Clinical improvisation is known by music therapists as one of the primary tools
used to engage clients of varying abilities and challenges (Bruscia, 1998; Bruscia, 1987).
Music therapists structure improvisation experiences to bring the musical freedom of
creation and expression to our clients. While these outcomes may seem basic,
opportunities for creation, communication, and interrelation are particularly significant
for those individuals who have communicative and cognitive challenges, such as
individuals with profound intellectual disability (ID). Many individuals within this
population have difficulties with communication and interaction, but can find ways to be
heard through clinical improvisation experiences with the therapist. The following case
study features one client with profound ID. His experiences in improvisational music
therapy sessions are described through analysis of video-recorded sessions. Aspects of
the client’s discovery of his ability to express himself, communicate, and interact with the
therapist are discussed through examination of his musical participation. The client’s
musicing is further analyzed through the Nordoff-Robbins evaluation scales, as well as
integration of theories of Abraham Maslow.