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This article explores the multifaceted role of silence in music and therapeutic applications in clinical settings. Drawing on philosophical, acoustic and therapeutic perspectives, it examines silence as an active component in musical structures and therapeutic practices. Philosophers like Valeriya Novikova and composers such as John Cage are referenced to highlight communicative and psychological dimensions of silence. Derived from a study at the paediatric department of Policlinico S. Orsola in Bologna, Italy, involving patients aged from 3 to 11, the article reports a case study of a 6-year-old non-verbal child with a physical disability and heightened sensory sensitivity, illustrating the therapeutic potential of silence. Key applications include encouraging sensory exploration, facilitating non-verbal communication, regulating sensory input and structuring engagement through strategic pauses. The exploratory article underscores the profound impact of silence in music therapy, demonstrating the capacity to facilitate engagement, regulate sensory experiences and support emotional expression as a dynamic tool for therapeutic healing.