music's waiting for you" (while holding an unresolved chord). (illustrative)
• Watch for: Driving too hard can overwhelm, especially with loud percussion or trauma histories. It is working when the client's playing gains intention: they anticipate the resolution, and they persist and initiate more.

4.4 Groove-based improvisation in popular styles

• Purpose / when: For clients, often adolescents and adults with disabilities, for whom popular idioms feel like real music. Aigen's Playin' in the Band (Nordoff-Robbins Monograph Series, vol. 3) follows a disabled young man over seven years. He moves from brief moments of active participation to organised, expressive improvising across whole sessions, developing on drums, guitar and piano in blues, jazz, country and rock. The book pairs the case with therapeutic and musicological theory of improvising in groove-oriented styles, and its first chapter is "Getting into the Groove". [source: Playin' in the Band publisher page] Aigen also wrote "Popular musical styles in Nordoff-Robbins clinical improvisation" (Music Therapy Perspectives 19, 2001); only the title is known, from a bibliography. Aigen's own account of what groove does clinically, and any use he makes of Csikszentmihalyi's "flow", are not described in the available sources [uncertain]. Nordoff-Robbins therapists' experience of flow has been studied separately (Geyer 2025).
• Steps: (1) Pick a style the client knows or likes. (2) Set up a groove: a simple repeating bass line and chord loop with backbeat. (3) Give the client a role that cannot fail, such as kick or snare, a single chord or a riff. (4) Keep the groove going steadily while the client drops in and out, so that rejoining is always possible. (5) As participation lengthens, add song-form landmarks (12-bar blues, breaks, solos) and trade solos. (6) Over time, teach more skills (drum beats, guitar chords, piano voicings) so the client gains musical independence. (7) Vary the style when the client is ready, to expand their musical range.
• Example language: "Let's play a blues. You keep the beat on the snare, I'll do the rest. Your solo's in four bars." (illustrative)
• Watch for: Hearing levels with drum kit and amps; the client feeling like a pupil rather than a bandmate. It is working when participation lasts longer, the client takes solos, and there is mutual give-and-take. [source: ch. 3–4 titles "We're Jammin'", "Moving toward Mutuality"]

4.5 Improvised and pre-composed songs, and repetition

• Purpose / when: To give structure, memory and identity. Being in Music stresses the importance of repetition with both improvised and pre-composed songs. [source: Being in Music contents]
• Steps: (1) Improvise a short song about the client or the moment, using their name, actions or words. (2) If it catches on, keep it, transcribe it and play it again in later sessions. (3) Repeat it with small variations so it stays alive. (4) Use songs as anchors (hello, goodbye, a transition song) or as material to develop. (5) Pre-composed songs may come from therapy repertoire or from the client's own culture and genres.
• Example language: Sung (illustrative): "Sam is playing, playing loud, Sam is playing the drum."
• Watch for: Repetition becoming rote. It is working when the client recognises the song, sings or plays along, asks for it, or changes it.

4.6 Silence, listening, pauses and call-and-response

• Purpose / when: To create space for the client's contribution and to signal that their sound matters. "Silence" and "listening" are among Aigen's musicing values. [source: Barcelona TOC ch. 4] In Hadar's time-model analysis (with Aigen), Nordoff's first phase built expectation through pauses, musical space and antiphonal playing. [source: Epp 2026 review, p. 3]
• Steps: (1) Play a short phrase and stop. (2) Wait, long enough to feel slightly uncomfortable. (3) Answer whatever the client does, even a single sound, with a musical reply. (4) Gradually lengthen the phrases and the gaps. (5) Hand over the lead: let the client's phrase become the call.
• Example language: Musical question and answer; spoken: "Your turn." (illustrative)
• Watch for: Silence can feel exposing for anxious or traumatised clients, so shorten the gaps or keep a soft drone going. It is working when the client fills the space on purpose and begins to call.

