Board-certified music therapists were surveyed about their use of clinical improvisation and the improvisation instruction they had received in undergraduate/equivalency programs in the United States. A distinction was made between music improvisation and clinical improvisation. The survey sought responses regarding client populations, goals, theoretical orientations, influential models of improvisational music therapy, and musical media that are relevant to MT-BCs' use of improvisation in therapy. Further issues addressed include whether clinical improvisation instruction was received in undergraduate/equivalency programs and/or during internships and how this instruction was received as well as perceptions regarding level of preparedness to use clinical improvisation. Results from 559 respondents indicate that improvisation is widely used by MT-BCs but that instruction in the method at the undergraduate/equivalency level is neither widespread nor consistent in programs across the United States. The adequacy of improvisation-based competencies and guidelines established by AMTA, CBMT, and NASM for instruction in effective and ethical use of clinical improvisation is questioned.