September. In schools this is when the year gets planned: the staff councils meet, the classes get divided up, everyone looks at the new names on the register. And in the middle of all that effort, every year, there is a teacher who lingers on one child — the one who doesn't speak, the one who runs off, the one who is always leaning against the wall — and thinks: what if we tried with music?
Then she looks it up online, finds the word music therapy, and the question she carries around with her is almost always the same: does it work?
No. Or rather: it's the wrong question.
Not because music therapy in schools doesn't work — in Italy we've been reasoning about this for almost fifty years, with a literature of our own that has never stopped, and outside Italy there is a body of research that in the last fifteen years has completely changed its mind about where to look. But because "does it work?" is a question you ask of a pill. Of a school project you ask a different one, and it sounds like this: whose project is this?
Why calling someone with a guitar isn't enough
There is a risk that in Italy we saw coming from a long way off, and the one who put it down in black and white was a music educator, not a music therapist. Mario Piatti wrote it in 1993: any activity that involves a person with a disability seems bound to take on, in and of itself, a therapeutic value. Play plus handicap equals play therapy. Horse plus handicap equals hippotherapy. Music plus handicap equals, necessarily, music therapy. And the conclusion is blunt: involving someone in musical activities is not, in itself, doing music therapy. (I don't have those pages of Progettare l'educazione musicale in my hands: I take them from Enrico Strobino, who recalled them on Musicheria in March 2025.)
Nine years later the same image returns in issue 6 of Musica&Terapia, our historic journal, where Massimo Borghesi, together with that same Enrico Strobino, ties it to a phrase of the sociologist Alberto Melucci, "the therapeutisation of everyday life": the mechanism by which therapy expands until it covers a person's whole life.
It wasn't an Italian anxiety. Eighteen years later, three Australian researchers sifted through forty international publications on what happens when a music therapist and a teacher work together, and among the tensions they found there is exactly that one: a basic, never-resolved confusion between what in those experiences is educational and what is therapeutic (Steele and colleagues, 2020).
It's a convenient equation and a wrong one, and it does double damage: it promises a cure where perhaps what was needed was an excellent hour of music, and at the same time it empties music therapy of what it can actually do.
Because the difference isn't in the instrument, nor in who plays it. It's in the goals — who wrote them, with whom, and how you check whether they've been reached.
A music education workshop has musical goals: the voice, rhythm, listening, the pleasure of playing together. They are beautiful goals and nobody needs to call them therapy to make them look more serious. A music therapy intervention has goals that are written somewhere else: in the Individualised Education Plan (PEI) of that particular child, discussed at the table where the school, the family, the health services and the local authority all sit. The music therapist doesn't bring them from home: they find them already there, and come to an agreement within them. And when the project is for a whole class, the table is the teaching team and the goals sit in the project the staff council has approved: the document changes, the rule doesn't.
That's why the answer to the question "how do you start?" isn't "you look for a music therapist". It's: you start from the table.
And it isn't a distinction of the season. In March 1978, in Assisi, a conference was held under the title "Music education or music therapy?": the proceedings are the first volume of the Quaderni di musica applicata, the series of the Pro Civitate Christiana of Assisi — that first volume is edited by Mario Piatti himself — and inside there is also an essay by Matteo Lorenzetti entitled Distinzione tra musicoterapia ed educazione musicale — the distinction between music therapy and music education. Almost fifty years ago. The border we're talking about, in Italy, has grey hair — and it still hasn't been settled.
What the law says, and what it doesn't
Here it's worth putting things in order, because this is the point where teachers get lost — and not through any fault of their own.
In Italy there are two tracks, and they never touch.