4.7 Expanding forms: melody, containers and transitional music

• Purpose / when: Middle to later work, once the client is secure in a frame. Aigen links musical form, development and transformation to personal transformation. He relates melody to self-identity, and transitional music to life transitions, using "expanding containers" as a metaphor for therapy. [source: Barcelona TOC ch. 13–14]
• Steps: (1) Introduce one change at a time to a familiar frame: a new section, a key change, a tempo or style shift. (2) Use bridging or transitional passages that carry the client from the known to the new. (3) Develop the client's own melodic motifs into longer melodies and give them back. (4) Bring musical transitions in step with real transitions, such as an ending, a move or a change of school, and mark them in the music. [synthesis]
• Example language: "Your tune from last week. Let's see where it goes if we change key here." (illustrative)
• Watch for: Change that comes too fast can lead to withdrawal or overwhelm. It is working when the client stays with a change, then asks for or introduces new material.

4.8 Building instrumental skill and musical craft

• Purpose / when: Where the client wants to play properly. Aigen lists "respect for craft" among musicing values, and Being in Music explicitly asks "therapy and/or teaching?". In Playin' in the Band the client learns drums, guitar and piano. [source: Barcelona TOCs and description]
• Steps: (1) Choose skills that open up more musical participation, not exercises for their own sake. (2) Teach inside real music: learn the beat by playing the song. (3) Adapt instruments, tunings or notation (open tunings, colour-coding) to the client's abilities. (4) Return each new skill straight into joint music-making. [synthesis for steps]
• Example language: "Let's get this chord so you can play the whole song with me." (illustrative)
• Watch for: Sessions sliding into lessons that judge the client. It is working when skill increases the client's freedom and enjoyment in the music.

4.9 Formulating musical goals and evaluating through musical analysis

• Purpose / when: Throughout. In Aigen's frame, musical goals are clinical goals, and reflection, transcription and analysis of the music clarify needs, track development and judge growth potential. [source: Barcelona TOC ch. 5; Christian & Putri 2025, p. 10] Brandalise names audio and video recordings, timing reports and musical analysis including score writing as the ways music-centred and Nordoff-Robbins work documents the music of therapy. [source: Brandalise 2009]
• Steps: (1) Record each session, with consent. (2) Within the week, listen back and note the key moments: initiations, changes of tempo or dynamic, mutuality, endurance, expressive peaks, withdrawals. (3) Transcribe the important passages (rhythm, melody, form). (4) Write goals in musical terms, e.g. "maintains a shared pulse across tempo changes". (5) Review progress over months by comparing recordings. (6) For teams, write a short translation that gives the musical description and then what it looks like functionally.
• Example language: In notes: "Initiated three tempo changes and followed two of mine." (illustrative)
• Watch for: Analysis that only counts behaviours and misses the musical quality. Storage of recordings must meet data-protection and consent rules.

4.10 Performance, recordings and musical products

• Purpose / when: When sharing music would empower the client: a recording, a concert, playing for family. Aigen includes "performance and products" among music-centred rationales, and The Study of Music Therapy discusses performance and client empowerment in its community music therapy chapters. [source: Barcelona TOC ch. 5; Lee 2018 review of Aigen 2014]
• Steps: (1) Discuss it with the client (and carers): who it is for, and whether they want it. (2) Choose material the client already plays securely. (3) Rehearse in session, keeping the therapeutic focus. (4) Plan support for nerves and an exit option. (5) Debrief afterwards, musically or verbally. [synthesis for steps]
• Example language: "Would you like to record this one so your mum can hear it?" (illustrative)
• Watch for: Performance pressure, exposure, and confidentiality (consent for audiences and recordings). It is working when the client shows pride and ownership.

