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Teletherapy Struggles and Solutions

by Jordan Bailey, MT-BC

Teletherapy is more prevalent now than ever due to the COVID-19 Pandemic. As a novice teletherapy provider, I am not necessarily in my element just yet. I know that with time and experience, teletherapy sessions will be smoother but needless to say, I’ve dealt with some struggles here and there. Here are some of the difficulties I have experienced and how I have decided to tackle them.

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There are so many changes to the normal ebb and flow of each of my music therapy sessions due to the switch to teletherapy. There are certain types of interventions that my clients are accustomed to that can only be authentically executed in-person. The changes disrupt routine and require relearning on the client’s part. This can be seen as a major disadvantage, but when this is used to your advantage, it exposes the client to new interactions and creates a new routine.

In order to combat the many possible limitations, some of your clients’ goals and objectives might have to be altered. I’ve had to make these changes and brainstorm new interventions that I can use to address new teletherapy objectives.

A concern that I’ve gotten from parents and attendants was whether or not the client was a good candidate for music therapy provided via the teletherapy avenue. The clients I serve via teletherapy function on all levels, so my best advice would be to just encourage your clients’ parents and attendants to give it a try. I’ve had some great successes!

Technological Issues

Technology is so great and it’s a wonderful way to connect with one another. Technology also has its moments when it’s not so smart. I’ve experienced many interruptions to the musical experience. These interruptions can be caused by a number of issues including, but not limited to being in locations with poor quality wireless service and having faulty or unreliable equipment. There can be issues with lighting, clarity of video, poor sound quality, video/audio delays, and even dropped calls. This does not create a very therapeutic environment as it has been quite frustrating for a few of my clients. A good way to improve internet connection is to connect the device directly into the modem using an ethernet cable, if possible.

There have been instances where I have wanted to use recorded music in a session. I’ve experimented with the best way to present the music to my clients. I’ve tried playing the music from my device; however, the sound quality was not the greatest on the client’s end. I’ve also attempted using a Bluetooth speaker to provide the recorded music. This had a better outcome, but the best method I’ve found was to send a link of the recording directly to the client using the teletherapy platform’s chat feature. This assures that the client is hearing the top-quality audio.

Concerns about Confidentiality

When the option of teletherapy came about, there were lots of questions from the parents/attendants of my clients. Some were concerned about the privacy and confidentiality of it all. There are many options, one of the most popular being Zoom. With Zoom, the therapist sends the client a link for the room and sometimes a password. I choose to use to provide HIPAA-compliant teletherapy sessions. This platform has a very simple layout. I send my clients a link to my personalized waiting room via and they sign in just by typing their name.

The free version of is fully HIPAA compliant and is very secure as opposed to some of the other possible options, so I feel very confident using it. It is also very easy for the client to use. 

Lack of Physical Presence

Many of my clients require hand-over-hand (HOH) assistance and more of a hands-on approach in general. Without HOH, some of my clients would not get the most out of their music therapy sessions. It is clearly impossible to assist using HOH over a video session. This is where the help of parents, siblings, or attendants come in handy. With clear instructions and a little training, the clients can get all of the assistance they need from the people that are around them. 

It might also be much more difficult to read the client’s body language as the video feed does not show the same view that we have when we are there in person. It is important to remember that your client is still very aware of your facial affect. At times it can seem harder to emote over the computer. This is something that I’ve had to be cognizant of even more than normal. 

Lack of Access to Instruments

In each teletherapy session, I already own all of the instruments and materials that I might need. On the client’s end they usually do not have the same number of instruments or materials available to them. Some clients might even have goals/objectives that are geared toward learning an instrument such as piano and/or guitar but may not own one of their own.

In our in-person sessions, I find that giving the client options throughout the session keeps the client motivated, sustains their attention, and it helps foster a sense of autonomy for the client. In the instance where instruments were not present in the home, some client parents have bought a set of their own instruments. My solution to this would be to have the client find items around the home that can be shaken in the same way a maraca or an egg shaker would or an item that can be struck/tapped just as a drum would.

Teletherapy has been a great new adventure. Though there may be difficulties at times, there are many solutions!

Jordan Bailey, MT-BC

Music Therapist – Board Certified

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