Poised in the Creative Now: Principles of

Nordoff-Robbins Music Therapy

Abstract and Keywords
Nordoff-Robbins music therapy was founded through the pioneering
collaboration between Paul Nordoff (1909–1977), an accomplished composer
and pianist, and Clive Robbins (1927–2011), an innovative special educator.
Their partnership began in 1959 at Sunfield Children’s Homes in Worcestershire,
England, and they worked together for approximately 16 years in Europe and the
United States. In 1975, formal training began at the newly opened Nordoff-
Robbins Music Therapy Centre in London. In the same year, Clive Robbins
formed a new music therapy team with his wife Carol Robbins (1942–1996). The
Robbins’ developed and disseminated the Nordoff-Robbins model, and in 1990
they established the Nordoff-Robbins Center for Music Therapy at New York
University’s Steinhardt School of Culture, Education, and Human Development.
Throughout its history, the clinical techniques, training methods, and research
within this model have been based in close engagement with clinical work.

Keywords: Nordoff-Robbins music therapy, creative music therapy, therapeutic

improvisation, clinical musicianship, self-actualization, developmental threshold

Within the music child, and reachable through it, is the presence of the being
child. In the assimilation of musical experience and the integration of musical
activity, the being child indwells the music child as the organizing agent that
gives the response or activity its integrity, its originality, its unique
meaningfulness, its message of individual human presence.

Nordoff and Robbins 2007, p. 17

Introduction
Nordoff-Robbins music therapy was founded through the pioneering
collaboration between Paul Nordoff (1909–1977), an accomplished composer
and pianist, and Clive Robbins (1927–2011), an innovative special educator.
Their partnership began in 1959 at Sunfield Children’s Homes in Worcestershire,
England, and they worked together for approximately 16 years in Europe and the
United States. In 1975, formal training in Nordoff-Robbins music therapy began
at the newly opened Nordoff-Robbins Music Therapy Centre in London. In the
same year, Clive Robbins formed a new music therapy team with his wife Carol
Robbins (1942–1996). The Robbinses continued to develop and disseminate the
Nordoff-Robbins approach to music therapy, and in 1990 established the
Nordoff-Robbins Center for Music Therapy at New York University’s Steinhardt
School of Culture, Education, and Human Development.

Today, this specialized approach is practiced throughout the world by music

therapists working with a wide spectrum of clinical populations. Also known
as Creative Music Therapy (Nordoff and Robbins 1977/2007), it is considered to
be the original music-centered approach within music therapy practice traditions
(Aigen 2005), and has a rich (p. 483) heritage with a highly developed model of
practice. The work of Nordoff and Robbins emphasized interactive music-
making with clients and “came about from a love of musical creation, musical
expression, and musical experience” (Robbins 2011, p. 66). The theories about
music as therapy that evolved were developed from their lived experiences of
music in clinical situations. Throughout its history, the clinical techniques,
training methods, and research within this model have all emerged from
engagement with clinical work. Influences from a range of traditions of theory
and practice related to music, philosophy, psychotherapy, health care, and
education are evident, even while this music therapy approach has remained
firmly rooted in close observation and analysis of the details of musical
communication and interaction that occur within sessions. The core principles of
Nordoff-Robbins music therapy reflect a continual endeavor to be informed and
guided by the creative now of each clinical encounter.

