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Musical Activities for Online Therapy

by Heather Dingle

Since temporarily moving to online work to support social distancing, we have been exploring which musical interventions work with online therapy. This article aims to share some of our discoveries, and our thinking behind them. Have you found this helpful, or is there anything you think we should add? Let us know at!
Music Performance

Online music therapy - lag, microphones, and the therapeutic relationship 


Moving to online therapy as music therapists brings an array of unique difficulties when it comes to using our normal techniques. Where we might usually sing or improvise freely with a client and respond closely to verbal and non-verbal cues, the few seconds of lag created by video conferencing can lead to uncomfortable mismatched sound, while microphone settings can deaden or mute the sound of an instrument. 


So why work online at all? Some may feel that the modifications you need to make to your practise feel like too great a compromise to your normal ways of working. How can we continue to call ourselves music therapists when we are unable to play music together in the way we are used to doing? 


Never fear, intrepid music therapist - there are still musical adventures to be had over your favourite video conference software! Read below to discover some of the techniques that you can continue to use in an online setting, while preserving your identity and practise as a music therapist. While these were developed with a specific client group in mind, they can be adjusted as needed to your work setting. 


***Please note that these were all developed using Zoom. If you are using Zoom or any other online platform for therapy, it is important to be aware of the appropriate security settings. Please see our separate article on how to use Zoom in your therapy sessions.***


Improvisation - the exception that makes the rule

There is always an exception that breaks the rule. In this case, to do with music improvisation, which usually feels stilted and unconnected when attempted over video chat. Although we have found that musical improvisation is generally not possible using online therapy, we have so far found that there are two ways to use musical improvisation over the internet that seems to withstand some of the variability of internet connections. 


1) Improvisation over a drone: The drone can be provided by the therapist, using an instrument that can provide a sustain note. This allows the client to play freely over the sustained sound without worries about lag or timing. The drone can also be provided by a pre-recorded sound (from the therapist or through something like Youtube) using a ‘share computer sound’ setting. Therapist and client can then play together over the drone using an agreed upon set of notes, as described below. 


2) Improvisation using a set of agreed notes: Agree a key or chord to improvise in and play together. Your music will need to be quite atmospheric without much deference given to rhythm or pace. Directing a client to only play ‘the black notes’ on the piano or play from a preselected set of chime bars/bells (if available) would be a useful way of containing this sound. 


We didn’t feel that either of these methods allowed for the same level of sensitive musical response that music therapy normally provides, but as colleagues it did feel good to be able to create together. This feeling of ‘togetherness’ might be worth it for your clients depending on their needs, despite the lag. 


Three Categories of Online Musical Play


The methods we have found for working with music in online therapy can be divided into three categories: reciprocal music play, collaborative music creation, and receptive music techniques. 


1) Reciprocal music play: musical play where the therapist and client are both creating music but wait for the other to be finished before starting, which avoids the difficulties presented by lag (turn taking, copying, opposites, sound ‘ball’, singing in rote)


2) Collaborative music creation: creative collaboration that allows for music making but does not require the client to actual perform music themselves, which is particularly useful for a client at home without instruments (making instruments, song writing/rewriting, musical storytelling and reflection, drawing to music, moving to music, emotional literacy & music)


3) Receptive music techniques: music is used to support a wellbeing experience for the client (music and relaxation, discussing music & lyrics)


Reciprocal Music Play


Turn Taking

Use clapping, body percussion, or an instrument/homemade instrument, to take turns performing for one another. This could be done in a loosely rhythmic way, like a call and response, or more contained individual performances back and forth. Turn taking can also be a way to sing a familiar song, taking turns with each line. As the therapist, you will probably want to start singing slightly earlier than you feel you should do in order to keep the song more closely in time. 



Similar to turn taking, except this could be a way to practice listening and responding. Use something you both have, like clapping, body percussion, or a homemade instrument. Take turns being the leader or the follower while you imitate one another’s playing exactly. 



Like turn taking or copying, except have the person following do the opposite to the leader. For example, if I play loudly you play quietly. If I play slowly you play quickly. You could also make use of the boundaries of the screen space to play ‘up high’ or ‘down low’. 