The first is the track of music for everyone. It's the road that brought music-making into compulsory schooling: the music-oriented courses in lower secondary school (scuola media), which have existed as an experiment since 1975 in Lombardy and since 1979 across Italy, and which Ministerial Decree 201 of 6 August 1999 — the one entitled, literally, "riconduzione ad ordinamento", bringing them into the standard curriculum — made ordinary, before the reorganisation under Interministerial Decree 176 of 2022, in force from the 2023/24 school year; and for primary school Ministerial Decree 8 of 31 January 2011, which set up music practice courses from the third to the fifth year, complete with a final certificate of the skills acquired. On this ground, and many years after the first of those decrees, a body of the Ministry is at work: the National Committee for the Practical Learning of Music for All Students, chaired for years by Luigi Berlinguer and since 2023 by Annalisa Spadolini — keep it in mind, because it comes back further on.
The second track is that of inclusion: the Individualised Education Plan, the table that writes it and reviews it, the Profile of Functioning (Profilo di Funzionamento) drawn up according to the ICF, the World Health Organization's classification. It's the track that concerns that particular child, not the class.
And music therapy? Music therapy has no track of its own.
I say this for what I've been able to verify, and I'd be glad to be proved wrong: there is no Italian rule that says "a school may have a music therapist", there is no decree, there is no professional profile, there is no dedicated budget line. Which means, very concretely, that a music therapy pathway always enters a school through the same door: as a project. Approved by the teaching staff council (collegio docenti), written into the school's three-year educational offer plan (PTOF), paid for with funds that have to be found again every year — or attached to the PEI of a single pupil, when the table puts it in there.
I'm not telling you this to discourage you. I'm telling you because it's the reason why "how do you start" matters more than "does it work": when something has no track of its own, the only thing that keeps it standing is the quality of the agreement between the people who do it.
A graft, not a transplant
I like to think of it as a graft.
Anyone with an orchard knows: you don't plant a new tree in the middle of the ones already there, because there's no room and the roots fight. You take a bud and graft it onto a plant that has been there for years, with its roots, its soil, its habits. For it to take, three things are needed: that the two plants be compatible, that the cut be made well, and that someone have the patience for a whole season.
The school is the big plant. It already has its roots — the curriculum, the class, the teachers, the timetable, the noise of the corridors. The music therapist is the bud: they bring something that plant doesn't produce on its own, but they don't survive a single day unless they attach to what's already there.
In New Zealand they gave this way of working a name: music therapy school consultation. Daphne Rickson, who wrote her country's first doctorate in music therapy on it, defines it as a process in which the music therapist enables the team — teachers, educators, family — to use music in an ongoing way with that child (Rickson, 2012). Not "coming in to run the sessions". Enabling. With Katrina McFerran she then wrote a whole book about it, about special schools and mainstream schools, and the title already says it all: creating music cultures in the schools, not bringing a service into them.
And here comes the part that gets said too little at conferences: the graft unsettles the plant too. Music therapy entering a school doesn't only unsettle music therapists: it unsettles teachers too, support teachers and class teachers alike. Because someone arrives who works in a different way, who holds a setting, who has a professional confidentiality to respect, and who can't tell everything they see. And it isn't a difficulty that passes by explaining yourself better: it's structural, because two trades meeting in a classroom have different rules about what can be said and to whom.
It isn't a problem to be solved quickly. It's the work.
And the teacher?
This is the question international research asked itself late, and which turned the table over.
When those researchers read the forty publications I was telling you about, the biggest tension they found was this: in describing the collaboration between music therapist and teacher, almost everyone looked at the child's needs, almost nobody looked at the teacher as a professional. As if she were the environment in which the work happens, not a person who knows how to do a job.
Three years later the same authors proposed a reversal, in Music Therapy Perspectives, with a title that is a programme in itself: Shifting the focus to teachers (Steele and colleagues, 2023). The reasoning starts from an uncomfortable and well-documented fact: the skills a teacher acquires working alongside a music therapist struggle badly to survive once the music therapist has gone. The project ends, and with it the music ends.