Meeting the Music Child

The therapeutic potentials of Nordoff-Robbins music therapy lie in the
development of interactive, inter-responsive musical relationships between
therapist and client, and among clients in a group. The therapist creates musical
forms utilizing dynamic forces inherent in the musical elements of tones, melody,
rhythm, harmony, dynamics, tempo, and so forth. This process is intended to
arouse and engage clients’ musical sensitivities, and thereby promote their
growth and development. Musical processes are viewed as the medium of
therapeutic change. A basic premise is that musicality is a fundamental, universal
human capacity. Nordoff and Robbins conceptualized this capacity as the music
child which is inborn within each individual, embodying his or her creative core
potential for growth and development, irrespective of disability or illness.
According to their inaugural text Creative Music Therapy (originally published in
1977), the music child consists of “an organization of receptive, cognitive, and
expressive capabilities that can become central to the organization of the
personality” insofar as an individual “can be stimulated to use these capabilities
with significant self-commitment” (2007, p. 4). By inviting the client into a co-
active musical relationship, the therapist promotes and supports the client’s
optimal engagement through the therapeutic opportunities in the music-making
process. As Nordoff-Robbins music therapy has expanded into a variety of
settings over the past five decades—including mental health, work with older
adults, and programs within medical settings—the concept of the music child
remains central, invoking the power of creative engagement to access clients’
capacities for resilience, flexibility, and adaptability throughout the lifespan.

Rather than follow a pre-determined protocol of musical activities, the therapist

observes, intuits, and responds to the presence and actions of the client, and
engages the client in spontaneous musical interactions. Such interaction is a
process of continuous empirical assessment: The therapist listens keenly to the
client’s music-making as evidence of who the client is and the ways in which
music might contribute to his or her development and well-being. An individual’s
music-making is thought to be of “uniquely personal significance” (Nordoff and
Robbins 2007, p. 3), revealing the creative potential within, as well as exposing
the limitations faced. The expressive qualities of one’s music convey the extent
of “flexibility (p. 484) and adaptability … fluidity and motion” in one’s
emotional life, and thus one’s capacity to be receptive and responsive to new
experiences (Pavlicevic 1997, p. 116).

In accordance with the humanistic principle of self-actualization (Maslow 1982),

the Nordoff-Robbins approach “utilizes music to harness the client’s will, and
recognizes that musical peak experiences can help clients transcend behavioral or
dynamic patterns that impede self-enhancement” (Turry 2001, p. 351). As clients
develop musically, they are considered to be discovering their core potentials.
They are not only becoming more able to engage in music and express
themselves musically; they are also becoming more fully themselves (Aigen
1998). By drawing a client into active musical collaboration, the therapist can
build upon the client’s impulses toward positive development, cultivating
intrinsic motivation for interaction and expression rather than scripted responses
to extrinsic demands. Clive Robbins referred to this process as working at the
client’s developmental threshold—intervening “to stimulate personal growth,
develop self-confidence, ameliorate a painful or limiting condition, and invite
him/her into experiences of healing support, liberation, and human
companionship” (Robbins 2008).
Communication and interaction through
the dynamic form of music
The Nordoff-Robbins approach addresses therapeutic goals through “in-depth
utilization of the structural and expressive elements of both improvised and pre-
composed music” (Guerrero and Turry 2012, p. 131). Tones and the relationships
among them are regarded as temporal events and dynamic forces that vitally
affect human experience. The therapist attempts to discern clients’ evolving
responses to aspects of the musical context, such as harmonic tension and
resolution; varying melodic and harmonic intervals; consonance and dissonance;
predictable tonal sequences and unexpected creative leaps; tempo and dynamic
contrasts; steady pulse or rhythmic freedom; the use of the voice; and shifting
textures of instrumental sound. In order to employ music effectively as a medium
of communication and interaction, therapists in training learn to develop fluency
and versatility in working with musical elements, tonalities, idioms, and styles.

Improvisation in this approach is often described as compositional improvisation,

since therapists incorporate rhythmic structure, harmonic direction, and melodic
motifs to create distinct musical forms which invite clients’ response. As Turry
and Marcus have explained (2003), “to the spontaneous expressive efforts of the
clients, therapists bring a thorough grasp of the aesthetic principles by which
such expression may be given form and context” (p. 201). In group sessions,
therapists can improvise music that “makes the contributions of each member
clearer to the others and enhances the possibilities for meaningful responsive
interaction. The resultant counterpoint preserves each individual voice yet unites
them in a common creative undertaking” (p. 201). Through such aesthetic
shaping, the music can lead clients into heightened responsivity and interaction
while embracing their present activity. In this way, clinical improvisation allows
the therapist to work at each client’s developmental threshold, “meeting her
impulses, enhancing their communicative impact, and affirming her gains” while
“providing a mobile repertoire of supportive, confirming, nourishing, and (p.
485) onward-leading musical experience” (Robbins 2008). Goals need not be
pre-determined, but may be uncovered and addressed sequentially in the ongoing
process of therapy.

