Patient-preferred music is often copyrighted music; prior research, however, has paid scant attention to music therapists’ understanding and use of copyrighted music. To fill a gap in the literature, this exploratory study sought to understand music therapists’ experiences and perceptions about permissible therapeutic uses of copyrighted music. Semi-structured interviews were conducted with 18 board-certified music therapists working in the United States. Collectively, these participants had over 300 years of professional experience. The interview transcripts were analyzed using an inductive approach to thematic analysis. Five main themes were identified: (1) copyright concerns created a complex psychological burden; (2) therapeutic needs warranted use of copyrighted music; (3) perceptions varied on permissible therapeutic practices using copyrighted music; (4) varied sources informed an understanding of copyright law; and (5) copyright clarity was needed to reduce the psychological burden. These themes suggest that psychological stress was produced by copyright uncertainty coupled with attempts by participants to satisfy diverse interests and protect multiple stakeholders, including patients, employers, their profession, and the law. Our findings suggest that a lack of clarity about permissible uses of copyrighted music can complicate music therapists’ decision-making about appropriate therapeutic interventions. Clarity on permissible therapeutic uses of music could yield benefits for music therapists, patients, and the community.