A few weeks ago a reader wrote me one of those blunt questions that fit in five words: can you make a living as a music therapist? In the July newsletter I sent him half an answer and promised the long one. Here it is, a little late, and with a warning: it isn't the answer he was expecting. It isn't about fees and turnover — I gave that answer elsewhere, and you'll find it at the bottom. It's about what makes people stay in this job, and what makes them leave. Because to answer it I didn't go looking for the people who made it: I went looking for the people who left.
And almost nobody does that. We always study the survivors — the colleagues who are still here, who come to conferences, who answer questionnaires. But someone who hung up the guitar in 2019 and now works in something else entirely shows up in none of our statistics. And then we're surprised that the picture always comes out a bit optimistic.
Who left, and what they said
Sara Langenberger, a paediatric music therapist at Primary Children's Hospital in Salt Lake City, did exactly that for her master's thesis: she tracked down a hundred former music therapists in the United States and asked them about the job they had chosen and then left. The study came out in Voices, the open-access journal that for twenty-five years has been the place where music therapy looks at itself in the mirror, and it has a title that is already half an article: Goodbye Yellow Brick Road (Langenberger, 2026).
One detail of the method matters more than it seems. The questionnaire is not an interview about feelings: it is the COPSOQ, an occupational health tool, the one used to measure psychosocial risk in a factory or a hospital. Translation: those people were not treated as disappointed vocations, but as workers. And the questions you ask workers are questions about the environment, not about character.
The answers cluster around six things: little safety in the workplace, little community and little support, a role nobody around them can quite define, high demands, few prospects for growth, and the burnout that arrives at the end of that queue.
Read them again slowly. Not one of them is about talent, or vocation, or being cut out for this. They are all words about structure. And to give you a sense of scale: according to the same study, between 2020 and 2021 around three hundred music therapists out of nine thousand five hundred board-certified ones left the profession in the United States. It isn't a haemorrhage, but it isn't background noise either — especially if you consider that those three hundred, before leaving, had studied and worked just like you.
It isn't about character (and there's proof)
I could stop here, and you would be right not to fully believe me. People who leave have every reason to say it was the environment's fault: that's the story that comforts. We need a check from the other side.
The check, by one of those coincidences that make you smile, is in the same issue of the same journal. Varvara Pasiali and seven of her students did a piece of memory work: they wrote down the significant moments of their first placement and analysed them together, students and teacher as co-researchers, which is already a small political statement (Pasiali and colleagues, 2026).
Out of it comes what makes a student grow when they walk into a ward for the first time and everything is shaking. Three things: the resilience that placement puts to the test, building relationships and support networks, and understanding how the therapy process works and what it does.
Sit with the first one for a second, because it plays against me. Resilience is a quality of the person — and I've been arguing for half an hour that the problem isn't people. So let's say it: yes, this job takes some guts, and nobody is denying that.
But look at the other two. Building supportive relationships, and understanding what is happening in the room, are not things you hand yourself: they are given to you around you, or they aren't. And the second item on the list of those who left — lack of community and support — is exactly the negative of the second one of those who grow.
And then the conclusion follows on its own, and it is less comforting than it sounds: a support network, and someone to make sense of things with, are not just for while you're learning. They are for always. It's simply that at some point nobody gives them to you any more. A student has a mentor, a group, a teacher who asks how it went. Someone who has been working for years has a VAT number and the sat-nav on.
What is clinical supervision in music therapy?
Because that thing — someone who asks how it went and waits for the answer — does have a name in our trade, and it isn't a poetic one: supervision.
Here I have to tell you I have a conflict of interest: supervision is among the things I do for a living, so take what follows with a pinch of salt — or better, check it with someone who has nothing to gain from it.
Laurie Peebles, with Gretchen Chardos Benner and Molli Smith, asked thirty-nine music therapists working on their own — practice owners and independent clinicians — about their relationship with clinical supervision. The study came out in Music Therapy Perspectives, the journal of the American association that deals with the craft more than with pure research (Peebles and colleagues, 2026).
Those who have it report three things: they feel valued, they have clearer boundaries with their supervisor, and they report less burnout. Those who don't have it usually aren't refusing it: the two things that decide everything are how much it costs and how easy it is to get.
So let me put it in the way that suits someone like me least: what those three studies are talking about is not a service, it's a pair of eyes. It's having someone look at your work together with you. You can buy that, of course — but you can also build it, and then it costs nothing: three colleagues who meet one evening a month and each bring a case; a peer intervision group, where nobody is the master and everybody is somebody else's outside view; twenty minutes of team time where, instead of handing over, you ask each other how it actually went. This is not a fallback for people who can't afford the real thing: among the Italian professional associations there is one that has peer intervision written into how it works, alongside supervision.
