‘Were they better today?’ Valuing a client’s individual therapeutic process within an institution’s expectation of positive progress and predictable outcomes

The broad context for this article is the provision of music therapy for children and adults with learning disabilities within the current social, political and economic context. The article explores themes regarding internal and external pressures experienced by the music therapist both inside and outside the therapy room. The external pressures are identified and discussed through literature, with the focus being on the commissioning institution’s expectations of the value music therapy will add and how this value can be measured and predicted. The internal pressures the music therapists can experience concerning their desire to know and understand the client are explored through literature in relation to their professional role and their personal desires when relating to others. The anxieties that these pressures can create, and the impact that they can have on the therapist’s thinking around the work, are considered in detail through a case study with particular reference to the music therapist’s capacity to work fully with not knowing and regression.