Their proposal is to change the music therapist's seat: not the expert who brings the expertise, but the one who makes it shareable. Working on the teacher's musicality, on her teaching, even on her self-care — and arranging the conditions so that what was born in those months carries on without us.
And it didn't stay a proposal on paper. The same authors went and knocked on the doors of six teachers six months after the end of a professional learning programme built with the tools of music therapy — it was called Music for Classroom Wellbeing — to see what had remained. Something had remained, and it wasn't the activities: it was the intentional use of music, in three directions — holding the class's relationships together, helping children regulate their emotions, differentiating the teaching (Steele and colleagues, 2026). Six teachers don't make rock-solid proof: it's a qualitative study, made of interviews, and it serves to understand what remains, not how much. But the difference between this case and all those in which the music evaporates lies in one thing only: here the programme had been designed from the start to leave something with them.
For anyone steeped in community music therapy this is nothing new. But said inside a school it becomes something very practical: the success of a project is measured by how much music remains when the project ends.
Who decides whether it worked?
Here's the question I like best, and luckily in Italy somebody has already asked it seriously — well before it became a line of research elsewhere.
Alberto Malfatti, again in Musica&Terapia, evaluated in 2014 a music therapy project in a primary school by going and asking something that usually doesn't get asked: the point of view of the teaching staff. Not the tests on the child, not the music therapist's opinion of his own work — what the teachers think, the ones who have that child in class for the other twenty-seven hours of the week.
It's a reversal that says everything. If a music therapy pathway works only inside the music room, for forty minutes, and nobody in class notices, maybe it worked for us more than for the child.
But the most systematic Italian work on this point is another: Musicoterapia per l'integrazione — music therapy for integration — by Lucia Chiappetta Cajola, Paola Esperson Pecoraro and Amalia Lavinia Rizzo, published by FrancoAngeli in 2008 with a foreword by Rolando Benenzon. It isn't a book of inspirations: it comes out of five years of action research carried out together with Sweden — the comparison between the Swedish music therapists of the FMT model — functionally oriented music therapy — who train at the Musikhögskolan Ingesund in Arvika, part of Karlstad University, and Italian practice — within the long-running experience of workshops of the Fo.Ri.Fo. association ("Formazione e Ritorno in Formazione", training and returning to training).
And the question it starts from is exactly ours: before even asking how you do music therapy in schools, the authors ask whether it's appropriate for it to come in at all, who the practitioners qualified to do it are, what synergies are needed between the different professionals, and by what concrete means.
The answer they give is a tool, not an opinion: assess with the ICF, the same WHO classification on which that child's Profile of Functioning is built. Put like that it sounds technical; in reality it's the most political move in the book, because it means that the music therapist and the school speak the same language, the one the PEI is already written in. And there's an idea, in that book, that would be worth pinning up in every staffroom: assessment as a lever for planning, not as a way of describing the deficits of the person in front of you — a tool for getting to know a person and checking whether the pathway is taking them where it was meant to. (The book has been out of print for years: if you find it in a library, it's worth the trip.)
And the thread didn't stop there. In 2022 the Verona Conservatory devoted a conference to inclusion in music therapy — the proceedings, which I edited with Enrico Ceccato, came out in 2024 from Gesualdo Edizioni and aren't online — and in them Paola Esperson Pecoraro tells the story of her doctoral research at Anglia Ruskin University in Cambridge: thirteen primary classes between Italy and the UK, more than three hundred children, who on both sides of the Channel improve in self-confidence, empathy and relationships. But the finding I take home is a different one, and it's an observation of hers: across most of Europe, North America and Australia, music therapy in schools stays tied to the medical model, probably because it's mostly special schools that ask for it — and the exceptions you read about above are just that, exceptions; here it could be born inside everyone's classroom, because Italy's integrated school system closed nearly all the special schools down. An experience, she writes, worth carrying across borders.
So, in the end: does it work?
Now I can answer for real, and the honest answer comes in two parts.