Because the point isn't the invoice. It's that none of us can see our own work from the outside, and somebody has to lend us that outside.
And in Italy?
Here I have to be honest: there are no Italian figures on who leaves. Nobody has collected them. Which is, in its own way, a piece of information — and it takes me a paragraph to explain why it isn't anybody's fault.
In the United States those nine thousand five hundred are board-certified: there is a body that counts them, and if you go, your place is left empty in a register. Here the count is harder, because music therapy is a profession not organised into boards and colleges: it is governed by Law 4/2013, which moved Italy from a system where you were either in a professional register or in a legal limbo, to one where professions can be full and legitimate without a register at all. Which, let me say it clearly, is good news: for thirteen years it has no longer been true that "music therapy doesn't exist because it isn't recognised". It exists, it has a technical standard of its own — UNI 11592:2015 — and it has professional associations that issue the quality attestation set out in article 7.
It's just that joining those associations isn't compulsory. You can work without joining anything, and that's perfectly legal. The result: we don't know how many of us there are, so we certainly don't know how many leave. Association members number in the hundreds; music therapists certified against the UNI standard by an independent body accredited by ACCREDIA are, in the whole country, eighteen.
But there is one point in this legislation that I went through line by line while writing my book on the profession — and it concerns supervision.
UNI 11592 puts supervision inside the twelve hundred compulsory training hours. While you are learning, someone has to watch you work: it's written into the standard, it isn't a suggestion.
Then you graduate.
And from that moment there is no obligation to have supervision at all for anyone practising music therapy for a living. No rule requires it. The only exception I found is an associative one, and to see how much it weighs you need a number: the Italian music therapy professional associations sitting in the European confederation are three. One of the three — Punto di Svolta, based in Villafranca di Verona — asks its members for sixteen hours of training and eight hours of supervision a year.
So, lining up the three studies and our own legislation: in Italy supervision is compulsory while you learn and optional while you work. Which is exactly the wrong way round — because the student on their first placement has a whole structure holding them up, and the independent practitioner, the moment they graduate, has nobody left.
Those who stay
We don't need a new law. We don't need to wait for a professional register, a national contract, a staffing plan — things that may or may not arrive, and certainly not by Friday. And above all it shouldn't take money: if a profession holds together only as far as each person can pay out of their own pocket, that profession has a problem that isn't called burnout, it's called inequality. What's needed is something smaller and duller: that having someone else's eyes on your work goes back to being normal rather than an extra — and the free version of those eyes takes three phone calls to organise.
Because this is the thing that struck me most, and I'll leave you with it.
In the July newsletter I wrote that those who stay are not braver than those who left. Reading these three studies one after the other, it seems to me even truer, and I'd like to say it better: if you're still here, it is very probably not because you held up better. It's because somebody held you — a team that made room for you, a contract slightly less acrobatic than the others, a colleague to laugh about it with on a Friday night, someone who asked how it went and waited for the answer.
And if that's so, then the right question is no longer "how do I keep going?".
It's two questions: who would you call, and who would call you?
Sources
- Caneva, P. A. (2026). Professione musicoterapeuta in Italia. Quadro normativo, standard qualitativi e prospettive future [The music therapy profession in Italy: Regulatory framework, quality standards and future prospects]. CC BY-NC-SA 4.0. In Italian. Free download
- Langenberger, S. (2026). Goodbye Yellow Brick Road: A descriptive, cross-sectional study of former music therapists' workplace attitudes. Voices: A World Forum for Music Therapy, 26(2). https://doi.org/10.15845/voices.v26i2.4702
- Pasiali, V., Jenkins, C., Kornmayer, G., Stafford, M., Moore, K., Cannady, M., Crate, N., & McGinnis, A. (2026). Significant moments of undergraduate music therapy students: A memory work project. Voices: A World Forum for Music Therapy, 26(2). https://doi.org/10.15845/voices.v26i2.4563
- Peebles, L., Benner, G. C., & Smith, M. (2026). An examination of the role of clinical supervision in music therapy private practice: A descriptive analysis. Music Therapy Perspectives, 44(1), miag002. https://doi.org/10.1093/mtp/miag002
- Law 14 January 2013, no. 4 — Disposizioni in materia di professioni non organizzate in ordini e collegi [Provisions on professions not organised into boards and colleges]. Italian Official Gazette no. 22, 26 January 2013.
- UNI 11592:2015 — Attività professionali non regolamentate. Figure professionali operanti nel campo delle Arti Terapie [Unregulated professional activities: Professional profiles in the field of the Arts Therapies. Knowledge, skill and competence requirements].