Music therapists who have trained in the Nordoff-Robbins approach have

attributed the therapeutic potency of music to the congruence between the
dynamic, kinetic qualities of musical form and the qualities of human emotions
and physiological functions (Pavlicevic 1997). Ansdell (1995) describes the
“pulses and tones, tensions and resolutions, phrasing of actions, bursts of
intensity, repetitions and developments” that characterize physiological
processes, coordinating the components of each of the body’s systems and
coordinating these systems with each other (p. 8). Pavlicevic (1997) observes that
“the ebb and flow, tensions and relaxations in music resemble the ebb and flow,
tensions and relaxations of human feeling” (p. 32). Music does not capture
emotions as static entities, but rather conveys the processes of their unfolding and
transformation over time.

Pavlicevic has developed the concept of dynamic form which draws upon Daniel
Stern’s concept of vitality affects, encompassing such qualities as “surging,
fading away, fleeting [or] drawn out” which may be found across various human
activities and experiences (Pavlicevic 1997, p. 106). Dynamic form is a
characterization of vitality affects in terms of musical elements, including
rhythm, tempo, pitch contour, dynamics, and timbre. Through the dynamic form
of an improvisation, qualities of expression are intimately linked with qualities of
experience, rather than being “an external display of … internal, categorical
emotional states such as joy, anger, sadness, and so on” (p. 121). Thus, to the
extent that a therapist responds musically to the dynamic form of her client’s
activity and presence, she is not merely “reading” or inferring qualities of the
client’s emotions; rather, she herself directly experiences these qualities. In this
way, clinical improvisation creates an immediate “intersubjective experience for
therapist and client,” and offers the client “an experience of ‘being known’” (p.
117).

The therapist endeavors to create music that itself understands the client
(Nordoff, cited by Aigen 1996). Inherent in musical understanding is direct
engagement; rather than merely “commenting on” what the client presents, the
therapist is “being with the client” through musical attunement (Pavlicevic 1997,
p. 152). Psychologists Mills and Crowley (1986) argue that “being with” a
client—perhaps especially so with clients who have limited verbal
communication—requires communication “at ‘breathing’ levels of awareness”
(p. 97), attuning to subtle non-verbal cues such as breathing and posture, and
thereby conveying to the client: “I see it, I hear it, I experience it; I do
understand what it’s like to be in that position” (p. 93). Such non-verbal cues
may act as a vital force in shaping clinical improvisation in creative music
therapy.

By joining readily in the client’s spontaneous playing, movement, and

vocalization, the therapist works to draw the client into increasingly reciprocal
communicative interaction. What is most importantly communicated in this
musical interaction is that each of them is affected by the presence and actions of
the other. As in the early, pre-verbal development of communication between
infants and their caregivers (Trevarthen et al. 1998), the interpersonal dynamics
of shared attention, mirroring, and emotional attunement are paramount in the
unfolding of musical communication between client and therapist. Just as
caregivers nurture the growth of communication by making their actions
contingent upon an infant’s spontaneous facial expressions, movements, and
sounds (Stern 1990), in clinical improvisation the therapist creates music that is
contingent upon the client’s spontaneous acts, placing these acts within a
framework of musical exchange. The therapist attempts to “read” the (p.
486)communicative potential of the client’s acts, and to offer a response which
the client can recognize as such. In spite of conditions that may hinder the
development of communication and relationship, the potential for this
development is addressed as the therapist seeks to engage the client’s
“communicative consciousness” (Pavlicevic 1997, p. 103).

