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.

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This article is a critical reflection on the development of a research approach to explore therapeutic relationships in psychodynamic music therapy with children and young people with complex needs. The article starts by positioning my research project within contemporary music therapy discourse, discussing literature from psychoanalysis, music therapy research and a broad range of related disciplines. This illustrates the development of a socially, culturally and politically contextualised understanding of the theory and practice of music therapy with people with complex needs and outlines the theoretical concepts which support and inform my research approach. Fricker’s Epistemic Injustice paradigm is used to provide a contextualised philosophical concept to explore why and how people with complex needs are frequently excluded from academic research. A critical disability study perspective is used to outline the need for inclusive research practice to develop epistemological frameworks and methodologies to include the voices of those marginalised in society. The article concludes with an outline of my current research project, discussing how the ideas previously described have informed the research approach and been integrated into the project design.