This chapter presents different structured and improvisational active proposals for music therapy practice. The term active refers to the client’s active involvement by playing or creating something in the session. Structured proposals are based on an understanding of music as a tool or as a facilitator of relationships. Improvisational proposals have music at the center in most cases. Structured proposals have the therapist leading, while improvisational proposals have the therapist as a facilitator in the experiences. The structured active proposals are divided here into recreational proposals and compositional proposals. In contrast, the improvisational active proposals are organized into just one category, which includes proposals based essentially on improvisation or proposals that create something spontaneous as the basis for their realization. The idea behind the proposals presented is that they can be adapted to different populations and practice contexts.