Primary Instruments in Music Therapy: A Toolbox

By Audrey Weatherstone, MusicWorx Intern

Music therapy education primarily focuses on piano and guitar skills, supplemented with voice and percussion. The AMTA Professional Competencies define these instruments as “functional” and are by far the most commonly used in practice by music therapists. For the purpose of this blog, “primary instrument” will refer to any instrument aside from piano, guitar, voice, and percussion. My coursework as an undergrad relied heavily on my guitar and piano skills within a music therapy setting, and my cello playing skills within a performance setting. Through my four years of undergrad, the two worlds of therapy and performance seldom crossed paths. 

Now that I am a music therapy intern, I no longer have anyone to hold me accountable for playing other than for my own enjoyment and I have struggled to identify myself as a musician. I believe many music therapists experience this transition, moving from a performance-heavy undergraduate curriculum, to having to develop a personal relationship with music and with one’s instrument. In using my cello for music therapy purposes, I have found joy in sharing my passion with my clients, and pushed myself to be more creative, more musical, and think outside the box. I’ll share my experiences integrating my cello into my music therapy practice and some specific interventions I have developed along the way.


Primary Instruments with Individuals

When I walk into an adult hospital or hospice room with my cello, I skip the preferred music question and just ask, “Would you like to hear my cello today?” This easy yes or no question takes the pressure off the patient. If the answer is yes, I will play a piece of music or improvisation that matches their goals, needs, and where they are. 

  • Prompts before listening:
    • “While you listen, close your eyes and imagine your favorite place and let the music take you there.”
    • “Notice the emotions you experience while listening.”
    • “Think about what the sound or melody reminds you of.”
    • Use any relaxation and guided imagery prompts you prefer! Make the music reflect the theme; a flowing feel to reflect ocean waves, dissonance and resolution for progressive muscle relaxation etc.
  • Follow up questions: 
    • “How does the music make your body feel?”
    • “How does it feel to hear this music today?”
    • “What did the music remind you of?”
    • “Where did the music take you?”

On the other hand, the primary benefits of using my cello with children has been that it is a novel object and sound, and therefore a motivator and rapport builder. Follow the leader, stop and go, and movement to music can all benefit from a new motivating sound. Active music making improvisation works well with my cello too, as it makes this activity more interesting and musical. 

  1. Play familiar melodies to listen to and guess the names of. Recognizing melodies gives a greater cognitive challenge than hearing the words.
  2. Provide alternative sensory stimulation through touching and playing the cello with assistance, as well as feeling the deep vibrations.
  3. Provide a “reward” at the end of the session to encourage clients to finish other interventions on schedule before getting to hear the cello. 
  4. Learn to spell “cello”!
  5. Create a musical exchange by following the client’s lead through improvisatory movement, singing, and instrument playing.
  6. Accompany structured client music-making.

Primary Instruments for Groups

When I walk into a group setting with my cello, I build immediate rapport with clients over their interest in the novelty of my instrument. When using a melodic instrument to facilitate group active music making, we bring in new aspects of music- a difference in tone, timbre, pitch, and range that may be unfamiliar. This can create a more novel or aesthetically pleasing sound and offer a greater cognitive challenge by combining pitch and rhythm. 

  • Using a melodic instrument to lead group active music making opens possibilities for musical activities or improvisation on drums, boomwhackers, tone chimes, etc. 
    • For errorless group music making, C major and A minor have no accidentals, making them accessible keys for boomwhacker use, easy piano playing, and let’s be honest, less for you to think about! 
    • OR challenge yourself to use modes for a more unique sound. D dorian and G mixolydian use all natural notes as well. 
  • Consider how you might use rhythmic or melodic cues for prompting. 
    • Direct the speed or volume of a drum circle with pitch.
    • Construct melodies to cue accents or different percussion parts. Using the melody to indicate what you want the group to do allows for your hands and mouth to be occupied playing an instrument. 
    • Use the natural movement of your specific instrument. For example, up and down motions following the up and down slide of a trombone, or back and forth movements with a violin or cello bow.



1. Conducting 

Goals: autonomy, speech and language, communication

  1. Present song visuals and ask client to choose which song they would like to hear. 
  2. Play selected song.
  3. Present conducting visuals and ask the client how they would like to hear the song 
  4. Play song accordingly.


  • Client can choose between “stop” and “go” while you play in a freeze dance style.
  • Address speech and language by having client ask “can you play (song).” In my experience, clients were working on using the correct pronouns, so I enforced asking “can you play” or “can we play.”
  • Multiple directions can be chosen at once, for example high and fast or slow and quiet.
  • Choose songs and directions for client to play on hand-bells, piano, etc.

Bonus Adaptation:

Clients can conduct without the visuals by moving their arms and hands up and down, fast and slow, and giving stop and go cues. Conducting can be explored for self expression, and even motor movements. Try having your client direct the music using different body parts to address motor goals. Download visuals here.

2. Build Your Own Song

Goals: self expression, active music making, autonomy, group support and cohesion

  1. Provide songwriting prompt (positive affirmations, familiar song with lyric blanks to fill in, mantras, a blues format, etc.)
  2. Demonstrate options for creating new song:
    • Choice between guitar/singing or cello melody
    • Choice between two melodies to either be sung or played on cello
    • Choice between two drum beats
    • Choice between two hand percussions
  3. Clients will build their personal song and the group will play through everyone’s together.


  • Offer different genres to choose from rather than two melodies. 
  • If the technology is available, songs can be recorded, or an electronic beat can be built.
  • If an affirmation is being played on a melodic instrument without words, clients can speak the words, or be prompted to think about them while listening.


3. Draw What You Hear

Goals: self expression, emotion identification

  1. Play three songs or improvisations that fall under different emotion categories; ex: happy, sad, angry.
  2. While clients are listening to music, they will draw what the music sounds like and identify an emotion felt while listening.
  3. Facilitate discussion about emotions felt, art created, different emotions felt among group, preferred music selections, etc.


  • The group can identify three songs they enjoy listening to that envoke similar emotions. Then, discuss how to use music as a coping skill and for altering emotions.
  • Clients can take their heart rates before and after listening to different music and record results. Then, discuss how to use music as a coping skill for physical responses.


Name That Tune 

Goals: cognitive stimulation, social engagement, reminiscence

  • Play melodies to familiar preferred music, and allow members of the group to call out guesses for the name of the song.


  • For more structure, adapt  to either a Bingo or Jeopardy format.
  • To extend the game, sing and/or play each song after it has been identified and the group can sing or play along with percussion. 


Discovering new ways to use my instrument and approach music therapy has been a wonderful challenge. I encourage you to consider how to incorporate your instrument into your practice! 



Originally posted on on September 7th, 2019.


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