Breaking the Bias: When Music Therapy Doesn’t Need Music

TissueBox Monster

It’s easy to assume that music therapy must always involve music in every session. I once held the

same belief. Not long ago, I began working with a junior client in what was meant to be face-to-face

sessions. Due to personal reasons, these sessions were moved online.

The transition was challenging. Online music therapy has well-known limitations—especially when

it comes to synchronised musical activities. Here, “time frame” doesn’t mean a long duration, but

the tiny gap of 1–2 seconds that can make all the difference. No matter how advanced the

technology, network lag is inevitable. This can disrupt music-based interventions, where timing and

rhythm—like in drum play—are central to the therapeutic process.

Another hurdle was the client’s lack of interest in musical activities. This can be difficult to unpack:

is it the therapist’s approach, the activity content, the setting, or simply the client’s current state? In

my case, I suspected the change in setting played a big role. I tried adjusting the musical content

multiple times, yet keeping him engaged for a full hour in front of the screen proved difficult.

One day, I came across a pack of 50 activity cards focused mainly on art, with potential to combine

with music. The first one my client chose was creating a “monster box” from a tissue box. Before

starting, I honestly didn’t expect him to stay focused for more than 10 minutes. To my surprise, he

spent nearly 50 minutes colouring the tissue box his mother had found, crafting and attaching “body

parts” for the monster, and even giving it a name.

In that moment, I was reminded how connection often matters more than the medium we use. By

giving him the freedom to choose an activity he genuinely enjoyed, I was able to meet him where

he was, rather than insisting on where I thought we should be. That mutual engagement created a

sense of safety and trust, which became the foundation for any therapeutic work that followed.

From there, I began to reintroduce musical activities bit by bit, whenever I sensed positive changes

in the rapport we had rebuilt.

What impressed me most was that this music therapy session had no music at all—not even

background music (at his request). Yet, his engagement was remarkable. At the very end, we used

the monster box to sing our goodbye song—the only musical element of the entire session.

Looking back, I realised that incorporating a non-musical activity allowed me to rebuild rapport and

connection with a client who had lost interest in musical activities due to life changes. As music

therapists, we sometimes hold firmly to the belief that music must be the primary tool in every

session. While our faith in music’s power is well-founded, it’s equally important to remain open-

minded and recognise the potential of non-musical tools to support and even enhance our

therapeutic work.

Ultimately, this experience reinforced for me that the heart of music therapy lies in the relationship

between therapist and client. When connection is prioritised, engagement naturally follows, and

music can be reintroduced in meaningful ways. Music itself is powerful, but its impact is magnified

when the client feels seen, supported, and truly involved in the process.

Sammy Chan RMT

Sammy Chan RMT

Sammy Chan is a Registered Music Therapist, based and trained in Melbourne, Australia. He has had experience in a range of contexts, including individual and group work with NDIS participants, children in schools, children in hospital and residential care for the older population. Sammy believes in enabling people through their own strengths and resources. He cherishes the connections he forms with people through music therapy and looks for respectful and meaningful collaboration with everyone he works with. Sammy speaks English, Cantonese and Mandarin.