This article explores how music therapy can be adapted to be conducted online and how it can best be facilitated. People Know How has adapted its Arts Therapies project online after the March 2020 lockdown and is moving toward a blended model of support in line with COVID-19 restrictions. The project provides support through both music therapy and art therapy, both of which necessitate differing considerations in their adaptation online. This article finds that online music therapy brings with it many challenges and news ways of working, but its convenience and the connection it provides during a time of isolation can be beneficial. However, music therapy online requires a different mindset about what music therapy is and how it can be conducted. New approaches to instruments, playing together, and even using composition and new technologies are needed to adapt music making to the virtual world. Technology poses practical problems as well as increasing mental exhaustion. Boundaries between home life and therapy, and between therapist and service user, may in some ways be blurred by online sessions. However, through active communication and repeated checking in, therapists and service users can collaboratively adapt sessions to build spaces “to be, create, feel, think and connect” (NHS Education for Scotland, 2020, 8:55). This article includes suggestions to People Know How and other organisations to help improve the efficacy music therapy online for both therapists and service users.