Individuals diagnosed with intellectual and developmental disabilities (I/DD) experience positive outcomes and desire to participate in decisions regarding various aspects of their lives but are often less likely to access this right than their peers without a diagnosis. These individuals may be able to increase their proficiency in self-determination through practice, but it is unclear the extent to which they may be involved in healthcare-related decisions, specifically while participating in music therapy. Through a survey of board-certified music therapists currently serving individuals diagnosed with I/DD, in this study, the author sought to identify aspects of self-determination being incorporated into music therapy treatment with individuals diagnosed with I/DD and to determine the extent to which self-determination is emphasized. Results of this study indicated elements perceived by music therapists to be essential to self-determination, benefits associated with access to self-determination, methods of incorporating self-determination into music therapy sessions, relationships between work experience, attitudes about self-determination, and the frequency of self-determination being incorporated into sessions. Based on the results of this study, future research could explore potential implications of music therapists’ educational background and work setting on self-determination and should include perspectives from service users.

Four composite case examples are presented and discussed as they relate to emotional expression, significant moments in the therapeutic process, and communication using a variety of modalities in music therapy with adults diagnosed with intellectual and developmental disabilities. Building on therapeutic awareness through discussing musical elements, body movement and posture, countertransference, and interactional patterns, the implications of deep emotional connection and processing are approached using primarily nonverbal methods. Composite vignettes from the author’s clinical work demonstrate awareness of these factors in the moment as they impacted the session, therapeutic relationship, and other professionals’ understanding of music therapy in this population. Implications for emotional processing in clinical practice are presented as they relate to the concepts presented in this paper.