Musical communication in this therapeutic approach emerges through immersion

in spontaneous interaction, rather than through direct instruction. This is
analogous to the process that occurs in young children’s natural acquisition of
their native language. Collaborative improvisation serves as a means of
immersing individuals in rich, spontaneous musical dialogue, thereby developing
their musical communication in a naturalistic manner. In this musical dialogue,
as Aigen (1996) has observed, the therapist seeks to create a meaningful aesthetic
context which enhances the expressive significance of the client’s actions. The
“spontaneously and flexibly evolving structures” (p. 19) of creative music-
making allow for learning through the repetition of familiar musical or verbal
material in new contexts, and the presentation of new material in familiar
contexts. As with the development of language in infancy, the development of
musical communication does not occur through mere exposure to the
communication medium, but rather through meaningfully structured engagement.
Clients’ growth in communication and interaction is intimately entwined in their
overall development; it becomes part of their way of being, unlike behavioral
change which is externally imposed.

Although the therapist will sometimes imitate the client’s playing, the therapist
works to create music that communicates her own experience of the client and of
their relationship. The flexibility of this improvised music sparks the client’s
recognition of the therapist’s separate, responsive presence, drawing the client
into enhanced inter-responsiveness (Aigen 1998). In order for the client to
perceive that he is being listened to, he must recognize the presence of the
listener. Benjamin (1988) has described the analogous interaction in parent-infant
communication. In vivid contrast to responses by mechanical objects, “the
mother’s response is both more attuned (it ‘matches’ the infant) and more
unpredictable … mixing novelty with repetition … The combination of
resonance and difference that the mother offers can open the way to a recognition
that transcends mastery and mechanical response, a recognition that is based
on mutuality” (Benjamin 1988, p. 26).

The infant’s sense of agency and personal initiative develops in the context of
this evolving recognition of others. Similarly, in therapy, a client may become
more self-aware when provided with music that asserts the autonomous presence
of the therapist rather than conforming to his immediate needs. As Aigen
(1998) has described in his case study of Indu, an adolescent client of Nordoff
and Robbins with cerebral palsy and developmental delays, “it is in [the]
nonmeeting of his immediate needs that Indu becomes more aware of his self and
his own desires; he thus experiences an enhanced motivation and ability to
engage in actions which express his needs … ” (p. 183). In this way, the client’s
intrinsic desire to communicate and interact is cultivated.

Creative processes in therapy

While the clinical use of improvisation is clearly advantageous to the therapist as
a versatile tool for “searching out a means of contact” with a client (Robbins
1993, p. 13), it has a further (p. 487) profound benefit: It affords the client the
opportunity to improvise, to “discover and explore both music and herself” (p.
13). Such creative activity supports the actualization of clients’ capacities,
making them “communicative and communicable” (Nordoff and Robbins 2007,
p. 195). The therapeutic significance of creative engagement, as Maslow
(1982) observes, lies in the fact that “capacities clamor to be used, and cease their
clamor only when they are well used.” In this respect, “capacities are also
needs.” The unused capacity “can become a disease center or atrophy, thus
diminishing the person” (p. 201). During peak experience through immersion in
creative activity, an individual’s capacities are fully expressed. Whereas
normally only “part of our capacities are used for action, and part are wasted on
restraining these same capacities,” at the peak of functioning “there is no waste”
(p. 106). One is “able to listen” to oneself and to others “without contamination
by expectations based on past situations … or hopes or apprehensions based on
planning for the future.” The result is “improvised … emergent and newly
created” activity which is valued for its own sake (pp. 108–109).

The development of self, in a humanistic paradigm, involves the discovery of

meaning in one’s own experience. Creative engagement in music offers clients a
forum for meaningful activity and interaction. As Robbins points out, for clients
whose range of experience has been constrained by disabling conditions,
“musical experience is so much more important because it is that much more
meaningful in proportion” (cited by Aigen 1996, p. 16). By participating ever
more fully in creative music-making, the client comes to experience himself, like
music, “as a form that is continually being improvised in the world” (Ansdell
1995, p. 27), ever emerging and undergoing transformation. Such experience is
congruent with the humanistic conception of the self as dynamic, a “continually
changing constellation of potentialities, not a fixed quantity of traits” (Rogers
1961, p. 122). Therapy presents the client with an opportunity to discover “new
aspects of himself in the flow of his experience” (p. 124), and collaborative
improvisation allows the therapist to join the client in delving into this flow.

