Autistic adults’ experiences of improvisation in group music therapy: A qualitative photo-based dialogue study

Introduction Research on music therapy for autistic adults remains limited, particularly regarding how adults experience improvisation-based group therapy. This study explored autistic adults’ lived experiences of participation in a group music therapy programme. To access embodied and often tacit dimensions of musical interaction, photo-based group dialogues were conducted after each session, using participant-generated photographs as catalysts for reflection.Method Three groups of autistic adults participated in a twelve-session improvisation-based group music therapy programme. Following each session, participants engaged in group dialogues using self-created photographs of daily life as visual anchors for reflection. Dialogue data were analysed using reflexive thematic analysis.Results Three themes were identified: (1) navigating musical uncertainty, (2) shaping musical conditions, and (3) claiming musical identity. Participants described entering musical improvisation as an effortful process that required managing inherent uncertainty. Over time, a growing sense of predictability supported more flexible and self-directed forms of engagement, in which participants regulated their musical proximity and developed a sense of musical intention. Through processes of mutual recognition and differentiation, participants gradually claimed a more authentic musical voice.Discussion The findings highlight the importance of autism-informed conditions in group music therapy that foster mutual understanding through the collaborative shaping of sensory, spatial-material, and relational dimensions of the musical environment. Therapists played a central role by holding participants’ uncertainty, creating a space for more affirming conditions to emerge, allowing participants to experience musical interactions as trustworthy and personally meaningful. Within this process, participants were gradually enabled to develop and claim an authentic musical identity.