This chapter describes music therapy work with adults with learning disabilities. This group of people have a cognitive disability that will not change, bringing with it challenges to living a fulfilled and satisfying life and sometimes associated health issues. A wide range of issues, from severe communication problems, bereavement, mental health problems, challenging behavior, to end-of-life issues require music therapists to bring a wide range of skills and approaches to their work. This chapter presents the diagnosis and history of this population, and the history of music therapy work in the area. The process of therapy is described, treatment models, and methods considered and clinical examples given.