For both clients and therapists, creative musical interaction allows the integration
of contrasting human faculties: rational and intuitive, cognitive and emotional,
conscious and unconscious. Similarly, the effective use of play in therapy has
been described as freeing both therapist and child “to use the whole personality”
(Winnicott 1971, p. 54). Wholly immersed in creative activity together, both
client and therapist may be affected in ways that lie beyond their immediate
abilities to construe or construct. In the training courses he taught at the Nordoff-
Robbins Center for Music Therapy at New York University (NYU), Clive
Robbins devoted attention to the therapist’s cultivation of creative freedom in
musical interaction with clients. He developed a diagram entitled “Poised in the
Creative Now” (Figure 26.1). This depicts the therapist embarking upon a
session, and indicates the broad range of resources, both acquired and intrinsic,
that the therapist can utilize in the creation of the music that drives the therapy
process. These resources are dispersed equidistantly under six headings that
surround the center of the diagram, which is designated as Clinical Musicianship.
The lower half of the diagram lists abilities or qualities that are largely acquired
through experience—musical experience, clinical experience, general clinical
training, and knowledge of the particular case. The upper half of the diagram
encompasses qualities that are more unlearned, but inherent, including Intuition,
Creative Freedom, and Expressive Spontaneity.

Click to view larger

Figure 26.1 Poised in the creative now.

The category of Expressive Spontaneity takes account of the therapist’s own

“musical self” or music child, as well as personal and artistic inspiration, which
are essential ingredients in the creative process of therapy. The forces
of inspiration and intuition, along with (p. 488) imagination, had special
significance in the anthroposophical teachings of Rudolf Steiner (1861–1925).
These were considered pathways to the development of deeper awareness and
knowledge (Steiner 1977, 1998). The founding and early development of
Nordoff-Robbins music therapy were substantially influenced by these
anthroposophical values and concepts (Robbins 2005).

The high value placed by anthroposophy on music and the arts in human
experience is reflected in Robbins’ writing (1993) about the historical context of
music therapy:

Throughout history, mankind has created music for self-expression, for socio-
political and religious rituals, and for artistic and cultural experience. The
inspirational processes and compositional techniques of music have been
channeled into many social purposes … In creative music therapy, the same
artistic processes that have produced and continue to produce the social
repertoire of music are at work. One is aware of an equal artistic integrity in
action, now clinically focused on meeting an individual human being’s needs,
whether adult or child. (p. 8)

From this perspective, the creative processes of music as an artistic medium are
vital to its therapeutic efficacy. Hence, therapists are trained to make musical
interventions “not only (p. 489) appropriately, but creatively” (p. 8), availing
themselves of the unique expressive possibilities music offers. As Robbins
argues, “we must remember that the power of music in therapy stems from the
reality that music is an art, that music therapists are privileged to mediate this art
to meet many areas of need and experience” (1993, p. 16).

By way of illustration, he describes the lyrical, tenderly expressive

song Wonderful which he and Walter Stafford, a music therapist who trained at
the Nordoff-Robbins Center, composed for their client Karyn, a nine-year-old
girl with developmental delays and characteristics of autism (Robbins 1993, p.
17): “The song was truly inspired by Karyn in exactly the same process whereby
a character in a libretto inspires a composer with a song or an aria. From session
to session, as in a studio, there was a working through; ideas were tried and
discarded, clearing the way toward the realization of a theme that had existential
truth and definition” (p. 25). He similarly describes his and Carol Robbins’s team
work with Nicole, a child born in the 24th week of gestation who was four years
old when she began therapy: “The improvisations for Nicole, for her piano
playing and dancing, were directly inspired by the uniqueness of her being as
manifested in the whole gestalt of her ongoing response. The living music
reflected—lovingly imaged—the living child, moment by creative moment” (p.
25).

