Music therapists’ attitudes, motivation, and use of treatment manuals: a survey study

IntroductionTreatment manuals and protocols (TM/Ps) are increasingly used to standardise clinical interventions in music therapy, but they often neglect the motivational needs of clients, which are essential for engagement and recovery. Therapists may, at times, modify or depart from established protocols in order to accommodate clients’ interests, preferences, or motivational needs. This study had two aims: to examine music therapists’ attitudes, practices, and reasons for deviation regarding TM/P use, and to introduce a novel, motivation-driven TM/P targeting a client group where motivation is crucial: clients in the subacute phase after stroke. MethodQualified music therapists (N=93) from five countries completed an online survey addressing demographic background, theoretical orientation, opinions, and behaviour surrounding protocol use, and reasons for deviation. Descriptive statistics were used to summarise the sample; hypotheses were tested using crosstabulations with χ² tests of independence and ordinal logistic regression analysis. ResultsMusic therapists held mixed views on TM/Ps, recognising their value while expressing concerns about impacts on personalisation, spontaneity, and motivation. Many agreed that non-client-focused protocols negatively affect motivation and identified spontaneity restrictions as problematic, though these concerns did not significantly predict actual usage patterns. Usage varied partially by setting (lower in educational contexts), theoretical approach (lower in anthroposophic and attachment-oriented and higher in integrative approaches), and specific attitudes toward TM/P importance, rather than by therapist experience or age, suggesting that contextual factors and individual beliefs about protocol value outweigh demographic characteristics in determining TM/P usage. DiscussionFindings highlight the ongoing tension between standardisation and personalisation in music therapy, reflecting shared practitioner concerns. Building on these insights and prior applications, the ReMoCo-IMS Protocol, a motivation-driven TM/P for subacute stroke rehabilitation, is introduced. This protocol advances flexible, evidence-based guidelines that support both clinical rigour and motivational, client-centred care.