On the first part — music as a tool for inclusion in schools — the evidence is there, but it says something subtler than we'd like. A 2025 systematic review examined nineteen studies published between 2010 and 2023 on pupils aged six to fifteen, and its sharpest conclusion is this: in most cases inclusion was achieved by placing the pupil with special needs inside everyone's music lesson — but integrating is not always including (Mommo and colleagues, 2025). What makes the difference are boring, concrete things: student-centred teaching, peer work, co-teaching. And what's missing, almost always, is specific training and resources.
On the second part — music therapy in the strict sense inside schools — the research is younger, more fragmented, made of small studies very different from one another. Anyone who tells you there is rock-solid proof hasn't read it.
Which doesn't mean nothing is known: it means that what we know is more about the how than the how much. And for the how, in Italy, there's a lot more than people think.
There's even a piece of field research, and few people know it: FFFortissimo. La musica dei bambini — children's music — gathers in three hundred pages an experimental music therapy intervention inside schools, edited by Rosa De Michele, Enza De Rosa and Diana Facchini for ISMEZ — the national institute for musical development in Southern Italy — in 2009, born of the work done in Naples. Even earlier, in 2003, Dorothea Oberegelsbacher and Giovanna Rezzadore had devoted a whole volume to the subject — Il potere di Euterpe, the power of Euterpe — in FrancoAngeli's series on pedagogy and special education. And in 2010 Fabrizio Alessandrini and Francesca Malatesta wrote Musica maestro!, a book in two voices — the music therapist and the psychotherapist — which the publisher presents as addressed "to teachers and educators who work with school groups", and which talks about prevention as well as remediation: that is, about the whole class, not only the child who's been flagged.
Then there's the journal. In the archive of Musica&Terapia alone, the area devoted to education, school and inclusion holds fifteen contributions — that's how the archive's Guida alla consultazione, the reader's guide edited by Gabriele Greggio, counts them, and it runs up to issue 43 — from the first interventions in school settings to pre-school (Chiara Tamagnone), primary school (Claudio Massola and colleagues, 2008), the crossroads between school and therapy (Bottone and Cappelli, 2012), all the way to music therapy read through the lens of Disability Studies (Matteo Maienza, 2020). They're free to download from the website of APIM, the Italian professional association of music therapists.
And then there's Amalia Lavinia Rizzo, who is an associate professor of Special Education and Teaching (Didattica e Pedagogia Speciale) at Roma Tre University and for years has been working on the meeting point between music, teaching and inclusion: with Chiappetta Cajola she co-authored the volumes on inclusive music and on inclusive teaching from an ICF perspective, and in 2022 she edited Strumento musicale e inclusione nelle SMIM, the results of a national research project on music-oriented lower secondary schools carried out — I told you it would come back — precisely with the Ministry's National Committee for the Practical Learning of Music. The volume is open access: you download it for free, and that's no small thing.
So the circle closes: the piece of legislation that brought music into Italian schools and the research that measures how inclusive it is are sitting at the same table. All that's missing is for music therapy to sit down there too.
The three things to have before you start
If I had to boil everything down to what you really need before picking up the phone, I'd say three things.
A goal that isn't the music therapist's alone. It has to come from the table, be written in the document that concerns that child, and be shared by you, who see that child every day. If the person coming in from outside chooses it on their own, you're not doing a project: you're doing an activity.
An alliance with those who stay in the classroom. The music therapist arrives for an hour a week and leaves. The teacher stays. It's the point on which the research of recent years has changed its mind, and it's also the easiest to check: if after six months you have nothing more in your hands than before, that project was ours — us music therapists' — and not yours.
A way of noticing if it isn't working. Not a final report saying everything went fine — we all know how to write those. Something decided beforehand, that can also say no. And if anyone tells you music can't be assessed, show them the ICF: it can be assessed all right, you just mustn't confuse assessing with judging.
The rest — the instruments, the repertoire, the songs — comes later. It always comes later, even though it's the part we like best.
