This paper considers the ways in which the use of music technology in therapeutic settings helps people with a range of differing abilities to establish a sense of identity as they adjust to changing physical abilities. A total of 12 interviews with six music therapists, each experienced users of electronic equipment using musical instrument digital interface (MIDI)-generated sounds triggered by specialist input devices, and working within a variety of therapeutic settings, considered the various applications, benefits, and risks of using technology in such contexts. Examination of case study video footage provided by each therapist was incorporated within the interviews in order to facilitate a detailed and focused discussion (cf. Davidson & Good, 2002). Data were analyzed independently by two multidisciplinary investigators using open coding procedures from grounded theory (Strauss & Corbin, 1998). The findings suggest that music technology provides a means to assist people with complex needs to form alternative identities by: (1) offering a sense of empowerment, independence and achievement; and (2) allowing access to alternative identities through associations with wider cultural contexts. The implications are far-reaching and suggest that music technology has a valuable role to play within therapeutic contexts which has not previously been identified.