Music/Sound ‘Ball’ 

This is an activity that can be found on the CAT Corner blog. Pretend to throw a ball back and forth from person to person across the screen. Each time you throw the ‘ball’ make a sound with your voice. This is quite a nice way to warm up if the client is feeling uncomfortable with using their voice or being playful.


Singing by Rote

This could be done with a familiar song or to teach the client a song they would like to learn. Sing a line of the song and have the client sing it back to you. You can do this a capella, but it also works when you play a chord on the piano/guitar at the start of each person’s line. You can play moving chords for your own singing, but not the client’s due to lag. 

Collaborative Music Creation


Making Instruments

This is an activity that can be found on the CAT Corner blog. Make shakers or drums with your client using household objects, especially cleaned out bottles or jars. You could also make rubber band guitars, or use pencils/pens as drumsticks on various objects. Explore the different sounds you can make with objects around you. You can then use these instruments for one of the reciprocal music activities.


Song Writing/Rewriting

Use an existing song and rewrite the lyrics, or write lyrics to a new song. You could have the client speak the lyrics while you write them on a shared screen, or have the client write them down if they want to. You can then write the song together by having them tell you the kind of music they want and singing it back to them, or have them create the music and sing it to you if they are able.  


Musical Storytelling and Reflection

Use music to support and reflect the story that a client tells as you go along, either a made up story or as they tell you about their own experience. Prompt the client with questions and reflect what they tell you using your words and music. You need to be careful to allow enough time for them to respond, as the delay means you might end up speaking over them when they share their ideas. However, you can keep a steady musical pulse going on the guitar or piano while they speak which can feel holding and sustain the musical experience. 


Drawing to Music

You can either play music via shared computer sound or from an instrument you are playing. This activity might be framed in a number of ways. For example, as a way of reflecting on a theme that has come up in the session, as a way of relaxation, or maybe as a way of self-exploration. The client can draw freely as they listen to the music, and then share their image over the video to allow for discussion. It will be useful to decide in advance how long this will go on for in order to provide boundaries to your client’s drawing. 


Moving to Music

As with drawing, this could be done to music provided by the therapist or a shared computer sound. The client could use movement to show how they are feeling in response to music, or lead the therapist in moving together. If both client and therapist engage in movement, you might want to take turns or copy one another in order to avoid issues around lag. 


Emotional Literacy and Music

There are a number of ways to explore emotional literacy with music over a video chat. One way would be to have a preselected variety of music that could be used to reflect different emotions or musical qualities. Talk to the client about what each emotion looks and feels like, perhaps through drawing, choosing faces, or acting it out. Talk about what music might sound like to show this feeling and listen to it together.  You could also do this by listening to a few different clips and having them choose the one that they feel matches a certain emotion. 


Receptive Music Techniques 


Musical and Relaxation 

Share computer audio to play relaxing music while talking through a relaxation script or guide your client through a body relaxation. Bear in mind that sharing audio from your computer might change the way your voice is coming through, particularly if you are using headphones with a microphone or another external microphone. One option would be to use a prerecorded relaxation script and music combined that your client can listen to, although this may feel strange for the therapist as they would not have a live ‘active role’ in the activity. 


Discussing Music & Lyrics

Listen to a song or piece of music, probably of the client’s choosing, and bring any lyrics up on a shared screen. Talk about what the music and lyrics mean to the client and what they can relate to or take away from the song. This can also be done with music played by the therapist that the client requests. 


A note on online ‘karaoke’ style singing - if a client wants to sing a particular song, maybe one that you’ve talked about the lyrics or what mood it represents, you could play music while allowing the client to sing with your encouragement. This could be done with a shared screen karaoke style youtube video (for example, lots of Disney songs have lyric videos). You would hear the music a second or two ahead of the client so you would need to avoid singing along to your music. 


A few other ideas about online working...


Another way to engage musically online is to support a parent or carer with doing musical activities with their child. Please see our article on working in this way. 


There is also a selection of app based and online musical software, including Chrome Music Lab and apps like Garage Band and A Cappella. We haven’t done much with these ways of working yet, and it would be important to check for GDPR and confidentiality compliance with any external apps you use.

Online Class
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