I'll stop here
One thing, though, I'd like to say to you — to you who these days are planning the year and who may have made it this far.
If you're thinking about music for that child, you're not thinking about something naive. You're thinking about the right thing: that there is a channel that gets through when words don't. It's just that that channel, on its own, isn't a therapy — it becomes an intervention when someone sits down with you, agrees on where you want to get to, and accepts being judged by you too.
Ask for a table, before you ask for a music therapist. And if the music therapist doesn't want the table, you already have your answer.
And you, at school — have you ever seen a graft take?
Sources
- Alessandrini, F., & Malatesta, F. (2010). Musica maestro! Scuola, musicoterapia e dinamiche di gruppo [Music, maestro! School, music therapy and group dynamics]. Almayer Edizioni.
- Borghesi, M., & Strobino, E. (2002). Musicoterapia a scuola [Music therapy at school]. Musica&Terapia, no. 6, 7–14. https://musicaterapia.s3-external-3.amazonaws.com/06-Musica-e-terapia.pdf
- Bottone, F., & Cappelli, A. (2012). Musicoterapia e scuola a un bivio: quale direzione? [Music therapy and school at a crossroads: which way?]. Musica&Terapia, no. 25. https://musicaterapia.s3-external-3.amazonaws.com/25-Musica-e-terapia.pdf
- Chiappetta Cajola, L., Esperson Pecoraro, P., & Rizzo, A. L. (2008). Musicoterapia per l'integrazione. Strategie didattiche e strumenti valutativi [Music therapy for integration: Teaching strategies and assessment tools] (foreword by R. Benenzon). FrancoAngeli. https://www.francoangeli.it/ricerca/scheda_libro.aspx?CodiceLibro=292.4.22
- De Michele, R., De Rosa, E., & Facchini, D. (Eds.). (2009). FFFortissimo. La musica dei bambini. Ricerca e intervento sperimentale sull'applicazione della musicoterapia in ambito scolastico [FFFortissimo. Children's music: Research and experimental intervention on the application of music therapy in schools]. ISMEZ.
- Esperson Pecoraro, P. (2024). Musicoterapia a scuola: uno strumento per lo sviluppo dell'intelligenza emotiva e sociale [Music therapy in schools: a tool for developing emotional and social intelligence]. In P. A. Caneva & E. Ceccato (Eds.), Dell'inclusione in musicoterapia [On inclusion in music therapy] (pp. 45–58). Gesualdo Edizioni – Conservatorio di Verona, "Cure sonore" series. ISBN 978-88-85498-38-9. [Proceedings of the Verona conference of 22 October 2022; the volume is not available online.]
- Greggio, G. (Ed.). (2022). Guida alla consultazione [Reader's guide: thematic index of the Musica&Terapia archive, up to no. 43]. APIM. https://musicaterapia.it/wp-content/uploads/2022/12/Guida-alla-consultazione-2.pdf
- Maienza, M. (2020). Musicoterapia e Disability Studies: percorsi per l'inclusione [Music therapy and Disability Studies: pathways to inclusion]. Musica&Terapia, no. 42. https://musicaterapia.it/wp-content/uploads/2021/04/MetT-42-web.pdf
- Malfatti, A. (2014). Valutazione di un progetto di musicoterapia: il punto di vista del personale docente di una scuola elementare [Evaluating a music therapy project: the point of view of the teaching staff of a primary school]. Musica&Terapia, no. 30. https://musicaterapia.it/wp-content/uploads/2014/02/MT_30.pdf
- Massola, C., Capelli [Cappelli], A., Selva, K., Bottone, F., & Demaestri, F. (2008). Quale musicoterapia nella scuola primaria? [What music therapy in primary school?]. Musica&Terapia, no. 18, 26–30. https://musicaterapia.it/wp-content/uploads/2012/03/MUSICOTERAPIA-18-1.pdf
