Music can touch you when you are alone and afraid. A song, improvisation, or rap can express deep suffering, pain, or joy. Musical structure can hold you if you are feeling out of control. The challenge in guiding adult survivors of complex trauma is to find a way through intense, overwhelming experiences into safety and healing. It is essential for music therapists to understand the unique needs of trauma survivors in a psychiatric setting in order to avoid missteps. Where the music therapist might celebrate the depth of feeling that a survivor expresses through music, the survivor may feel overwhelmed and back away. Music therapists need to understand the process from the trauma survivor's perspective and learn techniques for providing safety and empowerment. In this chapter two models are described. One is a structured approach working with symptoms and musical techniques to address them. The other is a more improvisatory approach of providing structure within the freedom of musical improvisation. The interplay of music and verbal elements is shown with clinical examples. With these tools the music therapist can enter with confidence and knowledge into the creative and healing musical space for adults in mental health settings who have experienced complex trauma.