The purpose of the article is to describe and understand the role of music therapy in working with a client who suffers from Selective Mutism (SM). Special attention is given to the definition, etiology, and treatment approaches of SM. My theoretical perspective, the importance of the musical act, and the role of the therapist in working with such clients are discussed. The case example that follows presents two years of work with Shiran, a 6 year–old girl who suffers from SM. I describe and analyze the therapeutic process and bring my insights and understandings as well as Shiran's changes throughout the process. An emphasis is put on the role of improvisation in processing unresolved issues in Shiran's life.