The author summarizes the development of research in music therapy groups with adolescents, considering how the breadth and depth of these studies has expanded over the past 30 years. Three prominent orientations to music therapy are considered: psychodynamic, humanistic, and ecological. These three approaches are each illustrated with practice vignettes that describe songwriting, song sharing, and improvisation. The author considers how each vignette might be adapted depending on therapist orientation, setting, and group members’ needs.