4.11 Verbal processing (optional)

• Purpose / when: Only when it serves the client: verbal adults, or after intense musical moments. In Aigen's frame words are "not avoided" but not necessary; he later argued that interpretation can undercut authentic music-centred practice. [source: Christian & Putri 2025, pp. 11–12; Barcelona TOC ch. 5]
• Steps: (1) Let the music finish and leave a pause. (2) Ask an open, experience-near question about the music, not an interpretation. (3) Accept a musical answer, or none. (4) Keep any psychodynamic understanding as your own background knowledge unless the client brings it.
• Example language: "What was that like to play?" / "Shall we just play it again?" (illustrative)
• Watch for: Talk that pulls the client out of the music, or over-interpretation.

4.12 Group and community musicing

• Purpose / when: Groups, ensembles and community contexts. The values "individual within the community" and "connection" apply, and Aigen traces music-centred thinking in Community Music Therapy. [source: Barcelona TOC ch. 4, 7] The Study of Music Therapy gives two chapters to community music therapy: how ideas of community and health are shaping the field, and how traditional professional boundaries are breaking down. [source: Lee 2018]
• Steps: (1) Set a shared groove or song that everyone can join. (2) Give each member a clear, achievable role. (3) Rotate solos and leadership so each voice is heard. (4) Manage volume so no one is drowned out and hearing is protected. (5) Close with a shared ending.
• Example language: "Everyone keep this beat; when I point, it's your solo." (illustrative)
• Watch for: Dominant members, excluded members, noise. It is working when members listen and respond to each other.

5. Handling problems

The available sources give almost no problem-specific guidance. Except where a source is named, everything below is [synthesis] grounded in Aigen's principles.

• Stuck client (the music stays the same for weeks). Listen back to recordings to find what you repeat. Change one musical parameter: style, tempo, register, harmony or instrument. Widen the container (4.7). The aim is to bring in a musical force the client has not met yet (4.3). Aigen's case work shows development measured in years, so judge stagnation over months, not sessions. [source: Playin' in the Band description for the long timescale]
• Refusal or not playing ("resistance"). In music-centred terms, non-participation is a musical stance. Keep the frame going without demanding anything. Include the client's silence or movement in the music, for example by playing to their footsteps. Offer an easier instrument or a familiar song. Never coerce, and never use music as a reward or withhold it as a punishment (principle: intrinsic rewards).
• Overwhelm (sensory, emotional or traumatic). Drop to soft, slow, predictable music or stop, then ground the client: name the room and the time, and orient them to safety. Lower the volume and remove triggering timbres. Afterwards, find out what triggered it (a specific song, genre, sudden crash, religious or national music, a minor key associated with loss) and add it to the client's avoid list. For clients with trauma histories, agree in advance on a stop signal, keep dynamics predictable, and warn before loud sounds.
• Hearing problems. If a client or the therapist reports ringing, muffled hearing or pain after sessions, cut amplification and drum volume at once. Use practice pads or e-drums at low volume and offer earplugs, and refer for audiological assessment if symptoms persist. Treat hyperacusis as a reason to adapt the work, not to exclude the client.
• Non-adherence (missed sessions, disengaged carers). Use a short opening song or groove so each session starts warm even after a gap. Share brief recordings, with consent, so carers can hear the progress. Agree session frequency realistically.
• Ruptures (musical misattunement, therapist over-playing, imposing style). Signs include the client stopping abruptly, playing against you, or withdrawing. Repair in the music: drop out, then follow the client exactly, mirroring their tempo and dynamics, before leading again. If the client is verbal, acknowledge it simply ("I took over there, sorry, you lead"; illustrative). Aigen's point that the relationship is musical implies the repair is musical too.
• Therapist's musical limits or blocks. If you only play in your own comfort style or avoid improvising, take it to supervision and personal music-making. Aigen notes that orientation can mask avoidance of the music or of the therapist's own unconscious fears. [source: Aigen 2014, p. 117, via Annesley]
• Team or funder demands for non-musical outcomes. Present musical goals with a functional translation (4.9). Name the orientation honestly rather than relabelling it as skill training. Aigen's "alternative view of generalization" does not make transfer to non-musical life a required test of the therapy [source: Barcelona book page]; the detailed argument is [uncertain]. The negotiation advice here is [synthesis].
• Client's genre preferences clash with your skills or values (e.g. explicit lyrics, music tied to risky subcultures). Continuity with non-clinical music favours working in the client's idiom. Set clear limits only where there is a safety or safeguarding concern, and learn the style.
• Emerging psychological material (grief, anger, abuse disclosure during or after music). Stay with it musically where that contains it, and offer words if the client wants them. Follow safeguarding procedures for any disclosure. Remember that musical behaviour itself is not evidence of abuse.
• Children and young people. Get assent from the child and consent from carers, including for recordings. Follow local safeguarding and mandatory-reporting duties. Agree with carers what will be shared, keeping the child's privacy in the music. Adapt by age: shorter forms and more movement and play for young children; peer genres and band roles for adolescents.
• Suicide or self-harm risk. Music-centred work does not replace standard risk assessment. Ask directly, assess, safety-plan and escalate according to service policy. Be alert to song lyrics or music choices that express hopelessness, and treat them as a cue to ask, not as a diagnosis.
• Spiritual frames. Nordoff-Robbins origins draw on anthroposophical ideas. Aigen's own theory is music-philosophical (Dewey, Zuckerkandl, schema theory), and none of it should be presented as treatment for physical disease. The anthroposophical link is unverified. [uncertain]
• Working outside your competence. A psychotherapist without music-therapy training should not attempt clinical improvisation as therapy. Refer to a credentialled music therapist, or co-work so that you hold the verbal and psychological thread while they lead the music.