Empirical phenomenology
In Nordoff-Robbins music therapy, clinical improvisation is regarded as an
empirical approach to treatment, since it requires therapists’ keenly developed
perception of and response to moment-by-moment developments in clients’
expression and interaction. This empirical phenomenology (Ansdell 2012, p. 3)
also characterizes the Nordoff-Robbins approach to research and theory
development. The creative spontaneity of musical interactions during sessions is
balanced by careful detailed observation which gathers evidence of clients’
responses to therapeutic interventions. To this end, therapists make high-quality
audio-video recordings of each session for review prior to the next session. While
reviewing a session, they frequently pause to examine significant events, noting
clients’ responses and transcribing music considered important to remember for
subsequent sessions. This method of close analysis—called indexing, as it
generates a time-based index of significant moments in each session for future
reference—is standard procedure in Nordoff-Robbins practice, originating in the
intense care and focus with which Clive Robbins and Paul Nordoff conducted
session analysis from the earliest days of their partnership. This has been
described as embodying Goethe’s concept of bringing love and devotion to the
study of an object (Ansdell and Pavlicevic 2010). As the first editor of Goethe’s
scientific works, Steiner was strongly influenced by Goethe’s principle of saving
the phenomena in theory-building and research, which entails close, respectful
observation of phenomena within their natural settings as opposed to reducing
them to theoretical or numerical abstractions (Ansdell 2012, p. 3). In accordance
with this principle, research within the Nordoff-Robbins tradition
characteristically involves in-depth examination of courses of therapy, which is
both idiographic—“attending to the individuality of each case, of each
manifestation of the phenomenon,” and seriated—“building a collection of
exemplary cases for comparison and amplification” (Ansdell 2012, p. 3).

As music therapists collaborate with professionals from other fields to provide

interventions and measure outcomes relevant to particular client populations, it is
important to (p. 490) characterize the therapy process with the highest possible
degree of specificity and completeness. The extensive archive of Nordoff-
Robbins music therapy session recordings serves as an invaluable resource for
the “musically specific research” (Robbins 1993, p. 16) that is indispensable for
understanding the process and outcomes of music therapy. Such research is
grounded in the premise that a client’s responses to therapy are “intimately
related to the kinds of musical experiences created, and to the musical techniques
that [establish] her skills and experiences and then [extend] them” (p. 16).
Robbins argued against reductive accounts of music therapy in which “the music
is left faceless, anonymous … as if music itself didn’t matter,” as if “all music
were the same, and all uses of music in therapy were equivalent” (p. 16). On the
contrary, in the Nordoff-Robbins approach, it is in the intimate details of the
music that the unfolding communication and relationship between client and
therapist are manifested.

Assessment and evaluation

Nordoff and Robbins developed a set of rating scales (Nordoff and Robbins
2007) that reflected their interdisciplinary collaboration with other professionals
in a clinical setting, while maintaining the musical specificity of their approach to
therapy. At the Day-Care Unit for Psychotic Children within the Department of
Psychiatry in the School of Medicine at the University of Pennsylvania, working
under a grant from the National Institute of Mental Health,1 they utilized an
existing assessment tool in clinical psychology, the Behavior Rating Instrument
for Autistic Children (BRIAC—Ruttenberg et al. 1966), as a model for
developing “instruments for evaluating musical and behavioral responses in
individual improvisational music therapy” (2007, p. 367) within and across
sessions. They drew upon two of the BRIAC scales—Scale I: Nature and Degree
of Relationship to an Adult as a Person, and Scale II: Communication. As
Nordoff and Robbins described, they applied these scales “to similar areas of
behavior in music therapy, their terminology being at first interpretively modified
to be relevant. Music therapy data were reviewed, subjected to comparative
analysis, and progressively incorporated” (2007, p. 367).

