Ethics and Harm in Music Therapy & Counselling

Music therapy is widely seen as a safe, effective, fun, and enriching therapeutic option. This is true in many cases. However, like any powerful tool, it carries ethical risks. Understanding how harm can occur and how to prevent it is crucial for both clients and therapists in a music therapy setting or relationship (Murakami, 2021; Gardstrom, 2008).

Music Therapy vs. Therapeutic Music

It’s important to distinguish between music therapy, a clinical profession led by Certified Music Therapists (MTA), and therapeutic music, which may include the use of music for general relaxation or entertainment. Music therapy involves trained professionals applying music-based interventions with therapeutic intent, grounded in client assessment, individualized goals, and clinical qualifications (Music Therapy Association for Alberta (MTAA), n.d.; Murakami, 2021). To ensure a standard of ethical care, always choose a Certified Music Therapist and look for their MTA credential. #MTA2026

Yes, Harm can Happen

Contrary to popular belief, music and music therapy is not automatically harmless. As Gardstrom (2008) points out, therapy isn’t always non-invasive; music’s power can provoke distress, overstimulation, or unintended emotional reactions.

Brea Murakami’s Music Therapy & Harm Model (MTHM) (2021) outlines six main sources of potential harm:

• The music itself (e.g., upsetting lyrics, overstimulating volume, musicogenic seizures, too complex)

• The therapist (e.g., poor matching of music to client needs, incompetence, personal motivations)

• The application of music interventions (e.g. when and how?)

• The therapist–client relationship (e.g. boundary violations, judging, unresolved transference and countertransference)

• Client–music associations (e.g., emotional associations, preferences, traumatic triggers)

• Broader ecological/contextual factors (e.g., cultural insensitivity, systemic oppression)

Brea Murakami’s Music Therapy & Harm Model (MTHM) (2021)

Contraindications & Boundaries

Murakami (2021) highlights the importance of tailoring interventions that are appropriate. While clients have autonomy in participating in therapy, the therapist has the responsibility to maintain safety. For example, clients with trauma, high arousal, or sensory sensitivities can be easily overwhelmed, making certain musical stimuli unsafe.

Similarly, traditional talk therapies aren’t always a safe first step, especially when clients can’t access verbal reflection under stress. That's why it is important for a trained music therapist to select interventions (i.e. music-based grounding or movement) at the right moment in the therapeutic process.

Using the Right Tools at the Right Time

Therapists need to be alert to the client’s state by using skilled decision-making and clinical judgement.

• Are they able to reflect in the moment?

• Are they overwhelmed, and in need of calm?

• Are they showing signs of ambivalence about change?

• Are they needing affirmation and validation before they can move forward?

• Is now the right time to explore deeper meaning, or is stabilization the priority?

• Are they expressing “change talk,” or still resisting the idea of intervention?

• Do they need structure and direction, or space and autonomy?

Motivational interviewing helps therapists respond to client cues with empathy and openness, gently guiding toward confidence and readiness without imposing goals (Miller & Rollnick, 2013; Gardstrom, 2008).

Professional Standards & Training Matter

Certified professionals are trained to foresee risk and adapt quickly moment-to-moment. The MTAA and the Certification Board for Music Therapists (CBMT) explicitly name the therapist’s role in recognizing, preventing, and repairing harm (Gardstrom, 2008). Murakami (2021) reminds us that such vigilance must be part of ongoing reflection, supervision, and advocacy in both training and practice settings.

To summarize, Certified Music Therapists are trained to assess needs, recognize contraindications, and select interventions at the right time. Ethical music therapy uses sound and music mindfully to support self-expression, healing, and growth - with trust, choice, and collaboration as its cornerstones (Bruscia, 1998; Murakami, 2020). Music can heal, and in some cases, harm without appropriate considerations. Ethics and supervision are non-negotiable parts of a safe therapeutic environment

Choosing Music Therapy Safely

• Ask about credentials. Look for an MTA (Certified Music Therapist).

• Share your experiences. Mention any trauma, sensory sensitivities, or music reactions you’ve had.

• Feel safe discussing discomfort. A good therapist will check in regularly, adjust methods, or pause if something’s not working.

• Partner in the process. You are the co-creator of your journey, with choice and consent at every step.

Music therapy can be a deeply healing experience when conducted with intention, care, and ethical vigilance. If you’d like to know more or feel uncertain if this is right for you, book a free consultation and talk to one of our therapists today.

References and Additional Resources:

Bruscia, K. (1998). Defining Music Therapy. Barcelona Publishers.

Gardstom, Susan C. (2008), ‘Music Therapy As Noninvasive Treatment: Who Says?’, Nordic Journal of Music Therapy, 17(2), pp. 142–154.

Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd edition). The Guilford Press.

Murakami, B. (2021). The Music Therapy and Harm Model (MTHM): Conceptualizing harm within music therapy practice. ECOS, 6(1), 003-003. https://doi.org/10.24215/27186199e003