Sources

Pages consulted:

• Music-Centered Music Therapy (Aigen, 2005), Barcelona Publishers — description and full table of contents
• Aigen (2014) Music-centered dimensions of Nordoff-Robbins music therapy, Music Therapy Perspectives 32(1):18 — abstract only
• Playin' in the Band (Aigen, 2002), Barcelona Publishers
• Being in Music: Foundations of Nordoff-Robbins Music Therapy (Aigen, 1996), Barcelona Publishers
• Paths of Development in Nordoff-Robbins Music Therapy (Aigen, 1998), Barcelona Publishers
• Christian & Putri (2025) scoping review of music-centered approach literature, Jurnal Seni Musik
• Review of Aigen, The Study of Music Therapy (2014), Approaches
• Article on psychodynamic vs music-centred orientations (UWE repository)
• Annesley, Two Kinds of Music Therapy: exploring 'genre' (UWE repository)
• Epp (2026) review of Hadar, Music, Time, and Self, Voices
• Sales & Freire (2024) A musicalidade clínica do musicoterapeuta musicocentrado, Per Musi
• Darnley-Smith (2013) What is the Music of Music Therapy? PhD thesis, Durham — partly read
• Bunt (2006) review of Music-Centred Music Therapy, BJMT — record only
• Being in Music retail listing

Further pages consulted:

• Lee (2018) review of Aigen, The Study of Music Therapy — Approaches journal page
• Brandalise (2009) Music-centered Music Therapy: Contributions for the Present and Future of Music Therapy, Voices 9(1)
• Arts therapist — UK Regulated Professions Register
• What is the Music Therapist-Board Certified (MT-BC) credential? — CBMT
• Geyer (2025) Nordoff-Robbins music therapists' experience of flow during clinical improvisation, MSc thesis, SUNY New Paltz
• Locket, PhD thesis reference list (UWE repository) — used only to check Aigen citations

Books cited: Aigen, K. (1996) Being in Music; Aigen, K. (1998) Paths of Development in Nordoff-Robbins Music Therapy; Aigen, K. (1999) reply to Streeter (title not verified [uncertain]), BJMT; Aigen, K. (2002) Playin' in the Band; Aigen, K. (2005) Music-Centered Music Therapy; Aigen, K. (2007/2008) In defense of beauty [uncertain: details not verified], Nordic Journal of Music Therapy; Aigen, K. (2014) The Study of Music Therapy: Current Issues and Concepts; Brandalise, A. (2001) Musicoterapia músico-centrada.