Thank you for this thought-provoking discussion of starting to define quality of life in music therapy practice. I have also found "quality of life" to be a phrase that can be ill-defined when used in music therapy and other literature. Sometimes it seems to be "what quality of life instruments/questionnaires measure" which may or may not be relevant to music therapy--or it may be relevant in one clinical area but not another. It is important to always remember the multifaceted and individual nature of quality of life. I find autonomy, competence, and relatedness a useful framework, and I keep going back to it in my mind when reflecting on clinical practice since reading this article. As you say, there are challenges and responsibilities when working with those who have limitations for whatever reason in ability to articulate their own priorities in life. I look forward to further discussion of these ideas.