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This article presents an improvisational approach to insight-oriented therapy in music therapy with a woman with severe cognitive impairments following haemorrhagic stroke. Analysis of five clinical excerpts across 40 sessions demonstrates how a prepared improvised musical experience can facilitate meaningful self-exploration in dialogue, leading to a renewed self-identity in life after brain injury. The therapist’s reflective processing is integral to the therapeutic outcomes; these are examined alongside the casework material. This article suggests that insight-oriented musical experiences may be one way of supporting the emotional health of individuals living with the enduring consequences of severe brain injury in slow-stream rehabilitation or long-term neurological care.

Towards a state of play: A case study exploring insight-oriented musical experiences with a woman with severe brain injury