top of page

AAC & Music Therapy

 Within Music Therapy, there are multiple facets that directly impact the client’s experiences; these include: arrangement of the therapy environment, role and function of music experiences, therapeutic relationships, and communication in verbal and non-verbal forms. However, there is a gap in the education and training of music therapists concerning alternatives to verbal communication, and the use of these alternatives in therapy. Looking at suggestions from music therapists and clients, how can we do better?



1. Undergraduate Education: Increase the discussion of this topic in educational settings. Most undergraduate music therapy programs do not cover AAC in their curriculums, advocate for your program, or those around you to do so. 

2. Supervision: It is recommended to seek supervision with therapists that have experience with AAC. Because it's not talked about in education, the most valuable resource you have is supervision with experience. Check out the forums on this website, or search for groups online.

3. Observation: Each individual client will communicate differently, it's almost like learning a new language, so be prepared to observe even small responses to your actions. Noticing these small details can lead to understanding communication styles already at play.

4. Co-Treatment: Learning how to co-treat, especially with speech therapists/pathologists can help music therapists understand pre-existing treatment goals, communication styles, and vocabulary.

Ethics And Values of Therapists

1. Value of Music: It's important to recognize the inherent value that music itself holds as a form of communication. Challenging all clients and therapists to explore their ability to communicate only through musical expression can have vast therapeutic benefits. Additionally, it can begin to normalize alternative communication forms. 

2. Group Work: In group work, integrating any alternative communication forms as valid voices within in the group is vital. As a facilitator, it may be necessary to step in and advocate for the voices of those who communicate differently, but ultimately, a group that can adjust to being open to communication styles different from their own is the beneficial to everyone involved.

3. Speech Reception: Never assume the skill level of your client. A common misconception revolves around the idea that non-speaking people are not able to receptively process speech too. However, this is often not the case, and no one's abilities should be assumed.

4. Dignity: Unfortunately, there has been wide spread abuse of non-speaking people due to their perceived lack of ability to communicate. Therapists should always seek informed consent/understanding before starting treatment, and throughout the course of treatment through multiple avenues of communication. 


1. Vocalizing: Vocalizations can be especially indicated in multiple ways. If a client has vocalization potential, working with this in music through vocal improvisation has been helpful. Additionally, using such singing to ask questions, and then take note of the client’s response can be helpful in beginning communication through music. This music facilitation technique is often termed soliloquy.

2. Close Ended Questions: Especially when beginning to communicate, using questions that can be answered with binary or list options was preferred by the client. However, after giving these options, it's important to wait for, or offer a chance for the client to voice further communication to elaborate. 

3. Initial Communication: Observation is the best way to begin to understand an individual communication style. Instead of imposing a communication system on an individual, this observation allows for the communication already in place to be shown and then built on. For example, offering instrument choices to a client, and observing their decision process and selection. Additionally, establishing a routine can assist in building rapport through the fulfilment of expectations.

Music Therapy Experiences

1. Adaptability: Virtually any method variation within recreation, receptive, improvisation, and composition can be utilized with non-speaking clients. Rather, it is up to the therapist to consider the communication style of their client and adapt accordingly.

2. Improvisation and Composition: Composition and improvisation can be used to create something beautiful and valuable shared between the client and therapist. These methods have been successful in addressing self-identified clinical aims of cerebral palsy clients. Additionally, composition is particularly important because the method can provide opportunities to practice and further develop cognitive organization skills. Giving clients choice in instrumentation and voice type (if used) in these methods can also be clinically indicated.

3. Device Use: Considering that not all clients will want to use the newest technology is essential in respecting client dignity. Use of devices, no matter their level of technology, can be used to create choice for experience type, and within the experience how the client participates. Additionally, some high tech devices may be utilized to create digital artifacts of these experiences for the client. 

 Alternative and Augmentative Communication:

Ethics and Possibilities in Music Therapy with Non-Speaking Clients

Through interviews and analysis, this thesis, presented in conjunction with the University of Dayton Honors College, explores the experiences of one non-speaking music therapy participant, and three board certified music therapists with relevant expertise, to empower current and student music therapists to advance their engagement with non-speaking clients in music therapy. 

About the Author

Amanda Bursch

Amanda Bursch is a 2023 graduate of the University of Dayton Music Therapy Program. She is working towards completion of her internship at Park Nicollet Health Services in Minnesota in April 2024. 

bottom of page