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In music therapy improvisation is defined as a process whereby client and therapist relate to one another in which the client makes up music, musical improvisation, while singing or playing, extemporaneously creating a melody, rhythm, song, or instrumental piece. In clinical improvisation, client and therapist (or client and other clients) relate to one another through the music. Improvisation may occur individually, in a duet, or in a group. The client may use any musical or nonmusical medium within his or her capabilities. Musical media includes voice, body sound, percussion, and string, wind, and keyboard instruments. Nonmusical media can consist of images, titles, and stories.