- Ministerial Decree 6 August 1999, no. 201, Riconduzione ad ordinamento dei corsi sperimentali ad indirizzo musicale nella scuola media [Bringing the experimental music-oriented courses in lower secondary school into the standard curriculum] — the courses had been authorised by the Ministerial Decrees of 3 August 1979 and 13 February 1996; replaced by Interministerial Decree 1 July 2022, no. 176, in force from the 2023/24 school year. https://www.gazzettaufficiale.it/eli/id/1999/10/06/099A8267/sg
- Ministerial Decree 31 January 2011, no. 8, Diffusione della cultura e della pratica musicale nella scuola primaria [Spreading music culture and practice in primary school] — art. 4 sets up the music practice courses; art. 8 states that they involve pupils "from the third year of primary school" and end in the fifth, with a certificate of the skills acquired. Text on the Ministry's website
- Mommo, O., Sutela, K., & Mononen, R. (2025). Inclusion and pedagogical support for students with special educational needs in music lessons: A systematic review. Research Studies in Music Education, 47(3), 403–423. https://doi.org/10.1177/1321103X251342143
- Oberegelsbacher, D., & Rezzadore, G. (2003). Il potere di Euterpe. Musicoterapia a scuola e con l'handicap [The power of Euterpe: Music therapy at school and with disability]. FrancoAngeli. https://www.francoangeli.it/Libro/Il-potere-di-Euterpe.-Musicoterapia-a-scuola-e-con-l'handicap?Id=11277
- Piatti, M. (Ed.). (1982). Educazione musicale o musicoterapia? [Music education or music therapy? Proceedings of the March 1978 conference]. Quaderni di musica applicata, no. 1. Pro Civitate Christiana. Indexes of the series
- Rickson, D. (2012). Music therapy school consultation: A unique practice. Nordic Journal of Music Therapy, 21(3), 268–285. https://doi.org/10.1080/08098131.2012.654474
- Rickson, D., & McFerran, K. S. (2014). Creating music cultures in the schools: A perspective from community music therapy. Barcelona Publishers. https://barcelonapublishers.com/creating-music-cultures-the-schools-a-perspective-community-music-therapy
- Rizzo, A. L. (Ed.). (2022). Strumento musicale e inclusione nelle SMIM. Ricerca, itinerari didattici e processi valutativi [Musical instrument and inclusion in music-oriented lower secondary schools (SMIM): Research, teaching itineraries and assessment processes]. FrancoAngeli. https://series.francoangeli.it/index.php/oa/catalog/book/771
- Steele, M. E., Crooke, A. H. D., & McFerran, K. S. (2020). What about the teacher? A critical interpretive synthesis on literature describing music therapist/teacher consultation in schools. Voices: A World Forum for Music Therapy, 20(1). https://doi.org/10.15845/voices.v20i1.2839
- Steele, M. E., Crooke, A. H. D., & McFerran, K. S. (2026). 'I think about music and how this can help': Exploring sustained outcomes from a music therapy informed teacher professional learning program. Australian Journal of Education, 70(1), 21–36. https://doi.org/10.1177/00049441251392282
- Steele, M. E., McFerran, K. S., & Crooke, A. H. D. (2023). Shifting the focus to teachers: A new approach for music therapists working in schools. Music Therapy Perspectives, 41(1), 10–18. https://doi.org/10.1093/mtp/miac020
- Strobino, E. (2025, 16 March). Musicoterapia e contesti educativi [Music therapy and educational settings]. Musicheria. https://www.musicheria.net/2025/03/16/musicoterapia-e-contesti-educativi/
- Tamagnone, C. (2017). Musicoterapia nella Scuola dell'Infanzia. Proposte, percorsi, prospettive [Music therapy in pre-school: Proposals, pathways, prospects]. Musica&Terapia, no. 36. https://musicaterapia.it/wp-content/uploads/2018/12/MetT-36-1.pdf