Getting to “No” You

When Nonspeaking Autistic People Refuse Music Therapy


  • Roia Rafieyan Private Practitioner



Nonspeaking autistic people frequently begin music therapy at the request of others. Typically, family or care systems are tasked with making decisions on their behalf and have decided this service will be of benefit. Consequently, music therapy is a given rather than a choice. For this paper I have used my own evolving understanding to explore the complexities and power dynamics related to nonspeaking people being able to say “no” to music therapy. Elements in this discussion include: (a) the ability, and safety, to say “no” in the context of a culture of compliance, (b) the complicated relationship between music therapists and the systems within which they work, and how this affects the therapy relationship, and (c) the role of music therapy practice standards. I advocate the following: (1) presume competence, (2) enter the therapy space with curiosity and openness, (3) be willing to “get to know,” (4) coping skills or communication attempts are not “behavior” in need of correction, and (5) learn how each nonspeaking person communicates “no.” Actively encouraging and respecting treatment refusal goes a long way toward building a respectful music therapy practice/relationship.

Author Biography

Roia Rafieyan, Private Practitioner

Roia recently retired from long-term employment as a music therapist in a residential care facility in the United States. Most of the last 33 years were spent in the company of institutionalized nonspeaking autistic people with whom she collaboratively andcontinuously worked to evolve into a more respectful music therapist. Her current interests are arts-based research, collage, and reading. Her enduring interests are relationally-based music therapy approaches, reflexive practice and clinical supervision.

Photo of author Roia Rafieyan


Additional Files



How to Cite

Rafieyan, R. (2022). Getting to “No” You: When Nonspeaking Autistic People Refuse Music Therapy. Voices: A World Forum for Music Therapy, 22(3).