The instruments that emerged from this process of adaptation were named Scale
I: Child-Therapist Relationship in Musical Activity (later renamed Child-
Therapist Relationship in Coactive Musical Experience), and Scale II: Musical
Communicativeness. Nordoff and Robbins also created Scale III: Musicing.
Forms of Activity: Stages and Qualities of Engagement based on an original scale
devised by the Day-Care Unit research group for “assessing stages of mastery …
to measure the emergence of a child’s autonomous behavior” (2007, p. 368).
Scale III was conceived as “the music therapy equivalent of this measure, as it
delineated the degree and nature of a child’s autonomy in terms of discrete areas
of musical activity” (p. 368), including “separate hierarchic taxonomies for
rhythmic and melodic forms, differentiated by their complexity” (Mahoney 2010,
p. 24).

The clinical source material for the development of these scales consisted of
Nordoff and Robbins’s courses of improvisational music therapy with 52
children and adolescents ranging in age from three to 16 years, including 26 who
showed behaviors characteristic of the autism spectrum, and others with a variety
of developmental disabilities or severe emotional (p. 491) disturbance. Therapy
sessions were audio recorded, and “a description of each child’s musical and
general behavior in every session was indexed to the recording” (Nordoff and
Robbins 2007, p. 369). The scales were developed through detailed study of the
session indexes. In the ensuing decades, the scales have been implemented in a
variety of settings internationally by therapists trained in the Nordoff-Robbins
approach. At the NYU Nordoff-Robbins Center, all three scales underwent
extensive revision based on analysis of video recorded courses of therapy
conducted at the Center (p. 369).

In addition to functioning as evaluation tools in Nordoff and Robbins’s project at

the children’s psychiatric Day-Care Unit and in subsequent therapy programs, the
scales “have served therapists … as instruments of clinical perception” (Nordoff
and Robbins 2007, p. 369), providing a developmental framework for describing
a course of therapy. As such, the scales have been of particular utility in Nordoff-
Robbins training programs. Scale I, the most widely used of the scales (Wigram
et al. 2002), sets forth seven levels in the development of the client-therapist
relationship, beginning with unresponsiveness or active rejection and progressing
toward stability and confidence in interpersonal musical relationship (p. 374). In
its higher stages of development, this relationship is characterized by mutuality
and reciprocity in the joint creation of music. At each of its seven levels, the
scale captures the dynamic interplay between qualities
of participation and resistiveness in the unfolding of the therapeutic relationship
(pp. 372–373).

Conclusion
In clinical practice and research within Nordoff-Robbins music therapy, human
beings and music itself are addressed in a naturalistic context of creative
interaction. Therapists meet clients as equal partners in collaborative
improvisation, adapting flexibly and sensitively to clients’ evolving participation.
Therapists cultivate their own musical responsiveness so that they may engage
clients as fully as possible in music-making, rather than imposing preconceived
limits upon clients’—or their own—experience of the expressive and dynamic
potentials of music. It is by generating and studying creative musical experiences
of significant depth and scope that practitioners of this approach come to
understand the ways in which music may contribute to human development,
healing, and well-being.

Future generations of Nordoff-Robbins practitioners, trainers, and researchers

will continue to build upon the legacy of Paul Nordoff and Clive Robbins. New
studies and materials for teaching are being published to add to the existing body
of training resources. Clinicians and trainers are providing a foundation upon
which to develop research methodologies to assess clinical processes and
outcomes. In turn, research on Nordoff-Robbins music therapy will continue to
test and refine its theory and clinical practice. New areas of practice are emerging
as Nordoff-Robbins clinicians enter into interdisciplinary collaborations within a
variety of institutions.

Even as these new developments take place, the unique essential characteristic of
the approach remains embedded—that musical structures in and of themselves
are harnessed in improvisation-based practice that is rooted in music-centered
theory. Techniques both to enhance creativity and to establish grounded scientific
methods of enquiry continue to (p. 492) develop. Just as music holds qualities of
both support and challenge for potential clinical encounters, the approach itself
brings together the highest ideals of art and science.