What is the Music of Music Therapy? An Enquiry into the Aesthetics of Clinical Improvisation

In many places in the Western world where music therapy occurs, improvisation is a significant and widespread practice in clinical work. The question of the nature of improvisation in music therapy is the topic of this enquiry, with particular reference to musical ontology and aesthetics. I examine how a consideration of ontology enables a distinction to be drawn between the music made within the clinical setting, known as clinical improvisation, and music that is made elsewhere. The context for this enquiry is the music therapy practice of the UK. Through an examination of the recent history of this practice, I establish two distinct approaches to clinical improvisation in the UK, music-centred and psychodynamic. I show how there are different ontologies of music ‘at work’ between these two approaches. I also demonstrate how these distinctions manifest in the question of the location of the therapeutic effect: is it in the music or the therapeutic relationship? Finally, I examine the nature of clinical improvisation in relation to performance. I explain how a consideration of distinct ontologies of music within clinical improvisation indicates a further distinction between the music of music therapy and art improvisation that is made elsewhere.